by: James Pike
At the publishing of this post on April 15, 2015, the ICD-10 transition is 168 days and 9 hours away.
Does that give you heartburn? Did you feel a little tickle down your spine? Were your first thoughts, "How do I know if my organization is ready?" and "How can I tell if we'll be prepared when the time comes?"
The embattled ICD-10 transition, despite being pushed back several times in the past, has a pretty solid chance of actually occurring on October 1, 2015 as planned. The latest attempt to push it back, brought by a panel of providers out of Texas, was not passed in the Omnibus Spending Bill at the end of 2014 after being met with stern resistance from lobbyists from AHIMA and other stakeholder organizations. Although that doesn't guarantee that an ICD-10 ceasefire won’t be snuck into any other major bills before October, it does seem to suggest a change in the wind.
So with ICD-10 on the horizon, what can your organization be doing to ensure it navigates this tricky time period? The answer to that involves an organizational focus on three specific groups of individuals:
- Your providers
- Your coders
- Your CDI specialists
Each of these groups will have a new and improved emphasis on documentation after the transition, and in preparation, healthcare organizations need to be supporting each of these groups in specific ways.
To start, your providers: they are the lifeblood of your hospitals and clinics. Without them, we don't have healthcare. Your providers are already taxed with charting, paperwork, Meaningful Use, Epic installations, not to mention caring for ill or injured patients. Finding the time to prepare will likely be the hardest task in front of them. If you have not done so already, consider reviewing vendor proposals for outside training materials. There are several companies devoted to making high-quality physician-facing training software. Many of these training packages include access to videos for brushing up on specialty specific verbiage, and contain provider toolkits with tip sheets, case studies, trial queries, even mobile device applications. Making it easy for your providers to receive the training they require in a manner that respects their time and expertise is the key to success for this group.
When it comes to your coders, they're likely either champing at the bit to get coding in ICD-10, or they're terrified of the prospect and ready to hide under a rock until October rolls past. Coders will be one of the most affected groups by this transition, and therefore, in need of the most additional training. Consider preparing them with additional classes in anatomy and medical terminology. ICD-10 related training for this group is not hard to find - the market is saturated with new training materials just for coders. Consider looking into vendors that provide a package deal for your coders - similar to the options for providers, many will include electronic training modules along with reference documents. Or if you prefer live face-to-face classes, many vendors offer that service as well. CMS and AHIMA have released some coding training case studies and tip sheets, which should be free through their respective organizations.
Of course, once you've worked so hard to train your coders, you will have to worry about coder retention. Many "contract coder" and staff augmentation organizations are paying a premium right now to employ highly skilled ICD-10 ready coders - and your coders will not be immune to their charms. Consider looking at negotiated salary raises for signed multi-year contracts; positive-reinforcing rewards tend to have better results in cases of staff retention than do costly penalties for leaving.
One final note about coders: they will highly benefit from real-time practice with ICD-10 coding. The typical approach to this is by introducing a dual-coding period (3-6 months before the transition), where coders are coding charts in both ICD-9 and ICD-10 (9 for billing, 10 for practice). Getting buy-in from your providers can improve this type of program even more, by helping prepare the query process for the transition. Having moderated case study sessions between coders and providers can go a long way to cementing good communication paths in place before the switch.
Clinical Documentation Improvement (CDI) may be one of those programs that has been historically overlooked; however, with the ICD-10 transition, many are seeing themselves thrust into the limelight. These tireless individuals typically review select charts to ensure the documentation provided allows for the best coding and best reimbursements. Better documentation = better reimbursements, and better documentation = fewer dollars lost to audits. These principles will only become more relevant after the transition, when the codes are more specific and require equally more specific documentation. CDI specialists are your best defense against the dread RAC audits, and help your organization maintain more of its reimbursements.
Depending on the maturity of your CDI program, you may have seasoned veterans or fresh neophytes; both will require additional training to be successful in October. Consider CDI "bootcamps" which aim to train your CDI specialists in an immersive several-day training venture. This could involve sending your CDI users away for training, or bringing the "boot camp" trainer to your location to perform the training on-site. CDI users require a mix of the clinical side of training, as well as the coder side - they need to be able to relate what the best reimbursement for X code is, and translate that to the providers to ensure that they are putting enough in the chart to back that code up. While CDI specialists will benefit from training materials and tip sheets aimed at coders and/or providers, they will most likely find the best experience reviewing them in combination with CDI-specific materials.
Some healthcare organizations are planning to hire contract coders and contract CDI specialists to help prevent a dip in AR days after the transition. While this may be helpful, contracted “mercenary coders” often have a period of reduced efficiency when beginning at a new organization as they learn new workflows. If you plan on taking this route, consider bringing them several months in advance to help them adjust before the transition. Your best bet is to focus on the abovementioned provider, coder, and CDI training - and have them begin practicing early with the ICD-10 review, query, and coding processes. A strong knowledgebase among your staff and a well-trained provider core, when met with positive reinforcement from CMOs, CIOs, and CFOs will be your best key to victory.
If you are interested in having the Sagacious Strategic Revenue Team perform an ICD-10 readiness audit, or are considering looking for outside contractors in training, project management, or analysis, please reach out to Pat Henson at firstname.lastname@example.org.