In just a few short weeks, the landmark ICD-10 transition that has been anticipated and delayed countless times will arrive on Oct. 1, 2015. With it comes the pressure to adopt the new coding system and get everything right so that billing goes through as intended and reimbursement happens without hiccups.
The only question is: is your healthcare provider organization ready?
Not quite, you say? That’s okay! Even in this home stretch, there is plenty you can do to have a smooth ICD-10 implementation and avoid undue stress. Your greatest weapon in this fight to gain compliance is a clear head and a game plan to make lasting, comprehensive changes.
So let’s suit up together to tackle the problem head on and gear your organization for a successful implementation of ICD-10. Here is how to do it:
1. Assemble a Team
If you haven’t already, you will need to gather a team of dedicated ICD-10 implementation overseers to help train, implement and audit the new coding procedures. Like any good crack superhero team, it will be made of a ragtag group from all walks of life. For your organization, that means no laying the responsibility on one single department. Just because the flak will ultimately fall upon finance when coding gets messed up doesn’t mean that finance needs to be the nanny goat in the situation.
Every department and staff group should be at least partially represented in this team. Administration, finance, IT, registration, nursing, quality, HR and, yes, even physicians. Not every department needs to have a specific member be on the team, but there should at least be someone as a liaison to help head up the initiative for them.
For example, physicians will likely be reluctant to participate in training sessions since coding changes do not directly affect them, but they may need to adjust their clinical documentation to allow for more specific coding. Someone must engage with the physicians to start this culture change, preferably someone they respect and heed advice from.
2. Bring in Allies
No team can go it alone. They need help from representatives further down the ladder that can be ambassadors to implement the changes.
More than anything else, each staff crew must have someone on it capable of providing definitive answers for questions. ICD-10 can be highly-specific in ways that slip people up, so someone who can shed light on gray areas to make them black and white can be an invaluable resource. This person can also watch over the shoulder of fellow staff to ensure that they are not slipping into old ICD-9 habits or misinterpreting ICD-10. Bring people like this to your side to avoid appearing like a monolithic oppressor and ensure that the transition and implementation is taking effect at the ground level.
3. Hit the Books
Your team members and your ally ambassadors should know the ICD-10 rules and changes inside and out. Medicare has already been testing hospitals as a trial, so you will need to be on top of your game to face that level of scrutiny.
Being able to quote the new changes chapter and verse is not quite necessary, but no one should be making huge conceptual blunders like asserting that a three digit-only code is adequate for all diagnoses. At the very least, everyone should be familiar with the ICD-10 manual to the point where they know which page to flip to when a question arises.
4. Identify Transition Bottlenecks
You will need to turn your workflow inside out to find every instance where ICD-9 is currently being used. Make note of the areas where the biggest potential for gridlock can occur. Naturally, finance will be one of these since they will be the last pair of eyes on reimbursement requests, but other departments like IT may have legacy systems that have trouble handling ICD-10.
This step is why it is so crucial to have diverse departmental representation on your transition team. Without input of departments like registration, you may have forgotten that your admitting system does not include specific enough form entries that allow for a seven digit code to be assigned later on. Something as basic as this can affect pre-authorization, setting up providers and staff down the line for failure.
Note that an outside consultant may sometimes be needed to completely recognize and address the true scope of the transition. A fresh perspective like theirs can be just what your team needs to eliminate half-measures.
5. Prioritize and Attack!
Once you have a “high council” of ICD-10 knowledge, it is time for them to begin spreading that knowledge down the chain of command so that others are up to speed on all the changes they need to make. Large-scale, all-at-once training efforts often result in little retention, so make training gradual and continual to ensure that the new procedures and code usage sinks in.
Test to ensure that knowledge is retained, including translating ICD-9 to ICD-10.
As training continues, remember to emphasize the absolute most important aspects so that staff can work their way through the more complex concepts gradually while remembering the “hard and fast” rules. The most important example is that Medicare will not refuse incorrect coding if the right family is used. Hammer in the idea that, if nothing else, they have to at least get that aspect right.
6. Audit, Re-Train, Lather, Rinse, Repeat
There is a very good reason that the ICD-10 implementation deadline has been pushed back several years in a row: providers were simply not ready. Expect that trend to continue throughout your organization as ICD-9 codes are still being used or ICD-10 is misused.
Continually train people to avoid such errors and audit procedures to locate problem areas. The full ICD-10 implementation will likely stretch out for several years as mistakes continue to be made, so the key is to remain patient and have a system designed to identify and fix failures.
Various vendors have an all-in-one platform which integrates electronic health records (EHRs) with practice management software, billing services, and more. These can even accommodate dual coding to help you manage legacy coded records with ease.