The Clock is Ticking

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Original story posted on: October 21, 2013

Oct. 1, 2014 will be here before you know it. Does it seem as though your practice’s ICD-10-CM clock is getting louder by the month? What can you do to reduce the noise? 

If the clock is thrown out the window, would that work? Not in your dreams!

What can you do now to prepare for ICD-10 implementation so late in the game? Start with a simple reality check. Why? Our industry has predicted that approximately 50-66 percent of providers will not be ready. A/R days are expected to increase by 20-40 percent, productivity by coders is expected to decrease initially by 30-65 percent (and never to return to a pre-ICD-10 rate), and denial rates are anticipated to experience a 100-200 percent increase (with delayed payments, decreased cash flow and lost revenues).

 

Those statistics should be enough to spark motivation toward mitigation by identifying risks, seeking out root causes, and implementing action plans. 

Personally, I recommend discovering the A-Team of Five approach.  What is the A-Team of Five? Here’s an introduction, complete with a game plan on how to go about implementing one:

  1. Assess — Where are you today? Where must you be on Oct. 1, 2014?
  2. Assimilate – Gather your team, representing each component of your practice.
  3. Assign – Delegate specific responsibilities to each team member, then put deadlines in place. Consider the following areas:
    1. Financial preparedness
      1. Recognize that there is a strong possibility that the ICD-10-CM claim process will have a negative financial impact on your business, with delayed payments, denials, an increase in A/R days, and possible loss of revenue.
      2. Build your cash reserves now, with an eye on using them for 3-6 months after the ICD-10 go-live date. Budgeting is vital to include in ICD-10-CM education for all staff, plus resources such as new coding manuals, loss of productivity, system/software updates, etc.
        1. Invest now in training all personnel.
          1. Start with ICD-10-CM awareness.
          2. Identify who needs to have training, and become familiar with the detailed educational level.
            1. Administration – Awareness
            2. Front office staff – Awareness to basic
            3. Documenters (physicians, non-physician practitioners, nurses) – Intermediate, related information to diagnosis
            4. Billers/coders — Expert-level
    2. Inventory Review
      1. Documents that may have diagnosis touch points, whether related to ICD-9-CM code or narrative description. 
        1. Policy and procedures
        2. Workflow diagrams or narratives
        3. Encounter, intake, pre-certification, authorization forms
        4. Job descriptions
        5. Order forms – laboratory, radiology, etc.
        6. Superbill
        7. Prescription forms
        8. All other documents that need to be reviewed
      1. System/software vendor readiness, including updates and 360 testing
      2. Unknown challenges required to be addressed
    3. Action — Develop using incremental goals and achievable objectives. How?
      1. Remember, your main goal is to have the entire practice ready for ICD-10  by Oct. 1, 2014.
      2. Become engaged; encourage all staff to be involved.
      3. Embrace communication; get the message out to all staff.
        1. Provide periodic updates of the process.
        2. Encourage staff participation — without them it will be a difficult journey.
  4. Establish biweekly meetings of one hour, and stay firm to this.
    1. Prioritize deadlines, expectations and responsibilities for incremental task completions on all.
  5. Develop a realistic agenda. Include:
    1. Old business
    2. New business
    3. Concerns
    4. Brainstorm (form team to seek out new ideas for revisions to plan, keeping each task moving forward)
    5. Reiterate assigned tasks, objectives and deadlines
    6. Set new goals and objectives for the next two weeks
    7. Accomplishments
      1. Weekly
      2. Monthly
      3. Quarterly
      4. Readiness by task, assignment, or deliverables

Focusing on the necessities of keeping your business viable through proactiveness will also improve efficiency of your operations. Working diligently toward goals and objectives, in tune with the loud ticking of the ICD-10-CM clock, may help you stay on course toward ICD-10-CM implementation.

The size of your practice does not really matter; the issues are the same for ICD-10-CM implementation preparation related to diagnosis documentation and coding. First, keep it organized, but simple. The Centers for Medicare & Medicaid (CMS) website (http://cms.gov/Medicare/Coding/ICD10/index.html) offers many useful pieces of information for small and large physician practices. 

Finally, examine your clock’s gears – in your practice, maybe some grease in between those gears will lessen the noise and add to the efficiency of its mechanics.   It’s not time for a panic attack just yet, as there are still a number of months left to go..

Even though time is not your friend at this point, you must remain focused and vigilant in your efforts to become ICD-10-ready. Question every step and search for every answer. This project can get complicated because of the ramifications to your business; seek information from your peers, asking what they are doing. Also be sure to learn from your affiliated hospital clinical documentation improvement specialist, health information management department, and/or internal administration, and get involved in ICD-10 committees and other activities. 

About the Author

Gretchen Dixon, MBA, RN, is a consultant at Hayes Management Consulting. She is a Certified Healthcare Compliance Officer, Certified Coding Specialist and internal auditor with more than 20 years of experience in the healthcare industry with an emphasis on clinical documentation improvement, compliance, revenue cycle and coding.

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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.
Gretchen Dixon MBA, RN, CCS, CPCO, AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador,

Gretchen Dixon, MBA, RN, is a consultant at Hayes Management Consulting. She is a Certified Healthcare Compliance Officer, Certified Coding Specialist and internal auditor with more than 20 years of experience in the healthcare industry with an emphasis on clinical documentation improvement, compliance, revenue cycle and coding.

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