October 24, 2016

The year ICD-10 was implemented: A Retrospective

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When we look back on what we learned in our first year of ICD-10, it’s clear that some providers were and some were not fazed by the Oct. 1, 2015, implementation date. As I reflect on conversations with our customers (at MediRegs, we service customers across the spectrum, including but not limited to those in hospitals, physician practices, long-term care, day-to-day coding, consulting, and auditing), I see that most of what I learned is that it comes down to three fundamental areas of focus: people, processes, and technology. 

In fact, what we learned during the last year with ICD-10 can be clearly applied to any industry or life change. When managing change, one needs to look at the people affected, the current and future processes that need to be examined, modified, and reassessed for effectiveness, and what technology is affected or can provide a workflow to assist in your success. 

The Fundamentals

People: 

Change is difficult for some, while others can pivot quickly and adjust.  Either way, whether or not one is resistant, everyone impacted needs to be prepared. Unfortunately, with the delays we saw with the ICD-10 implementation date, it was inevitable that some people went down the path of procrastination. Today, with all of us having a year of ICD-10 under our belt, it’s clear that those who prepared were the ones not fazed by implementation. Those who procrastinated may not have fully tested, trained their staff to near nausea, looked closely at all end-to-end processes, or put an effective remediation process in place.

To be successful, in general, people need to be informed. Great informants keep lines of communication open. With open communication, there are no surprises. With ICD-10, there were many work streams to attend to due to the vast scope of the new coding and payment system. 

Part of the communication process has to be to ensure that people collaborate frequently, as well as be properly trained and educated. Both communication and education become the key to ensuring that all parties involved understand how they will be impacted by the change.  

Lesson Learned: Be prepared; be proactive instead of reactive.  

Processes:

Testing the process from end to end was the key to ICD-10 implementation success. Not only was it important to test, but every provider still needs to have a cadence and rigor regarding their workflow processes. Evaluate your processes on a frequent basis to assure they are gap-free; and if gaps or issues are noted, then a sound remediation process should be put in place.

Once a process is in place, also know that it may change, especially with our ever-changing Centers for Medicare & Medicaid Services (CMS) rules and regulations. Changes to processes will occur as you address gaps, implement remediation processes, or implement new regulations.  

Everything we do on a daily basis has a process. Good, sound processes lead to best practices that can be adopted by others. 

Lesson Learned: Change can be good and lead to best practices.

Technology:

This area is last but not least in importance. As we just discussed the importance of end-to-end testing, your software/technology needs to be up-to-date and current. Late system updates caused a hiccup early on in the first quarter following the implementation date. The importance of communication and being “in the know” – when to expect updates and then implement them as part of the process – is critically important. Provide current and relevant resources so that all parties involved know when changes occur and can make adjustments, if warranted, for success. 

Additionally, whether it is ICD-10 or you are launching a new software product, testing should always happen in a different environment from the production environment. This allows any issues to be transparent without inhibiting the day-to-day workflow. 

Lesson Learned: Be in the know at all times; keep your technology current. 

ICD-10 was an enormous undertaking with grand collaboration among people, processes, and technology. As I look back, it was a huge success, and we should be proud of our accomplishments with ICD-10 implementation.
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.
Maria Bounos, RN, MPH, CPC-H

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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