67, 66, 65, 64 days and counting…. We are officially on the FINAL countdown to ICD-10 implementation. Health systems, providers, payors, etc., are working diligently to review that “Master Task List” we all created, what seems to be, a decade ago by now. At this point, time is short and some in the healthcare industry have not begun preparation efforts. With the remaining time, many are asking “Where do we focus?” Outlined below are a few high priority focus areas recommended for review. It should be noted however that it is NOT inclusive of the myriad of detailed tasks requiring completion prior to October 1, 2015.
Are your coding professionals appropriately trained?
- Do your coders know how to appropriately utilize a code book for code selection? Encoders are great tools, but not recommended for use until coders have proficient understanding of ICD-10 guidelines and conventions.
- Have you completed a gap analysis to determine any education needs that may exist and/or issues requiring monitoring? Are coders utilizing the correct Root Operation…Resection vs. Excision, Repair vs. Replacement, etc…?
- Do you have a quality control process in place for timely and clear feedback to affect change when error or inconsistencies are uncovered?
- Do you have a resource(s) available to support on-going coder training needs?
- Have you looked at your existing coding guidelines to determine what will need to be rewritten for the ICD-10 code set? The guidelines will be as crucial to assisting the coders in ICD-10 as they were in ICD-9.
Have your Medical Staff and Allied Health Providers been trained?
- How quickly can your organization acquire and deliver training resources? Many of the professional associations and governmental bodies (AMA, AAPC, CMS, AHIMA) have tool sets developed by specialty to address the most significant changes. This may be a place to start to shorten any training development cycle.
- Most organizations are exclusively utilizing an electronic health record (EHR) tool to assist with code selection, but are the providers trained in documentation requirements to support the selected code? It is never too early to start documenting specificity and working with your information systems support to update templates can be a fast win.
- Do they have access to quick tips, reference cards, and portable apps that will assist them with the transition if they are uncertain or do not recall their training?
- If your physicians code their own encounters and do not have an electronic tool to assist them, has a crosswalk of their most frequently used codes been completed, and do they have access to a code book for new ICD-10 codes after September 30th? Will they need some “live” support from coding personnel?
Does your organization have appropriate controls in place to monitor any suspected DRG shift or quality metrics deviations?
- What is your high-risk population (by volume or known changes in code composition)?
- Keep a pulse on your data monthly to ensure a similar comparison to previously reported data prior to the conversion.
What is imperative to complete prior to Oct 1, 2015 so you can get a claim out the door?
- Have you tested with your clearing houses and payors the full cycle of a claim?
- Are your customary edits prepared to be converted to ICD-10 for October 1, 2015?
- Have you received guidance from your payors on their preparedness levels and what their transition strategies are?
Do you understand how prior authorizations and pre-certifications will be processed after October 1, 2015, by payors to avoid delayed payment or denial?
- What is their cutover plan?
- When are they accepting ICD-10 codes? Some are accepting them now.
- What if a service was authorized with an ICD-9 code for a date of service prior to October 1, 2015 and the date of service changes to a date following the ICD-10 compliance date – will a new authorization be required?
Have you planned for reporting to quality agencies and determined how the conversion may impact weekly, monthly or quarterly reporting?
- Most agencies are willing to test. Testing is highly recommended to ensure you understand how your data will be utilized for your quality metrics, profiles and potential reimbursement incentives/disincentives.
- It is anticipated that the disruption of data caused by the code set change will be part of the health care landscape for 2-3 years. It is vital that resources remain available to analyze ICD-10 data shifts.
Have your end-users who utilize internal reports for financial analysis, registries, decision outcomes, etc. been made aware of the changes they can expect to see in reports?
- Have your reports been reviewed for potential new inclusion/exclusion criteria? The new code set is intended to assist in finding more specific conditions, and as a result, many quality monitoring organizations have rewritten their specification manuals to reflect a truer intent of the measure. This could result in a new learning curve for understanding the patient population.
- Do they have access to tools to help them understand the crosswalk or how to look-up new codes that need to be included in their reports?
Will your Information Systems be updated and converted to allow for new clinical nomenclature and code use?
- If you are utilizing third party products to support clinical nomenclature and/or codes, when will these updates be available to you?
- When do your technical experts plan to implement them and do the end-users need to be made aware of any functionality changes they might experience?
Have you planned for “expected” operational impact that may result from the October 1, 2015 implementation of ICD-10?
- Is Senior Leadership aware of the change and supportive of the initiative?
- Will you experience coding productivity decline that result in an increase in AR or DNFB?
- Will the organization and providers need support post go-live?
- Is there a central contact/listserv to report problems or ask questions?
- Is at-the-elbow technical support needed?
- Is coding knowledge support needed?
If you are a small Physician Office, have you visited the CMS Road to 10 website http://www.roadto10.org/ to assist with A-Z preparation efforts?
- CMS has invested time and energy to resources that will guide and assist with training. If you do nothing else, make sure you review the planning guide and start taking action NOW!