With the ICD-10 transition only two days away, health systems and hospitals are performing their final, last-minute preparations before the compliance deadline.
At Indiana University Health La Porte Hospital (La Porte, Ind.), the clinical informatics department has been working with health information technology (HIT) vendor Cerner Corporation for the past two years on preparing the hospital for the shift from ICD-9 to ICD-10. But beyond just the change in coding sets, the team of clinical informatics analysts, led by Susan Daniels, as the Cerner system ICD-10 project leader, has put a strong focus on ensuring that the transition goes as smoothly as possible for IU Health La Porte’s physicians and staff.
“We have a great team of analysts that have been working with Cerner over the last couple of years to implement as many tools as we can in the system to help our providers ease into this transition,” says Daniels, who serves as clinical information analyst II at IU Health La Porte. “In starting the process with a patient being scheduled and registered all the through to processing and sending out the claims, we have worked diligently to ensure that everything is in place in the system to uphold our quality standard of care throughout this transition over the past couple of years.”
Now, with less than a week before the transition, Daniels says her main focus is communicating and educating providers on ICD-10 and system changes that will be occurring.
“We want to ensure a smooth transition without disrupting our productivity, efficiency, and quality of care that we provide to our customers,” she says.
In fact, the hospital’s ICD-10 implementation team designed buttons that read “Stay Calm and Embrace ICD-10.”
“This is to let everyone know that we are ready for this transition, so hopefully it will help ease their minds and remind them that, from a systems standpoint, we are here to help them,” Daniels says.
According to Daniels, technology played a large role in preparing for the transition. Working with Cerner, the hospital’s clinical informatics team implemented a number of technology tools during the past two years that has allowed for gradual system changes. One of the first steps, Daniels says, was implementing Intelligent Medical Objects.
“The provider-friendly terminology acts as a synonym with SNOMED, ICD-9 and ICD-10 codes for diagnosis,” she says. “So when the user enters an IOM term, it would automatically map to the correct ICD-9 or ICD-10 code for future use. So when we implemented that terminology, we got the providers using that terminology instead of just entering the diagnosis codes directly.”
The clinical informatics team also implemented tools to enable schedulers to enter ICD-10 codes for patient appointments scheduled after Oct. 1 and to enable coders to perform dual coding.
“This helped our coders get accustomed to coding with ICD-10 codes, as well as ICD-9, and we felt this would help their training and increase their productivity once ICD-10 went live,” Daniel says.
Daniels’ team also implemented a number of other Cerner tools to assist providers, such as the Diagnosis Assistant application, which enables providers to select appropriate and clinically relevant ICD-10 diagnoses and a tool that allows providers to view and interact with ICD-9 and ICD-10 codes together.
The hospital also conducted several rounds of end-to-end testing, which helped to identify areas where workflow changes might occur, as well as repetitive testing on build steps for night of go-live.
“Those rounds of end-to-end testing definitely increased our confidence with our system capabilities,” Daniels says.
“And, before we go live, we have some steps that we’re going to have to change in the system to basically have the system recognize and send out ICD-10 codes past October 1. Cerner helped us to identify those steps. So, in our testing domains, we’ve practiced those steps to get them perfected, so there will be next to no end-user impact. We are planning to do this without a downtime, so patient care can continue as it regularly does,” she says.
On Oct. 1, the clinical informatics team will have hotlines set up to assist IU Health La Porte staff if they need ICD-10 codes.
“We are beefing up our support so we can accommodate all the needs of the end users,” Daniels says.
After ICD-10 goes live, the clinical informatics team will focus on upholding standards and productivity, as well as collecting data on claims denial trends. And, in fact, some of the technology tools that IU Health La Porte implemented as part of its preparation for the ICD-10 transition will be valuable tools after the conversion as well.
“The Access/HIM application that allowed for dual coding also allows us to financially look at how the ICD-10 transition will impact the diagnosis-related group (DRG). There will be some DRG changes with the transition so we wanted to try to get some data collected as far as what kind of changes would occur,” Daniels says.
The hospital also has implemented Cerner’s ICD-10 adoption reporting Key Performance Indicators application, which measures providers’ adoption of ICD-10 and the impact on productivity.
“The Key Performance Indicators give us a good baseline. Once ICD-10 transitions, we will see if the providers’ productivity has dropped, and that indicates if more education needs to happen or if there needs to be some improvements or enhancements in the tools that will enable providers to increase their productivity,” she says.
And, of course, after Oct. 1, a key area of focus for most health systems and hospitals will be on the revenue cycle with regards to reimbursements as well as managing claims denials. The Centers for Medicare & Medicaid Services (CMS) issued a guidance stating that for 12 months after ICD-10 implementation, Medicare will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as the valid ICD-10 code that’s used is from the right family. However, many providers are concerned about claims denials after the transition.
“We know that the denial rate will probably be going up with the ICD-10 transition,” Daniels says. “We know that CMS has said that for one year they will not deny a claim based solely on specificity of the ICD-10 diagnosis code as long as the code is from the right family. But commercial insurance does not have to follow that and it’s going to be on an individual health plan basis. So, we’ve developed a protocol to look at these denials and we are going to gather data on these denial trends.”
“And then our focus will be on making any necessary changes and educating end users to decrease the number of denials going forward,” she says.
CMS also has announced that it will set up a communication and collaboration center, headquartered in Baltimore, for monitoring the implementation of ICD-10 and to identify and initiate resolution of issues that might come up during the transition. CMS also named William Rogers, M.D., an emergency physician who heads CMS’ Physician Regulatory Issues Team, as the ICD-10 Ombudsman to triage physician and provider issues. Providers can contact Dr. Rogers at email@example.com