September 11, 2012

Reinvigorate Education, Implementation Plans to Meet the New ICD-10 Deadline

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On Aug. 24, the Centers for Medicare & Medicaid Services (CMS) published a final rule setting the compliance deadline for converting to the ICD-10 system of diagnostic and procedural coding to Oct. 1, 2014, a change of plans from the original date of Oct. 1, 2013. The U.S. Department of Health and Human Services (HHS) said the extra time would give healthcare organizations, especially small organizations, adequate time to get prepared for the changeover.

"By delaying the compliance date of ICD-10 from Oct. 1, 2013, to Oct. 1, 2014, we are allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing," HHS said in announcing the rule. "By allowing more time to prepare, covered entities may be able to avoid costly obstacles that would otherwise emerge while in production."

So now that the date is set, where should facilities start? It’s time to reinvigorate your education and implementation plans. Here are three recommendations regarding areas on which to focus.

1. Documentation. Put greater emphasis on your clinical documentation training programs for physicians and other caregivers. You should develop processes, guidance and support to foster improved clinical documentation under ICD-10. Improved documentation skills – even involving minor changes, such as introducing more specificity in notes – create obvious financial and non-financial rewards: fewer claims denials, reduced RAC audit exposure, improved case mix index and improved cash flows. Most important for all of us, patient care is improved when downstream clinicians can review more complete chart notes and when better data is available for analytic and comparative studies. Target high-volume specialties in your organization projected to be impacted most by ICD-10, and train specialists in proper documentation while educating the coding team on accurate coding. Then, move on to the next specialty for training.

2. Training and Development. Act now to invest in the training of your coders and those who will use coding data. Improve the basic skills of your coders in ICD-9 areas that also will be relevant in ICD-10. The transition to ICD-10 has pushed healthcare to invest in training our coders as skilled knowledge workers. As part of our own ICD-10 preparations, Precyse assessed the coding skills of nearly 300 coders on our staff to evaluate their ICD-10 readiness. We found additional training needs related to anatomy, physiology and pathopharmacology, as well as opportunities to improve their understanding of coding system logic and principles. So Precyse, in addition to developing individual training plans for every coder, invested in and developed a comprehensive, multifaceted training program that can be delivered via virtual webinars and as part of our online Precyse University. This investment has paid off for Precyse clients handsomely, yielding a better case mix index for hospitals, improved coding compliance audit results, increased coder retention and the attraction of new coder recruits who are eager to develop and perfect their skills. We recommend that you perform side-by-side ICD-9 and ICD-10 coding, assessing documentation and coding gaps and targeting training based on these findings.

3. Build a strong foundation for process improvement. Assess the flow of information across your organization and develop a plan to address gaps through process improvement and technology. Invest in automated systems that streamline the entire clinical documentation process. ICD-10 is not just about retraining medical coders – it’s about having enhanced patient and treatment data, which affords vast opportunities for improvement in how data is captured and processed. This also leads to a more complete and useful set of codes, which is crucial in a fully automated electronic medical record environment. Today, inefficient, labor-intensive workflows abound, whether involving clinical information inputs such as dictation and transcription; service approvals, coding, physician queries and other myriad elements involved in billing for services; or abstracting and analyzing quality indicators to improve patient care. We also recognize the promise of future innovations such as automated speech recognition, computer-assisted coding using Natural Language Comprehension™ (NLC) and clinical decision support tools – but know that realizing their full promise tomorrow requires that we improve how current users interact with and use their existing systems today. Those of us in the healthcare information management/information technology community must use our skills to innovate for clinicians. We must develop workflow platforms and applications that allow healthcare providers to do their jobs more efficiently and effectively. We do not want to add more time and complexity to an already burdensome process.

About the Author

Chris Powell is president of Precyse (www.precyse.com), which provides ICD-10 education as well as services and technologies that capture, organize, secure and analyze healthcare data. The company transforms this data into actionable information, supporting the delivery of quality patient care and optimizing operating performance.

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