EDITOR’S NOTE: This is the eighth in a series of articles on fast-tracking ICD-10 implementation.

As I started developing training plans for hospital facilities and physician practices, I realized it would not be an easy process. It may sound simple, but it isn’t. There is so much to consider: who needs training, what type of training, when the training will be delivered, and who will deliver the training. Then, on top of these issues, we must consider continuing medical education (CME) and continued education (CE) for physicians, coders, and others.

Every education subcommittee must do the following:

 

  • Define training needs of employees by function, department, and location.
  • Establish types of training necessary (i.e. awareness, fundamentals, in-depth training, etc.).
  • Determine who will provide training, along an established budget.
  • Develop a training plan for the entire healthcare system.
  • Establish a training schedule, timeline, and locations.
  • Communicate information about the training plan to affected employees and management in order to provide adequate staffing.
  • Work closely with health information management (HIM) and medical staff leadership to develop physician documentation training.

It is important to provide the right type of training at the right time. Also, beware that not all of those who provide training are “expert” trainers. Make sure your chosen professional is an American Health Information Management Association (AHIMA)-approved ICD-10 trainer who has undergone the necessary training and testing. Keep in mind, also: If you are using physicians to train other physicians as “physician champions,” make sure they are well-versed in ICD-10, coding and documentation. I don’t claim to have the expertise to treat patients, as I am not a physician, and neither should a physician claim to be an expert in coding. Make sure you ensure that your training is performed by a well-seasoned professional, keeping in mind that not all coders are effective trainers or educators.

The first step in the training process is to identify all roles played by every department, including patient access, patient accounts, coding, physicians, C-suite, board of directors, clinical departments, clinical documentation improvement, case management, and others. 


 

As part of developing an action plan, I always identify by department all training that may be required. From there we must narrow down what positions each staff member holds and what type of training would benefit him or her. Review this excerpt of a department/role analysis for a hospital system that owns several medical practices:

Department

Job Title

Anatomy and Physiology

Awareness

Fundamental

In-Depth

Documentation

Occupational Health

Biller

2

2

2

 

2

Physician Practice Management

Billing Manager - Clinic

5

5

3

2

 

Information Technology

Business Analyst

 

3

 

 

 

Cancer Registry

Cancer Registry Tech

 

4

 

 

 

Cardiac Catheterization

Cardiac Cath RN

2

5

2

 

 

Cardiac/Pulmonary Rehab

Cardiac Rehab Assistant

1

1

1

 

 

Case Management

Case Mgmt Informatics

4

4

3

1

 

Case Management

Caseworker

 

3

 

 

 

Cardiac Catheterization

Cath Lab Tech

 

2

 

2

 

CCC-Cath Lab

Cath Lab Tech

 

1

 

3

 

Health Information Management

CDI Specialist

4

4

 

4

 

Health Information Management

Clinical Data Tech

5

5

2

3

 

Health Information Management

Coders

14

14

4

10

4

Case Management

Clinical Documentation Specialist

 

4

 

4

4

Physicians

Family Practice, Internal Medicine

 

10

2

 

10

Coder Physicians

Coders

14

10

10

4

0

Home Health

Coders

1

2

1

1

0

Occupational Health

Nurse Practitioner

4

2

2

 

2

Wound & Ostomy Clinic

Nurse Practitioner/ET Nurse

 

2

 

 

2

Anticoagulation Clinic

Nurse Resource Specialist

 

2

4

 

2


 

Department Training/Roles Excerpt

I have broken down my trainings into five tracks:

  • Anatomy/psychology training;
  • Awareness training;
  • Documentation training;
  • Fundamental training; and
  • In-depth training.

Let’s start with anatomy/psychology training. It is important that all coders and staffers using ICD-10 codes are either tested on anatomy/psychology skills routinely or attend a course to get them ready for ICD-10. ICD-10 is far more clinical than ICD-9, so lacking these skills would be a handicap.

Awareness Training

It is important to provide the right type of awareness training. General awareness training would benefit the entire organization, whereas documentation awareness would benefit physicians, non-physician practitioners, and other clinicians. The last type of awareness training should be developed specifically for coding and billing staff.

Documentation Training

All physicians, non-physician practitioners, and other clinical staff can benefit from documentation training. Most practitioners will use their electronic health record or other methods to code in ICD-10, but documentation as we all currently know it will be a significant issue. Documentation in its current state may not be sufficient for ICD-10. It is important to break down documentation training by specialty.

Fundamental Training

I call basic ICD-10 training “the fundamentals.” Fundamental training should last no more than one day and be designed for those who are exposed to the coding, physician orders, executing ABN’s, etc. All staffers who have exposure to diagnoses, whether in description form or code format, need a basic fundamental class.

