Beware of Errant Sea Lions!

It is highly unlikely you will be hit by a sea lion – new ICD-10 code W5612XA, but it’s a sure thing your revenue stream will take a devastating blow if you are not fully prepared for the transition to the new ICD-10 coding set. The code mentioned in the previous sentence is just one example of the seemingly ludicrous granularity of the new ICD-10 codes. This increased specificity, which offers well over 70,000 codes, will create an overwhelming potential for errors in your coding workflow. Even your most experienced coders are going to find this transition challenging.

A survey reported in the 8/14/13 edition of HISTalk claims only 38 percent of providers participating in the survey were at least somewhat confident in their practice’s ability to transition to the ICD-10 code set. This indicates we still have a “long road to travel with a short time to get there.”

You need a plan in to mitigate the risks to your organization’s revenue stream

The first element of your plan should be a readiness review. Only with this kind of information can you determine where your organization stands in its preparedness for ICD-10. This new code set will mandate a huge change in your entire organization. To deal with this change management, select a key person within your organization to be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before and after the deadline of October 2014, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them that ICD-10 compliance is critical to the financial health of your organization, and to ensure there is “a sense of urgency” within your organization to drive the necessary changes forward.

Understanding how ICD-10 will impact your organization, enterprise-wide

Your readiness plan should include a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the impact of ICD-10, enterprise-wide. Any aspect of your organization that will be impacted by the transition to ICD-10 should carefully examined, including the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

Take advantage of educational opportunities

Specialty associations, such as AHIMA, AMA, MGMA and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The learning curve, as stated previously, is going to be tremendous. Online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you mitigate your financial risks. Technology is available today in the form of computer-assisted coding (CAC) tools.  These tools automatically derive and assign medical codes from within clinical documentation. Many are presently ICD-10-ready.

With this kind of technology, your organizations can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with the requirements of payer and quality reporting. Additionally, some of the CAC technology vendors offer on-site coding expertise to ensure there is no lag in your coding workload. These types of technology solutions can work with your electronic health record (EHR) and financial system to produce extremely accurate coding.

The benefits of CAC tools are many and you are going to need all the help you can get during this trying period. These systems do not do away with your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes. This approach will alleviate the negative financial effects that will come from the October 2014 “hard cut over” deadline to the new system.

Mitigating Your Financial Risk

Suffering and ill effects of being hit by a “crazed” sea lion are doubtful, but you can count on the transition to ICD-10 having a tremendous impact on your organization and its revenue stream, and this impact will be felt for years after the ICD-10 migration has begun. Having a documented plan in place that will help you understand how your revenue stream will be affected will go a long way toward mitigating any negative impacts. Taking advantage of the educational programs that are available today will help you manage the ICD-10 transition and ensure that the risk remediation programs you put in place can be maintained over time to mitigate future impacts to your revenue stream, long after the ICD-10 deadline has passed. And finally, employing some type of CAC tool, possibly with onsite coding expertise, will mitigate the risks to your reimbursements and your revenue stream as you cope with the transition to ICD-10.