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Lisa Trundy, CPA

Tips for Beating the Clock on the ICD-10 Countdown

2015-06-16

We recently attended a healthcare conference and talked to providers about getting ready for ICD-10. Someone said: “If you haven’t started by now, you’re not going to make it.” Another said: “But what if it’s delayed again? We don’t want our efforts to be wasted.”

Here’s our response: (1) Chances of another delay before the October 1, 2015, compliance deadline are very low. (2) You can make preparations that will not be wasted if you keep your eye on the big-picture benefits of process improvement and staff training to strengthen your organization, no matter what happens.

How to get your ICD-10 implementation on track in time

Most providers have made preliminary plans for implementation, and many put those plans on hold during the delay. Here are some tips to get your plan back on track:

  1. Confirm that you have appropriate teams in place
    If your teams have not met in a while, make sure you’ve got the people you need. Fill any spots created by staff turnover or role changes. Team members should have knowledge of your current processes and understand how the ICD-10 code set will impact the processes.
  2. Cover your technical bases
    Communicate with everyone external to your organization who plays a part in your ICD-10 implementation. Ask your vendors and payors about their overall preparedness plans, and then dig deep, asking technical questions of:

    • Software vendors and clearinghouses to verify that their upgrade
      timelines are on track for October 1, 2015
    • Payors to understand their plans in the area of testing
  3. Training
    Now is the time to be sure your organization’s education plan is underway. Choose the education plan that best suits your organization’s needs and budget constraints, but make sure the training is progressive and includes hands-on practice. Training will require dedicated time each week for your coders, clinical documentation improvement team, and physicians. Aim to finish training by the end of August because you don’t want to worry about completing training modules in the fall during the final stages of system testing.
  4. Testing
    Testing should start now! You will need several months, given the multitude of codes to be tested, the number of clearinghouses and health plans to test with, and the need to make changes when issues arise. Remember to test within the organization and outside the organization. The testing is literally worth the time—it helps confirm that come October 1 you will continue to be paid and that you will be paid appropriately.
  5. Dual coding
    Dual coding must be an integral part of your transition from ICD-9 to ICD-10. Dual coding should begin as soon as possible and continue as long as needed post-implementation. It will assist in financial modeling and reimbursement impact analysis. Consider using these strategies:

    • One coder codes the same record in ICD-9 and ICD-10
    • Multiple coders dual code one record
    • Coders review each other’s records
    • Temporary staff backfill for productivity losses during dual coding

    Master the codes that matter, and focus on high-utilization, high-dollar codes. While dual coding may be expensive and time-consuming, it will pay off when the conversion occurs.
  6. Communication
    ICD-10 is an organization-wide issue. While some areas will be impacted far more than others, the entire organization should be engaged—because everyone will feel the impact if the implementation is not done properly. From now on, your communication team should communicate regularly with the organization, letting everyone know how the conversion may affect them. Make a plan for handling any issues that may arise on October 1. Identify the key committee members of your communication team who will be in your command center on October 1, along with their roles and responsibilities.
  7. Prepare for productivity changes
    Until the organization is well-versed in ICD-10, productivity may decline dramatically. Understand where your workflow is going to change. Providers will need more time for documentation, and coders will require more time to code the medical record. The time to get a bill out the door is likely to increase, which will result in increased accounts receivable and decreased cash flow.
  8. Prepare for cash flow disruptions
    Prepare your compliance team to review records after the transition. Make sure the team is tracking and understands the root cause of any denials so that the problem can be remedied quickly. Most importantly, monitor cash flow and other critical metrics (benchmark against 2014) to make sure that everything is functioning as expected and the practice can survive.

Conclusion: The silver lining

While the uncertainty about the ICD-10 compliance date caused a great deal of angst, the one-year delay gave healthcare providers additional time to understand the impacts of the new code set, provide education to staff, and prepare business offices and IT departments for the transition. These efforts to improve readiness and reduce risk to the organization will pay off on October 1, 2015, and beyond, strengthening organizations’ overall workflow and productivity.