This is a first in a series blogs that we believe presents an excellent strategic approach for achieving every healthcare provider’s end-goal during the transition to ICD-10 — ensuring there is NO reduction or stoppage of their revenue stream. Our mission is to see a stronger U.S. healthcare delivery system come out of this momentous transition.
Conduct knowledge gap assessments
This blog deals with how to develop and execute a strategic plan of action, and the first step in that plan is to assess the knowledge gaps in your clinical, administrative and coding staffs. What you don’t know can hurt you during this transition. The specific impacts of ICD-10 are hard to identify, but it is anticipated that due to multiple technical and clinical system interdependencies these impact will be very involved and serious.
The new code set is designed to provide benefits to patients, payers and providers, such as enhanced tracking and trending of diseases, innovations in payment design and contracting, improved care coordination, more effective case management and improved utilization management. These benefits come at the price of an increase in the number and specificity of diagnosis codes. The added complexity is evident in the increased specificity in coding injuries, additional codes for laterality and emphasis on affected body systems. Coders who are light on anatomy and physiology knowledge will have an increased learning curve adapting to ICD-10.
Organizations should perform a knowledge gap assessment as soon as possible and establish a training timeline to address how their staff members will handle the impact of the greatly expanded number of diagnosis codes in ICD-10. An effective “hands-on” staff training program should be started immediately.
Multiple programs will be affected by ICD-10
Almost every ongoing healthcare project will be affected by ICD-10. ARRA HITECH’s Stage 2 Meaningful Use requirements will be affected by ICD-10’s new data and specificity requirements. CMS will no doubt push healthcare providers to use ICD-10’s new codes in their efforts to prepare for future value-based reimbursement and accountable care programs.
Additionally, Clinical Documentation Improvement (CDI) initiatives will be affected. The best way for providers to assess the impact ICD-10 will have on this program is by analyzing their present CDI program. The key is adequate and relevant documentation. Documentation improvement initiatives can be conducted in conjunction with coder education in ICD-10-CM preparation. Documentation improvement will be the driver in successful integration of ICD-10-CM and will be less challenging with greater preparation. (We will have a specific blog later on the importance of CDI)
Estimate the potential for loss of coding productivity
Coding productivity losses are estimated at anywhere from ten to 70 percent as suggested by industry pundits. Your organization should start a coding health assessment by selecting an experienced coder, preferably with medium to strong clinical knowledge to code randomly selected cases with both ICD-9 and ICD-10 systems. Run the test for a period of approximately 30 days to gather data across a representative service and case mix. Measure the initial production patterns at the beginning stages of the pilot period and at the end. Identify the learning period, and as the coder reaches stable and familiar state see what he or she can optimally produce. Use these results to plan contingencies for interim coding support and long-term staffing changes.
There are three key preparation issues that if addressed properly, can help providers cope with the challenges of ICD-10: knowing their practice service patterns, assessing their staff’s knowledge, and determining training needs. Being keenly aware of their practice operations, will allow providers to determine the top 80 percent of the ICD-9 codes they presently use, from this information they can devise cross-walks which will significantly reduce the ICD-10 conversion hassle. Providers should analyze their most frequently denied ICD-9 codes. Understanding these frequently denied -9 codes, will create a reference point from which to monitor similar codes in the new ICD-10 code set. Assessing staff knowledge — coders, billing editors, denial resolution teams – will allow providers to benchmark the training needs for these critical positions. Remember, what you don’t know can hurt you!
Stay tuned — next up – Dual Coding!