concepts as it pertains to their specialties, but will also need focused training on clinical documentation to ensure that a suffi cient explanation of patient condition and services is available for the coder to be able to assign the appropri- ate ICD-10 code. Training on advanced clinical documen- tation technologies, such as speech recognition and natural language processing, will also be important. Staff members that do not have a high level
Sashi Padarthy is director of Cognizant Business Consulting’s healthcare division.
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of interaction with ICD codes today would require a basic level of understanding so that they are aware of the changes that are being implemented and how they will impact the organization. Financial impact analysis: A majority of hospital inpatient reimbursement is based on ICD-9 codes and on patient clas- sifi cation systems. There are two factors that may have an unintended impact on reimbursement because of ICD-10 migration: 1) the grouper logic is changed because ICD-10 classifi es clinical conditions and procedures differently from ICD-9, and 2) payers may be mapping the ICD-10 codes received from a claim to ICD-9 so that they can use their existing ICD-9-based systems without any modifi cations. Early indications are that there will be shifts in diagnosis- related group codes (DRGs). Analyzing the fi nancial impact
due to the shift from ICD-9 to ICD-10 will play a critical role in effectively maintaining revenue integrity. Testing: Testing plays an especially important role in ICD- 10 remediation because of the breadth and depth of how the codes are used in both clinical and business processes, as well as the need to ensure the transition does not harm clinical decisions, fi nancial or operational processes. Because ICD- 10 codes are not an exact one-to-one match with ICD-9, approximations and mismatches will affect reimbursement. Organizations must plan for end-to-end testing. It will be critical to get on the testing schedule for vendors and clear- inghouses in order to test the compliance of each product and transaction, and avoid downstream or upstream impact on business processes.
Begin with the end in mind The transition to ICD-10 offers the opportunity to im- prove clinical documentation, revenue cycle performance and analytic capabilities for business intelligence, and create the fl exibility to respond to the industry’s continuing evolution. Making the transition will require adequate time for assess- ing impacts to clinical documentation, business processes, patient satisfaction, IT and training. To meet the challenges and ensure timely compliance, health systems need to view ICD-10 as a strategic initiative for the organization, establish a proper project governance structure and secure support from executives and physicians.
HMT Impacts of ICD-10 on revenue cycle management from fi rst point of contact to full and fi nal payment
HEALTH MANAGEMENT TECHNOLOGY