How Do You Know If You Are Ready for ICD-10?

December 8, 2013
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Will The Transition to ICD-10 Become Your Waterloo or Battle of Normandy?

Will The Transition to ICD-10 Become Your Waterloo or Battle of Normandy?

ICD 10The path towards our country’s new healthcare system will invariably contribute to the increased demand for more physicians. Without an adequate number of physicians to drive revenue and handle the needs of patients, hospitals and physician groups must carry out strategies to offset the financial risks associated with healthcare reform and the ICD-10 transition.

In order to insure revenue continuity for providers, it is also imperative that hospitals and physician groups employ enough fully qualified coders to make sure that bills drop on time. Hospitals and Physician Groups must have enough qualified coders to meet the demands of the transition to ICD-10.  Adding additional coders, internally or from a qualified outsource partner will reduce overall down time, create less coding backlogs and reduce the volume of denials.

Clinical systems are better than they have ever been. Providers now have many interconnected systems that can solve issues related to the ICD-10 transition. The interconnected systems pose problems for syncing data and ensuring that information flow is uninterrupted and accurate. One way to reduce the negative effects of ICD-10 transition and health reform is to make sure that there are enough employees to support the transition and the implemented new technologies. In this time of change, it is essential to build a safety net strategy to offset risks associated with initiatives like ICD-10.

Provider coding resources may become the Achilles heel in making the transition to ICD-10. There are major issues to consider as they relate to proper clinical documentation. Currently, there are no transition systems which are built to test the information flow from beginning to end. Even CMS’s system has not been tested against all variables. Many clearing houses pose a significant risk due creating a bottle neck due to inadequate testing.

Current coder experience and competency levels are well matched to ICD-9. With ICD-10, those same coders may not be predisposed to handle the transition. They may:

  • Not have the capacity to learn the new system
  • Not have a desire to change their work habits to learn the new system
  • Are at the end of their career and would rather retire than learn the new system

There is a high likelihood that the pending changes in healthcare will combine to create the perfect storm of disaster. The future state of clinical documentation is converging with a complex overhaul of the healthcare system with the introduction of healthcare reform, the HITECH Act, the 501(r) implementation and the ICD-10 overhaul of clinical documentation.

Many providers are behind the eight ball, moving from paper to EMR systems. The current EMR systems in place today may not be ready for the significant changes ICD-10 will bring to the new electronic data warehouses.

The interconnected technologies will surely create challenges for providers as they prepare for the many operational variables associated with ICD-10. The right coding approach will help mitigate the risks of implementation. The following are questions providers should be asking themselves about their ICD-10 strategy:

  • Should I set up dual coding to insure the cross mapping of ICD-9 and ICD-10 is accurate?
  • Do I have enough coding personnel resources?
  • Are my current coding personnel capable of keeping up the demands of ICD-10?
  • Have all of my coders been adequately trained and tested?
  • Has our transition process been tested with experienced and new coder personnel?
  • Do I have a safety net plan in place to be able to scale my coder staff if necessary?
  • Have I contracted with a coding outsource expert to insure proper production targets are met?
  • Have I tested the entire coding process from end to end?

ICD-10’s implementation is sure to have a negative effect on coding production, and will invariably lead to coding inaccuracies that can materially affect a hospital’s reimbursements and financial health.

The transition of ICD-10, the implementation of electronic medical records systems and the changes in payer rules puts providers at risk of experiencing a reduction of revenue. Having an abundance of certified coder’s from internal employed staff and a contracted group of external outsourced coders provides insurance against unexpected production slowdowns and inaccurately coded charts.

Hospitals and Physician Groups are operating in a time of uncertainty and need a solid operational and safety net strategy to support functions such as coding, auditing, insurance denials and claim follow up. With the proper implementation strategy, providers can overcome the operational impediments they will face during the initial transition to ICD-10. That said industry experts believe that long term coding and documentation challenges are likely to continue through 2016 and beyond.

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