May 2, 2011

Assess, Implement, Evaluate: Understanding the Impact of Technology on ICD-10

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ED. NOTE: Maria Bounos provides a three part series on the impact of technology on ICD-10. This is the first installment.

When it comes to ICD-10, are you hiding your head in the sand?

After studying ICD-10 for the last few years and talking with colleagues on a daily basis, I can’t believe more people haven’t started thinking about how it will impact their facility from a technology perspective. It’s not just about a new coding system, to say the least. When I think about ICD-10, I specifically think about a three-year timeline for implementation. But as I talk with colleagues who are performing ICD-10 impact assessments as consultants, I am learning that few have begun the process of examining this matter closely.

I’m not sure why I have such a hard time understanding this behavior. After all, some behaviors never change. It reminds me of my years in healthcare consulting, and specifically in 2000 when there was the threat of Ambulatory Payment Classifications (APCs) being implemented. Yes, Centers for Medicare & Medicaid Services (CMS) had talked about APCs for years, just like it has talked about ICD-10. APCs were implemented more than 10 years ago, and I vividly remember discussing the impact of APCs on clients’ facilities, with many staring me in the face and saying “it will never happen.” It later were those same clients who called me frantically when APCs did in fact go into effect, as their facilities were in no shape to perform under the new payment system. Everyone was in a panic, with systems not speaking to one another, claims going out the door without codes on them, incorrect codes, duplicate codes, you name it – all leading to more work in accounts receivables. Are we back there again? Do you know where your information systems are, from a financial, clinical and practice management standpoint? Don’t let yourself get caught up in an “it’s never going to happen” mentality. It will happen, and the implementation date is less than three years away, scheduled for Oct. 1, 2013.

The Impact Assessment

If you haven’t started to perform an impact assessment, it’s time to start now!  Make sure you involve the appropriate people; examine all processes, and before you train your coders, look at your technology. Every electronic transaction needs to be addressed as you begin your assessment. Also, be sure you know the ins and outs of how you currently do business under the ICD-9. This will be the key to creating a realistic impact assessment. Let no stone – or should I say piece of technology, paper, interface or process – go unturned.   

Some areas to look at include your software applications for medical record abstraction (e.g. your encoders), current data reporting, utilization, billing, claim submissions, groupers and clinical systems, to name a few. These areas, if not understood and managed correctly, will impact the revenue cycle when ICD-10 goes into effect, not to mention possibly affect decision support, storage, interfaces, edit software and contracts.  

Facilitate organizational awareness through education and training. Coordinate resources and link technology with informational needs. Talk to your vendors and payers to determine their readiness as well, and take the time to put together a checklist to ensure that you have asked all the right questions. Also make sure you budget for potential software and operational expenses related to ICD-10. Assess your payer contracts to ensure that they reflect the specifics of ICD-10, and determine the reimbursement impact to your facility and confirm that policy revision is part of the overall process.

Truth or Consequences

What are some of the consequences you will face if you are not prepared for ICD-10? Let’s think about what happens whenever there are huge coding backlogs. Coding backlogs lead to a technological nightmare of increased rates of claims rejections and denials, increased delays in processing, possibly improper claims payment, incorrect data, and most importantly, compliance issues. Let’s not give the third-party auditing bodies any more ammunition than they already have!



Take the time to look at every department; you can’t afford not to. What happens on Oct. 1, 2013? What if you forgot to look at the wound clinics and physicians in that department document on paper charge tickets that still have ICD-9 codes listed on it? What if the interface between health information and billing suddenly can’t handle the increase in code sets? What if your clearinghouse has an issue? How big of a financial setback is your organization able to withstand?

These are several things to think about, and more will be entertained with further dialogue in parts two and three of this series, covering implementation and evaluation.    

As part of the discussion on implementation, we will discuss strategy and workflow.  Think about Day 2, or Oct. 2, 2013: What happens with delays? Do you have a Plan B?  

As a result of your impact assessment, do you plan to “go early,” possibly testing as soon as 2012? Consider going live in July 2012. Do you have the capability to run two coding systems (ICD-9 and ICD-10) simultaneously?    

When or will your vendors be ready? How and when are they going to test?

There’s a lot to think about, but there’s one thing I know for sure. ICD-10 is not going away; it’s going to happen, and the effective date will be here before we know it!  

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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Read 4 times Updated on September 23, 2013
Maria Bounos, RN, MPH, CPC-H

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.