Updated on: March 14, 2016

Fast-Tracking ICD-10 Implementation

By Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P, CDIP; AHIMA-approved ICD-10-CM/PCS Trainer
Original story posted on: March 7, 2013

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

Currently, not everyone is getting ready for ICD-10.

Some hospital systems still are calling to get quotes and proposals for their preparatory work. I can understand this strategy being employed by critical-access hospitals and rural health systems, since finances are tight and other competing projects have to be completed first – but most of the hospitals contacting me are the larger ones.

 

What are they thinking? Some of the providers that approached me in early 2011 are telling me now they are not ready, and even asking if we have resources to help them. Yet resources are running short all across the country.

So here’s some simple advice to everyone: secure your implementation assistance right now (today), or you will be left out in the cold.

Yes, I am still going to try to help inquiring providers, and yes, I will continue to send proposals and engage with hospitals and other organizations to try to help them get ready, as I do have a team of very talented and qualified individuals to help me. However, right now we are “fast-tracking” all of our clients we are engaging with for ICD-10 implementation preparations. Right now, everyone should be executing an action plan. And what am I doing? Impact assessments on the run, for one thing. Let me give you an example: I recently spent two weeks in a Midwest hospital interviewing department heads so I can determine compartmentalized projected impacts of ICD-10. Our process is very simple, and I will start at the beginning.

Getting off on the Right Track

When I first engage a client, my team and I like to make sure we have a seat on the steering committee, not as a voting member, but simply to provide guidance and recommendations as discussions about implementation of ICD-10 unfold. This way I am always front and center at the steering committee meetings (which can create challenges when you have several hospital systems to serve, but so far, so good).

Step No. 1:

Get the steering committee organized. I typically meet with the CFO and/or stakeholders to outline who needs to be part of this committee and to go over the implementation so they understand the process. Then I typically put together a presentation. We also discuss who needs to be part of the steering committee, subcommittees or other teams. Most critical-access hospitals and rural health systems do not like to refer to their subcommittees in this manner and prefer to call them “teams.”

Once the steering committee is put together and the project charter is drawn up, I like to have a kickoff meeting with all the steering committee members. We typically try for a mid-week morning meeting, though not too early.   Don’t forget about food, which is important. I also like to have other key department directors at the meeting so they can understand the scope of what we are trying to accomplish, as they might assist on subcommittees (such as the communication committee, template committee, etc.).

The meeting then starts out with every member of the committee and others within the system introducing themselves, telling us what their roles are within the organization. Then I introduce my team and outline what role they will play in ICD-10 implementation, also describing our expertise so everyone feels comfortable.

I have a presentation that outlines the basics of ICD-10 (what, why, when, etc.), and after going over that, I describe the steps we need to take to accomplish a successful implementation. This takes a couple of hours, with a Q&A session to follow at the end.

Step No. 2:

Schedule the impact assessment. I know that many providers just want to send a survey to their departments to determine how ICD-10 will impact each of them, asking about what software they use, what reports contain diagnoses, etc. But I take a very different approach. The goal for my team and me is to become a partner in the trenches with each organization in order to help them through the entire process, start to finish. We obtain a list of every department, regardless of whether the client thinks, scrutinizing projected ICD-10 impacts and meeting with each department director/manager/supervisor. We don’t typically meet with the housekeeping or maintenance departments, since we know there is no impact there. Usually, social work is not affected either, at least according to what we have discovered thus far.

We have a series of standard questions, but we like to let the departments just tell us about their workflow, what software they use, what reports they generate, how much interaction they have with coders, whether they enter any charges, etc. Once we complete an impact assessment we go back to the office and analyze the data we have gathered, identifying risk areas such as HIM, coding, IT, etc. and ranking them as high, medium, low or unaffected. We also work with IT to obtain a complete list of software used in each organization. I find it amazing that IT departments in many cases are not aware of every piece of software used in their organizations. One funny story: we were performing an impact assessment in one client’s department that should have been checking medical necessity – but they did not know how to use the software, so they didn’t do so. We often are able to uncover operational issues that should be addressed even though they are not related to ICD-10.

Step No. 3:

Put together a gap analysis and identify the “current state” and “future state.” When we reach this step, we present our findings in a written report to the steering committee. Of course, we are present at this point to explain our findings to the client, answer questions and discuss next steps, such as budgeting, forming an action plan, project planning, etc.


 

Step No. 4:

Develop an education and training plan, individualized by roles within the organization, so a training budget can be built.

Step No. 5:

We work with the CFO or whoever is assigned to develop the budget for implementation, focusing on education and training, IS (information systems), operational changes, etc.

Step 7:

Develop the education plan with the communication team.

The budget, communication and training plans then are presented to the steering committee with approval from the chair (CFO).

Step 8:

Develop the action plan. We identify action items, plot out a timeline from start to finish, identify responsible parties, etc. We also use project management software to manage timelines (similar to Microsoft Project). In critical-access hospitals and rural hospitals, we typically assign the action items to their various teams.

Step 9:

Execute the action plan. We stay on top of each action item and attend team meetings and subcommittee meetings to assist and keep clients on track.

Each month at the steering committee meeting, each group provides a written report to the SC, with discussions unfolding over problem areas, barriers, successes, etc.

This is an ongoing process, and the tasks are dependent on the teams. For example, the IS team will outline timelines for testing (internal and end-to end), communicate with vendors, etc. The template team works with in conjunction with IS to revise templates within the electronic health record to ensure ICD-10 compliance.

The communication team works on communication schedules, methods, timelines and communication materials. The training team works on training methods, resource evaluation and the development of the training schedule for the entire organization.

We assist with providing education and training to all staff, also providing in-depth coding training to the coders and others.

All committee action items, reports and plans must be approved by the executive steering committee.

Another implementation matter to consider is when to begin dual coding. Many hospitals will begin no later than April 2014, so coders and others who require in-depth training will need to be trained prior to then. The purpose of dual coding is to measure productivity and proficiency with ICD-10.

Physicians also will need documentation reviews and education on documentation changes for the specific conditions they treat. This should be accomplished immediately. Training for physicians needs to be done now in order to achieve compliance before the implementation date. We are building a database of conditions with ICD-10 documentation requirements to enhance physician training.

Our team plans to be available for each client’s various departments as they roll out operational improvements and changes, and also during the go-live period to offer assistance and guidance.

Post-implementation we will offer hands-on assistance to patient financial services and coding departments as well as other departments in order to resolve coding issues, claims issues, productivity issues, etc.

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.