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August 1, 2011

You’re Only as Good as Your Weakest Link

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I’m almost sure you all have heard and understand the meaning of the saying “you’re only as good as your weakest link.” If you haven’t, imagine pulling a metal chain from each end.

Depending on how strong the links in the chain are, the force needed to break it could be large or small. If every link can withstand a strong force before it breaks, then the chain is strong. However, if just one link breaks under a weak force, then the whole chain is weak. The adage speaks to pointing out the weak points in a certain structure, noting that you only can improve the entire structure once those weak points have been made stronger. Has your organization determined the weak links in your ICD-10 chain?

The industry is preparing for quite a strong force come October 2013, and a weak link in your ICD-10 strategy could have a major impact on your organization. Organizations may appear similar to each other from the outside, but it is not uncommon to find differences between many of them. Each has its own unique culture, complexity, environment, medical staff and patient population. While organizations may be approaching ICD-10 in a variety of ways, there are core elements that are common among all of the viable approaches. What often is different from organization to organization is the degree of preparation for improving the infrastructure to strengthen the ICD-10 revenue stream chain.

Revenue Stream Chain

We could write an entire book on the impact ICD-10 will have on all of the touch points in an organization’s revenue stream. It is critical that your ICD-10 revenue plan covers all of these touch points, from contract to denials management. It is also critical to understand that the revenue stream chain actually will be comprised of several different chains. Most organizations are concentrating on their inpatient revenue streams and the impact ICD-10 will have on the case mix index as the major emphasis for inpatient revenue preservation. This is understandable, as this is the most critical area of potential financial exposure for the majority of organizations. The case mix index revenue chain is short in its simplest form, with the following links:

- Clinical documentation;
- Coding quality; and
- Patient population.

These are the contributing factors that will impact your case mix index and associated revenues for both ICD-9 and ICD-10. A closer look at these links and the potential strengths and weaknesses associated with them warrants a force test to determine how strong your chain is.

October 2013 is the Truth Machine

When the industry converts to ICD-10 in October 2013, the truth machine will reveal how strong your operations are, and any weaknesses in the process chain will be evident thanks to significant financial loss. Organizations must at a minimum perform a “force test” on these critical success factors to determine where weaknesses need to be strengthened. Start by critically evaluating the following:

- Clinical documentation programs;
- Internal/external coding quality review programs;
- Education plans (physicians, coders, billers, CDIS, etc.);
- Staffing complements (coders, CDIS, reviewers, abstractors, billers, etc.);
- Technology tools (encoders, auditing, compliance, tracking, CAC, etc.); and
- Decision support tools (outcomes analysis, data warehousing, etc.).

Any weaknesses in these critical components will have a negative impact on your inpatient revenue stream. Trying concurrently to manage operational challenges you will encounter in October while mitigating the impact of the conversion to ICD-10 because your organization did not prepare for it thoroughly is a situation in which you do not want to be.

Conclusion

A key success factor for preparing your organization for ICD-10 will involve continuing to look to strengthen your processes and programs. ICD-10 is a game-changer that will require strong processes, controls and monitoring outcomes to manage the clinical documentation and coding process.
What is the risk of over-preparing for ICD-10? Improved physician documentation, improved coding quality, expanded quality and compliance programs and improved data integrity. Sounds like a winning combination to me.

About the Author

John Pitsikoulis, RHIA, is a Strategic Advisory Services Client Executive and ICD-10 Practice leader at CTG Health Solutions (CTGHS). John is responsible for the strategic advisory services such as ICD-10, EMR clinical documentation integration program, and Computer Assisted Documentation Services. John has over 25 years of Health Information Management (HIM), coding, and compliance consulting experience working with clients on ICD-10 services, RAC, coding, and clinical documentation improvement engagements.

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Read 84 times Updated on September 23, 2013

John Pitsikoulis, RHIA, is the ICD-10 practice leader and an AHIMA ICD-10-Approved Trainer for Nuance Communications. John has more than 28 years of revenue cycle, health information management, coding, and compliance consulting experience. John has developed and led several corporate and client strategic engagements for managing the conversion to ICD-10, including ICD-10 assessments, implementation planning, integrated testing, education plan management and revenue preservation strategies.

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