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Updated on: March 16, 2016

Close to the ICD-10 Home Stretch: Florida Hospital Ahead of Many

Original story posted on: October 14, 2013

How can we retain our coders during the transition to, and following, the ICD-10 system implementation? That’s a question on the minds of many healthcare providers now, and senior leaders at Boca Raton Regional Hospital in Florida have answered this question and others as the implementation date of Oct. 1, 2014, approaches.

Rudy Braccili, executive director for the hospital’s revenue cycle services, joined the Oct. 8 broadcast of “Talk Ten Tuesday” to share the status of his facility’s preparations. For one thing, the ICD-10 transition leaders are now finalizing the facility’s coder-retention policies.


As Braccili explains, “Having invested significant dollars in our training programs, we want to be sure our coding professionals and clinical documentation improvement specialists stay with us. … We want them to get us through the critical months of implementation and beyond.”

So that they aren’t lured away by other hospitals and vendors, leaders decided to pay “a chunk of change” on or about March 2014. This is a conditional payment that coders and CDI specialists would have to repay to the hospital in a prorated fashion if they leave before January 2015. However, they also will receive milestone payments as rewards for their loyalty to our institution on January and October, 2015, and October 2016, which don’t have to be repaid. 

Developing a plan to retain coders and CDI specialists was just one of the topics addressed at the monthly steering committee meetings, which are well-attended, even by the hospital’s senior leaders. Other topics include training programs, dual coding, computer-assisted coding, system readiness and payer preparation.

Braccili reported that a significant portion of the coder and CDI clinical documentation specialist training was completed in August, using 21 computer-based modules from the American Health Information Management Association (AHIMA). Subsequent training included three full days of classroom training for the ICD-CM code set and two days for the procedural coding system section.

The hospital is even “making progress” with the specialty-focused education for physicians, which is a combination of peer-to-peer training, computer-based training and one-on-one feedback by clinical documentation improvement specialists. Transition leaders also have done the legwork to ensure that physician participants will receive CMEs for their participation.

The hospital plans to go live with dual coding in November, the preparation of which was “easier said than done,” he said. To get to this point, they had to ensure that their:

  • Coding systems could accommodate both ICD-9 and ICD-10 code sets
  • Patient accounts system could receive the data from the coding system to get meaningful reporting
  • Electronic medical record could store both code sets once codes are assigned to the claims
  • Develop a plan for quality review for dual coding
  • Ensure a method to ascertain what physician documentation was missing that prohibited comprehensive I-10 coding in the dual environment.

November also marks the CAC launch. Braccili noted that the hospital leaders selected a leading national vendor whose system includes both a CDI module and a coder module.

Payer-management efforts are progressing. “Multiple payers know we are ready, willing and able to serve as a beta-testing site with them,” he reported. “We are getting many responses to that. Some payers are interested, others will only test with clearinghouses, and others say they will get back to us.”

Phrases like “we’ll get back to you” are likely to be common for healthcare entities that are behind Boca Raton Regional Hospital in their preparations. Demands on vendors will increase as the ICD-10 deadline gets closer, and, as repeated numerous times by several Talk Ten Tuesday guests, the time to get ready is now.


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.

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