Updated on: March 16, 2016

The ICD-10 Implementation Olympics Rewind!

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Original story posted on: April 21, 2014

February 2014 brought the Winter Olympics to Sochi, Russia. More recently, it seems to be the beginning of the ICD-10 Implementation Olympics in the United States. There are only 541 days (as of April 8) left before the opening ceremonies, with the passage of HR4302! As we rewind our ICD-10 implementation activities, please consider these events in your project plans.

 

There are several events in the ICD-10 Olympics, including financial investigations, testing, education, software remediation, business operation transition, and communication. Qualifying runs for these events should be in full swing. Let’s look at each:

Financial Investigation: Organizations should be reviewing their financial preparations as the ICD-10 transition approaches. This event includes ensuring financial stability through the transition (securing lines of credit, adjusting operating budgets, etc.); understanding reimbursement changes that may occur (DRG shifts and contract changes); and creating a human capital plan (having the right resources) during the preparation and transition phases.

Testing: Healthcare organizations should be testing software to ensure ICD-10 preparedness. The testing event includes several steps. These steps include testing within the software, testing with an interface, testing within an internal process, and testing with an external business partner. Testing the software should include simply verifying that the software will process ICD-10 codes and show ICD-10 codes. That is an easy step. If the software uses any interfaces, ensure that it will send ICD-10 codes to the interface and that the interface will accept ICD-10 codes. Process testing involves beginning a process such as coding and abstracting with ICD-10 codes. The coder enters a ICD-10 code into the abstract, and the information then is forwarded to claims processing, which produces the UB-04, prompting several questions. Does the ICD-10 code make it through the process unencumbered? Does the code look the same from the abstract to the UB-04? If the code is the same, then you have passed this step. The final step is testing with an external business partner. After creating a UB-04 (or a 5010), can you submit it to a payor or clearinghouse and have the claim be accepted? If so, you have won the silver medal! The gold medal will be awarded to the institutions that can submit claims and receive reimbursement on those claims.

Education: Education is a significant effort at this time. Groups to be educated and/or trained: coders, clinical documentation specialists, physicians, case managers, utilization review, patient access, patient financial services, registration/patient access, financial advisors, information technology, finance, compliance, etc. Your organization should determine your distinct training groups. Some groups require detailed code set training, which should include how to find the appropriate ICD-10 code using encoders or books. The American Health Information Management Association (AHIMA) has provided the projection of 40-60 hours of training, but the coders will need time to practice, practice, practice to increase their efficiency. Dual-coding is a method many facilities are utilizing to promote ICD-10 practice. Dual-coding involves coding cases in ICD-9-CM and then natively coding the same cases in ICD-10-CM/PCS. This activity assists the organization in documentation improvement, testing, and ICD-10 coding practice. Many groups will need overview education, which should provide a general code set understanding and an overview of ICD-10 impacts. Education/training can be provided using computer-based, instructor-led, and blendedapproaches. The education/training audience can be peer-to-peer or a general approach. Education/training should be tailored to meet your organization’s needs and personality. The gold-medal winners will be the organizations that realize less reduction in coder productivity, limited changes to reimbursement, and continued cash flow.

Software Remediation: This event should be well underway, as time is of the essence if you have to replace any software. All vendors should be contacted regarding ICD-10 compliance status. Products that are scheduled to be sunsetted should be replaced. Changing entrants in this event may be very difficult. Software remediation will impact your testing strategy. You can’t test an entire process without all involved software being remediated. Ensure that you have identified all software/interfaces/databases that utilize ICD-9-CM codes today and determine what the ICD-10 remediation status is. The gold-medal winners will be the organizations that have the software remediation completed on time.

Business Operations Transition: ICD-10 Implementation Olympics is not just an information technology (IT) event. It also involves business processes, which also will require attention leading up to ICD-10 Some business processes to consider include:

  1. Data reporting to statewide databases

  2. Submission of quality data to the Centers for Medicare & Medicaid Services (CMS)

  3. Pre-authorizations that will begin before Oct. 1, 2015 for admissions occurring after that date

  4. Production of advanced beneficiary notices

  5. Creation of trending reports (merging ICD-9-CM and ICD-10 data)

The gold-medal winners of the business transition event will be the organizations that view ICD-10 implementation as more than an IT project and anticipate business operation changes.

Communication: Communication is the premier ICD-10 implementation event. Communication events are public, organizational, technology-related, process-oriented, etc. The public should be advised regarding changes to your organization’s explanation of benefits or detail bills. Enterprise-wide, there should be general communications that are released regarding ICD-10 implementation status. This communication could be a monthly/weekly newsletter or dedicated space on the organization’s intranet site regarding activities completed and scheduled. Technology can be the focus on a separate set of communication that would provide information regarding the status of software remediation. Communication is crucial at the departmental level. This communication could be verbal, delivered during staff meetings, or posted on bulletin boards. The communication should focus on changes in the department from a business or technology standpoint. Scheduled activities also should be part of this process. Frequently, questions regarding training are raised. You should be very clear about training and expectations with regards to training. The gold-medal winners are the organizations that have knowledgeable staff and business partners who are not fretting (more than usual) about the transition.

ICD-10 implementation is a marathon, not a sprint. All of these events require time, expertise, and technology. Just be sure to go for the gold!

 

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.
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.