ICD-10: An Opportunity to Improve your Organization

Two 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

In part one of this series I discussed the importance of performing an ICD-10 risk assessment sooner rather than later at your facility. What I have experienced is that some facilities have started the process, but for the most part many have their heads buried in the sand. For those of you that have kept current and are trying to wrap your arms around this big undertaking, I'd like to share some implementation best practices that I have learned from my fellow colleagues. Within this article, I will focusing on the strategy and workflow processes that you may want to consider as you implement ICD-10 at your facility.

ICD-10: Organizational Preparedness

A remark I was exposed to at the AHIMA ICD-10 Summit in April was that almost every system in your facility will be affected by ICD-10 with the exception of housekeeping! Really? Yes, really…one Director of Patient Financial Services spoke of over 80 systems being affected at his facility. This same director's strategy around ICD-10 was to take the opportunity to improve their overall business of the organization and look at ICD-10 as a benefit versus a have to. The organization developed a strategy around ICD-10 so that they could:

• Better measure outcomes
• Take the opportunity to enhance clinical care so that the facility can promote wellness over time
• Begin accountable care organization (ACO) negotiation with contracting
• Look at the opportunity for stimulus funding as they opted to be an early adopter of ICD-10, and
• Provide physician education

A big part of strategy is organizing the effort around ICD-10 and developing project goals. Particularly, one of the common goals is to establish a governing body. The governing body should take a top-down approach, as leadership typically leads the charge for change within a facility. This governing team will define responsibilities, priorities and create a time line. Project goals should include facilitating organizational awareness, support education and training, coordination of resources, understand the reimbursement impact and link technology requirements with informational needs. Instead of merely focusing on leadership, the governing team will include executing items, such as establishing project goals, guiding an advisory team of key stakeholders that will focus on outcomes, budgetary impact analysis. This also includes continuous evaluation of the project goals and a steering committee based on systems and departments impacted such as information technology, clinical and financial members.

There are many areas within your organization to think about from a technology perspective. Will all systems be ready come October 1, 2013? As you think about your strategy and workflow around ICD-10, take note of the following departamental considerations:

Information Technology

Understand how you currently do business under ICD-9. There needs to be an assessment of all systems that utilize ICD-9 codes for one reason or another. Check all systems with the exception of housekeeping.

• Do a system inventory of ICD-9 data storage
• Be 5010 ready
• Understand system transitions and conversions of historical data

Reporting

Understand the reporting workflow impact of ICD-9 to ICD-10 and vice versa.

• Identify all current reporting workflow processes that utilize ICD-9 data
• Assess which vendors are available to facilitate understanding the comparison from I-9 to I-10
• Identify what tools are available in the market to facilitate understanding the process and assure that GEMS mapping available through CMS is part of the workflow tool assessment
• Perform a vendor readiness survey

Finance

Understand what the reimbursement impact will be to your facility and assess Payer readiness.

• Assess payer contracts- now is the time to negotiate
• Negotiations should include preparing future contract language to include ICD-10
• Create a payer readiness survey
• Perform a reimbursement impact analysis (using reimbursement maps provided by CMS)
• Recommend starting with top 10 DRGs
   

Documentation

Understand your risk related to documentation. Documentation is probably an area of risk due to the specificity of coding with ICD-10. Recommend engaging a third party vendor to review documentation.

• Ratio of records to review to hospital bed size: review 100-200 records per 100-300 bed hospital
• Review third party documentation recommendations and identify gaps in current documentation process; revise templates as warranted, and educate physicians on documentation requirements.

Education

Identify training needs for all personnel. Training will be differentiated based on personnel role in ICD-10.

• Start with ICD-10 educational awareness programs
• Identify method, timing and depth of training by type of personnel.
• Account for ongoing education and new staff training

Team ICD-10

Identify members that will drive all of the moving parts to implementation. For some, this is the steering committee.

• This team needs to assure that all areas that could be affected by ICD-10 are addressed
• Members are involved in training and education and assure that every moving part is well communicated throughout the organization

Overwhelming to say the least, but the implementation process needs to be addressed. As you look at your current workflow processes, you may want to modify your current workflow or completely revamp. It truly depends on how well your current processes work under ICD-9. Just remember that implementing ICD-10 is a work in progress and you can and will need to be flexible for change. Ultimately, change can be good as it provides an opportunity to improve.

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 on site 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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