January 6, 2012

Seven (and a Half) Things to do for ICD-10 in 2012

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For many people, the beginning of the year is a time for reflection. For others, it is an opportunity to look ahead – and to make plans, list goals and itemize the steps it will take to achieve them. As healthcare organizations continue the march toward ICD-10 adoption, 5010 is nearly behind us, but there’s still a lot of work to do to ensure a successful transition.

As organizations progress toward the Oct. 1, 2013 implementation deadline, there are several high-value initiatives to consider undertaking this year. Organizations that haven’t completed an assessment yet should make that a top priority. We’ll call that half an item on the to-do list, because with what time is left, organizations that have not completed an assessment will need to do so at the same time they focus on another high-priority task. For those organizations ready to move beyond assessment, here are at least seven items to have on your 2012 agenda.

Understand your system requirements. As part of the migration to ICD-10, healthcare organizations will need to change systems, whether that means upgrading applications to make them ICD-10-compliant, altering an existing system or acquiring a new system. Such changes take time, so this should have a priority position on your ICD-10 to-do list.

This is also worthy of top-tier attention because of the magnitude of change ICD-10 adoption will bring to systems, people and processes. An on-air discussion last year on ICD-10monitor’s Talk Ten Tuesday podcast indicated that hospitals normally change financial systems once every five years, and the change is typically nominal. With ICD-10, however, hospitals are changing financial systems at more than double the normal pace. This is putting pressure on the vendor community not only in terms of managing widespread change, but as it pertains to the community’s ability to deliver systems in a timely manner.

Having insight into system needs and imminent changes is critical. As organizations prepare for the impending coding change they need to understand the functional changes required and the costs of upgrades – as well as any associated fees – so they can budget properly.

Preparing for system changes must happen in 2012 to ensure that vendors are able to accommodate business requirements and schedule logistics necessitated by ICD-10 prior to the adoption date. Planning ahead helps minimize disruptions by coordinating delivery and implementation at times that make sense for the business.

Consider contracts modeling. When thinking about system changes, organizations also should be mindful about tools for contracts modeling. For example, when payers start submitting contracts with ICD-10 reimbursement terms, providers will have limited time to understand the impact. This is why it is critical to develop a strategy now for influencing the payer community and to find a tool that will evaluate the impact of any new rates and reimbursement changes quickly.

A modeling tool, especially one for your managed care contracts, will help ensure accurate outcomes and predictions about this impact. It also will help minimize reimbursement risk to providers following ICD-10 implementation.

Commit to monitoring. Review payments frequently and regularly as you start using the new code sets. Also, be on the lookout now and in late 2013 for any new reimbursement trends due to 5010 or ICD-10 changes.

Conduct a retrospective review. If you have not conducted a retrospective review recently, this is the year to do it. A key benefit of such a review is that it can help you review readiness of your existing processes with an eye on ICD-10. Getting a good start in this respect is essential because it will take several months to analyze the data, and several more to collect the revenue. It is early enough in the year to get the work done by the end of 2012 if you start now.

Analyze your data to prioritize operational tasks. The intent of healthcare reform is to bring changes, and with that come changes in strategies for dealing with data. Completing an assessment along with a review of claims data can provide insight into priority changes to be made, including changes to payments for services rendered. Having this information provides organizations with the intelligence needed to be better prepared and can help set priorities and identify opportunities for streamlining operations and eliminating unjustified costs. Stay on track by ensuring that focus is on top priorities.

 


 

Focus on physician training and documentation. Rather than waiting until 2013, when the ICD-10 code sets are newly activated, organizations should take the time to prepare physicians and get a handle on training and staffing needs now. Prepping physicians to meet revised documentation requirements for clinical care relative to ICD-10 should happen immediately so that organizations can devote resources to hands-on coder training and practice in 2013. Planning ahead will help step up coder skill sets to minimize the anticipated decline in productivity following implementation.

Take an organized approach to vendor management. Most people reading this will have completed an assessment by now, but those who haven’t will need to navigate many tasks and system changes simultaneously. Understanding systems, having a tool for contracts modeling, planning adequately for resource allocation and appropriately training staff all require rigor. Managing vendors to understand how their changes will impact these areas is a key focus to have, and this can be accomplished through a vendor management program.

Organizations will need to take a proactive, organized approach to partnering with vendors. Following changes to applications, system delivery and implementation will need to be scheduled in a way that doesn’t conflict with business priorities. Organizations also will need insight into resource and training requirements, as well as understanding of what payers will change and how that will affect benefits plans, appointment scheduling and other processes.

With so many moving parts, it is essential to take a best-practices approach to vendor management using solid project management principles. Organizations must understand the roles and responsibilities of vendors and payers in order to identify areas for additional assistance, such as support for contracts modeling or coding.

As we enter a new year, it is a great time to think about what already has been accomplished and what needs to get done to ensure successful ICD-10 adoption. Organizations should take this time to get organized and plan ahead to minimize hiccups, maximize productivity and focus on the initiatives that will add the most value to operations as they migrate to the new coding system.

About the Author

Veronica Hoy, MBA, is vice president of SOURCECORP HealthSERVE Consulting, Inc. Veronica has been an operating executive for 10 years, focusing on providing strategic leadership and direction to healthcare professionals and organizations. She has more than 20 years of healthcare experience in business process outsourcing, accounts receivable management, coding, billing, release of information, consulting and systems implementation.

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