In-depth or Advanced Training

In-depth training should last at least 3-5 days and include at least two days of ICD-10-CM training and two days of ICD-10-PCS training, covering format and structure, guidelines, and coding case studies to build skill. I conduct my training in four days and then conduct an advanced training a couple of months later for those who want more case studies.

What Training method is best for Your Organization?

I think employing a variety of different methods is of great benefit. Awareness training can be delivered easily via webinar or recorded as a podcast or short presentation that should last no more than one hour.

Anatomy and physiology training can be most cost-effective when delivered via a learning management system. Many companies offer this type of online training and can even test proficiency before and after.

Documentation training, fundamental training, and in-depth training can be delivered via the Web or in person. I strongly believe that it is of greater benefit to conduct in-person seminar or classroom-style training for documentation, as many practitioners and clinicians will have questions. In addition, my preference for fundamental and in-depth training is to conduct training face to face. Coding is not always a clear-cut science, and there are many gray areas in which having an experienced ICD-10 instructor can provide great benefit, answering some tough questions.

It might be beneficial to bring a trainer in to your facility if you have the accommodations and enough people requiring training to provide value for your organization. It is often less costly to bring a trainer in, rather than sending staff out. Many trainers also are able to offer discounts if you provide the room for training.

Defining the Timeline

Timing is everything. If you train too soon, what was learned can be easily forgotten. If training is provided too late, you might not be able to accommodate everyone who needs training, or choices may prove limited. I recommend that my clients begin awareness training right now, and documentation training should begin no later than the first quarter of 2014.

The sooner we get physicians documenting for ICD-10, the greater advantage we have to meet compliance. Fundamental training and in-depth training should begin during the first two quarters of 2014. If you are planning on conducting dual coding, which should begin in April 2014, coders will need their training by the first quarter of 2014. Make sure that when you build your schedule, you take your time and cover all bases.


 

Also make sure you review staff roles again, and make sure everyone who needs training is included. Make the training available more than once as well, ensuring that everyone has the opportunity. 

One more suggestion: Don’t let each department decide what type of training they will get. Whether you are with a large medical practice, hospital, or some other facility, make certain that decisions for training are made at the education committee level, and that the ICD-10 steering committee approves all training along with costs. I have found that some departments in hospitals schedule their own training, and the steering committee can find out about it after the fact. Making everyone in the organization aware that you are working on a training plan is critical.

What will Our Training Cost?

I am finding that training costs are all over the place. One golden rule to follow is this: You get what you pay for. It is hard to gauge quality these days, as everyone says their training is best. One rule of thumb is that awareness training should be fairly reasonable in cost. I would pay no more than $100 a person for this type of training. However, if you purchase awareness training for your entire organization, the cost could rise as high as $5,000 for three webinars divided by group (which can be recorded and housed in your learning management system or on your intranet).

Fundamental training should cost no more than $300 per person and should include a codebook. In-depth training can range from nearly $1,000 to $2,500, depending on length of training time. Codebooks and a workbook should always be included in this training. Online training can be just as costly, but if you engage in training by an expert  instructor, you will get great value for your money. I know that when budgets are cut, so too is education. However, you must keep in mind that ICD-10 training is critical to the success of any organization, and in order to remain solvent in the healthcare industry, training is not optional, but a necessity.

Conclusion

It is important to map out the right training at the right time for the right price. Don’t wait until the last minute to build your training plan, as it should be developed soon after your impact assessment.

If you have not begun your training plan development, don’t wait until 2014. Do it now! 

About the Author

Ms. Grider, a Clinical Documentation Improvement Practitioner, is an AHIMA-approved ICD-10 trainer and an American Medical Association coding author. She is a senior healthcare consultant for Blue & Co., LLC, and has more than 30 years of experience in coding, reimbursement, practice management, billing compliance, accounts receivable, revenue cycle management and compliance across many specialties. Her specific areas of expertise include medical documentation reviews, accounts receivable analysis and coding and billing education. She is the Indiana Health Information Management President-elect.

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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.
Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 34 years of industry experience and a recognized national speaker, consultant and American Medical Association Author who has been working with ICD-10 since 1990 and is the author or Preparing for ICD-10, Making the Transition Manageable, Principles of ICD-10 and the ICD-10 Workbook, Medical Record Auditor, and Coding with Modifiers for the AMA.  She is a senior healthcare consultant with Karen Zupko & Associates.  Deborah is also the 2017 American Health Information Management Literacy Legacy Award Recipient. She is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.