ICD-10: Going Back to the Basics — a Workflow Perspective Assess, Implement, Evaluate

The final article of a three-part series on the impact of technology and ICD-10

By Maria T. Bounos, RN, MPM, CPC-H Business Development Manager, Wolters Kluwer Law & Business

When I began to think about writing this article series on the impact of technology and ICD-10, I thought about how I would approach this mammoth task if I was leading the governing team for ICD-10. I immediately thought of applying the nursing process, a workflow process that resonates with me. Clinicians reading this article will chuckle to themselves as it is a workflow that becomes second nature to nurses and can be applied across the spectrum. With ICD-10, many of you will find yourselves going "back to the basics." Assessment, implementation and evaluation are key criteria and basic elements for the nursing process. When you think about ICD-10, think of these three elements as you attempt to wrap your arms around the technology workflow processes within your organization. In articles one and two, I discussed the key points around the importance of a risk assessment and implementation strategies for ICD-10. Now, I would like to complete this series by focusing on the significance of evaluation.

Prepare for the unexpected. More than likely, many of you are still in the risk assessment or implementation phase. Even the early adopters of ICD-10 are not ready to completely evaluate. I want you to begin to think about and prepare for October 1, 2013. Will you be ready? Do you have a Plan B? You will experience challenges as you work through the implementation process. The workflow processes that are implemented from a technology perspective are fluid and subject to change; as ICD-10 is not just a coding issue but a business issue that affects your revenue cycle, payer contracts, documentation systems, and other systems throughout your organization.
Some of the challenges you will face throughout the implementation process are amongst the following areas, of which will need to be evaluated continuously.

Key Players: Understand that the key players you have identified to be on your governing team, advisory and steering committees are fluid as well. Key players cannot be static and will need to be moved around as issues arise.

Resources: Evaluate the resources that you have requested related to ICD-10. This includes educational tools, information technology system inventory, database conversions, outside consultants and vendors as well as human resources to assure you don't step on any toes along the way.

Documentation: During the implementation phase, expect to perform a documentation assessment. Recommendations favor using a third party vendor or audit firm to perform this assessment. During the evaluation phase, analyze the trends and systems affected by ICD-10 and identify service lines by facility of which documentation needs to be a focus.

Coding: Evaluate your coders and physicians readiness and do them a favor; don't give them a black box which tells them what to code, but give them the workflow tools they need to transition to the new coding system. You will find that going back to the basics will be the key to your coder's success. Remember that your coders and clinicians are visual people and will need paper or electronic code books early on so that they can practice ICD-10. It is an expectation that coder and physician productivity will go down once ICD-10 is implemented. The numbers anticipated are a 40% drop for coders and a 60% drop for physicians. Assure that productivity is part of the evaluation process.

Vendor readiness: Evaluate where your vendors are as it relates to your system readiness timeline. Are they on target or are they behind? Will you need to put together a Plan B, should they be behind? Recommendations include running I-9 and I-10 simultaneously before and after October 1, 2013. How long afterwards is in question.

Payer readiness: Evaluate every contract where ICD-9 is mentioned and the implications of ICD-10 are apparent. Know what will be required of you as a provider as it relates to claim submission come October 1, 2013.

Government readiness: What will the rules be? What type of transmittals should be anticipated? What about national coverage determinations? In order to be proactive you will need to assign a gatekeeper for this type of information and a plan to communicate it throughout the organization. It may make sense that you invest in a tool that assists you with this process.

Financial: In article two, I discussed looking at your top 10 DRGs when you perform your reimbursement impact assessment. Once the results are presented, evaluate how you currently do business and what changes will need to be made to assure you get the reimbursement you are entitled to under ICD-10. The second piece of finance is the budget. Evaluate your budget for expected and unexpected software and operational costs. This includes incidentals that were not accounted for before and after the implementation process.
 

Education: Evaluate where you are in the education process. Remember that ICD-10 will affect everyone with the exception of housekeeping, so make sure each entity gets the training they need to do their job under ICD-10. Most will agree that utilizing a known and accredited train the trainer program facilitates the ease of this massive task.

The undertone with ICD-10 is that it is a huge undertaking with many moving parts. Whether you are a large or small organization you will need to be prepared. Give yourself some slack as its fine to go back and tweak the process along the way—in fact it's expected. It will be a journey you will never forget and once you get there, you will still need to be prepared for the unexpected.

About the Author

Maria joined Wolters Kluwer in the fall of 2007 and is currently the Product Manager for Regulatory and Reimbursement software solutions. She is responsible for product development, maintenance and enhancements and business development. She has twenty years of experience in healthcare including nursing, coding, and healthcare consulting.

Specializing in regulatory compliance, reimbursement, and process improvement, she has led improvement projects that have delivered significant financial benefit for large academic medical centers as well as mid-sized community hospitals and critical access hospitals.

Prior to joining Wolters Kluwer, Maria was a Senior Manager with GE Healthcare and led large revenue cycle projects, developed service line offerings and mentored consultants. Prior to GE, Maria was Vice-President Operations for a national management-consulting firm, specializing in reimbursement, operational improvement, and regulatory issues. The firm provided on-site consulting services as well as web-based applications to help hospitals review and maintain their charge description master (CDM), outsource CDM management, perform outpatient and inpatient coding compliance reviews, and assist in answering corporate integrity agreements. In this role, Maria was responsible for developing and maintaining the operating budget, developing and implementing the training program for new employees, sales and implementation of web-based applications, and being the client executive for onsite engagements, as well as, providing consulting services to clients.
 

Maria has a Masters Degree in Public Management with Concentration in Health Systems from Carnegie Mellon University and a B.S. degree in Nursing from Carlow College. For calendar year 2006, she was the Greater Pittsburgh Chapter President of the American Academy of Professional Coders.

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