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Five ICD-10 Tasks to Complete by the End of 2014

By Jennifer Bresnick

ICD-10 isn’t going to take a holiday, but providers can take a few basic steps to prepare before it’s time to celebrate the new year.

- Believe it or not, the winter holiday season is nearly upon us, and ICD-10 is tops on the list of projects that are likely to be put aside in favor of office parties and family vacations.  While the new code set will not come into effect until October 1, 2015, if the current implementation date holds, there are plenty of ICD-10 tasks that providers should consider getting under way before the end-of-the-year slump.

Already have an impact assessment?  You might need to do another one

If you’re one of the 27% of providers who have not completed a financial impact assessment at this point in the transition process, you know what to do.  Whether you hire a consultant or scrape together some in-house resources, it is critical to have a thorough inventory of what health IT systems need to be upgraded, what staff members must receive education, and how much it will cost.

“With ICD-10, it’s anticipated that days in accounts receivable may go up by 20 to 40 percent,” warns Summer Scott Humphreys, Executive Consultant for Beacon Partners.  “Denials may increase.  I would suggest having a strong revenue cycle team in place that actually starts looking at denials now as problem areas now are just going to become larger with ICD-10. Focusing on those denials by provider, by coder, by payer and figuring out why they’re happening is going to help an organization prepare for ICD-10.”

If you have already completed an impact assessment, but the results are from before the first few delays in 2012 or 2013, you might wish to consider a do-over.  Technology needs have changed drastically over the past few years, and some organizations may have implemented new systems since the latest delay was announced in April.  “You may have already checked the box and said, ‘Hey, I’ve passed this gate,’ but the reality is with the shift in timeline you may very well have to repeat various aspects of your testing strategy and other aspects of your implementation plan,” says Erik Newlin, Vice President of EDI Platform & Compliance at Xerox and Co-chair ICD-10 Assessment Workgroup at WEDI.

READ MORE: CMS FAQs Offer Guidance for ICD-10 Compliance

It’s 2014: Do you know where you upgrades are?

Recent surveys have shown the number of ICD-10-ready vendors has crept upwards, but many providers are still waiting for products that haven’t been released yet.  While two-thirds of vendors have already made their products available, according to a WEDI poll in September, more than 25% won’t have their upgrades finalized until 2015 or don’t even have an idea when they’ll be ready.

Providers who are waiting on software or hardware should continue to hound their vendors for a delivery date in order to move their implementation timelines along as quickly as possible.  October of 2015 may seem far away, but large-scale upgrades can take more time than anticipated, and may also be subject to unforeseen setbacks or rescheduling.

If you’re not already testing, nail down a schedule

Ensuring that the right technology is in place is so crucial because it is a pre-requisite for adequate testing.  While a third of providers had already started external testing as of September, more than half don’t anticipate beginning the process until 2015.  That could put some organizations in danger of squeezing up against the deadline without the opportunity to address any problems that may arise.

READ MORE: ICD-10 Implementation Yields 80% Success Rate, KPMG Reports

“If providers are waiting until the last second, you’re doing your own harm,” Newlin says.  “Waiting until the last second does not leave enough of a ramp for payers to rectify any problems they might run into.  We’re not going to have a seamless transition if that happens.”

“Any time you go through a major change like this the more detail you can check off, the less chaos you’re going to endure as you go through your conversion,” agrees Ken Kilmer, ICD-10 Project Manager at Nash Health Care, which participated in a full-scale simulated go-live in order to thoroughly put the system through its paces.  “If you’re a hospital out there and you’re not already thinking about doing this type of testing, then it’s something you should consider.  People just tend to do this right before the event, and I don’t think it’ll give them time to react and prepare the way they could be otherwise.”

Even if you don’t begin testing before the end of 2014, sit down with your ICD-10 transition team, your payers, and your technology providers to see if you can’t hammer out a rough schedule or sign up for a CMS testing opportunity before offices start emptying for the holidays.

Make sure your coders and physicians are on board with education

Technology is only half the battle when it comes to ICD-10.  It is primarily a process improvement project which affects the quality of documentation, both clinical and financial.  For ICD-10 project leaders, this means training physicians to produce better notes on the front end and giving coders the best possible tools to turn documentation into dollars as claims head out the door.

READ MORE: CMS to Update eCQM Value Sets for 2017 Reporting Period

Clinical documentation improvement (CDI) can be an uphill battle if physicians aren’t properly engaged in the ICD-10 project.  Consider presenting CDI as a way for physicians to better express their existing clinical expertise, not as a mandatory requirement for an administrative process that doesn’t directly fit into their wheelhouse.  “Doctors want something simple and something that works,” declared Dr. Richard Garcia, MD, MPP, MHA, Emergency Department Director at Beverly Hospital in Montebello, California.  “Physicians and HIM people have to align together to make this whole process work, because if we’re not respectful of each other’s workflow, it’s not going to happen.”

The New Year is a perfect opportunity to re-commit to CDI if your program wilted a little with the 2015 delay.  It’s also a great time to start giving coders the practice they need to become proficient in the complex new code set.  Before shutting down for the holidays, consider planning, introducing, or ramping up dual-coding and advanced training for coders who will need time and encouragement to adjust to the new ICD-10 environment.

If you’re in good shape, consider lending a helping hand

If you went through this list and checked off every part in your head, there’s one more task you might want to add.  Healthcare providers, especially smaller practices and solo physicians, continue to struggle with the very basic pieces of the transition process.  In the latest AHIMA and eHealth Initiative survey, more than a third of organizations who haven’t planned testing yet have cited a lack of knowledge as the reason why.  Forty-five percent of those providers were small clinics or physician practices.  CMS is doing its best to provide resources and education, but if your organization is already on point, you might want to think about reaching out and offering guidance to local partners who might be less well-prepared.

ICD-10 is an endurance race for the entire industry, not an individual event with a gold medal at the end.  Every member of the care continuum, from payers to vendors to patients, stands to be impacted by a failure to make the great leap, so it’s in each provider’s best interest to ensure that October 1, 2015, isn’t a date to be feared.

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