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Why ICD-10 Transition Hinges on Clinical Documentation

By Kyle Murphy, PhD

- University of Missouri Health System is ready for upcoming ICD-10 transition deadline. In fact, it has been ready for over two years now, but a series of delays have at the very least provided MU Health with opportunities to fine-tune its ICD-10 preparation activities.

The ICD-10 implementation is two weeks away

According to MU Health ICD-10 Program Manager Gregory Brown, PMP, the buildup to the ICD-10 implementation has made clear what is most essential to a successful ICD-10 transition — clinical documentation. In the following one-on-one interview with EHRIntelligence.com, Brown provides detail about his organization's ICD-10 preparations, keys to success, and concerns counting down to October 1.

To Brown, challenges transitioning to ICD-10 are going to emerge. The solution to overcoming them is putting in the work ahead of time and sticking to the plan.

EHRIntelligence.com: What does the role of ICD-10 Program Manager entail?

Gregory Brown: There are several project managers who are in charge of specific projects. They all have bunches of buckets with tasks and activities that they do. But I have the big bucket — the one with the big handle on it. I'm in charge of everything they are working on. We have worked on clinical assisted coding, the physician transition, and all sorts of applications. Basically, as Harry Truman said, "The buck stops here." I'm the final person. When there is a problem, then I'm the person who gets the joy of solving that problem.

EHRI.com: How would you describe MU Health's approach to ICD-10 to date?

GB: It's been really pretty interesting. We were ready two years ago. I actually wrote a couple of articles for Project Management Institute about how we were going, and then we didn't. And then again last year, we were ready to go and I wrote another article, interview, and webinar for a couple folks…and we didn't.

We have been prepared and continue to be prepared. I know a lot of people have gambled. I know a lot of folks who thought it would not go forward. But it has gone forward. The big thing that we have truly focused on — early on we realized it really wasn't about coding; that it's about fantastic documentation. If you do fantastic documentation, it doesn't matter if it's ICD-9, -10, -11, or whatever version that might be out there, you're going to be successful. That's what we have worked on.

EHRI.com: Has the focus on clinical documentation meant working more closely with clinicians?

GB: Absolutely, we have worked with them as far as getting WBT [web-based training]. But right now as we're getting to the final push, we're going out to the docs to their medical staff meetings and working with the specialties, elbow-to-elbow and saying, "This is what you need to do to be successful with ICD-10. You need to have the laterality. You need to have the specificity within your specialty. You don't need to know hundreds of thousands of codes; you have to be a good documenter."

EHRI.com: How has MU Health made the best of multiple ICD-10 delays?

GB: We lost several hundred thousand dollars because of the delays. But again if you're focusing on being the best that you can be and focusing on excellence, then you realize at some point it is going to happen. We took that opportunity to fine-tune it, get better and better, and get more cohesive. Now are there some things at the very last minute where we're running around and flailing our arms? Sure. That's going to happen with any project. There are days when definitely my hair is on fire. But we are there. I keep knocking wood — what's missing, something's wrong. As a program manager by training, I am supposed to be looking for the dandelions in the yard or the cracks in the sidewalk and pointing those out. And there are fewer and fewer dandelions and fewer and fewer cracks in the sidewalk for me to point out.

EHRI.com: What are you top concerns heading into October 1?

GB: It's really about having a smooth transition. We have prepared cut-over steps and have those documented, so that every system that we are on that has to have something flipped or toggled or flagged has those steps laid out. We have who is supposed to do that.

I may be naïve, but I am not so much concerned about the actual transition. There are going to be issues — there's no doubt about that. There is something somewhere that we have missed. But it's issues, it's not a hard stop. What really concerns me is more the payers when we get to that point where we are dropping the bills and trying to get reimbursement. That's what concerns me — getting money so that we can continue forward.

EHRI.com: How has MU Health prepare for life post-October 1?

GB: Certainly, we have mitigated those risks. Our assistant CFO has put aside several million dollars for us for disbursements in case we have a problem — denied on billing, backlogged on coding. We can disburse that money over the next four months so that we are prepared and it won't put us into a financial bind. We're really about mitigating as many risks as we can think of.



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