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ICD-10 Time for action

Ten critical areas of ICD-10 focus for healthcare executives. By Jim Jacobs and Bonnie Cassidy


ere are 10 reasons why healthcare executives should start preparing for the ICD-10 transi- tion as soon as possible, along with strategies for doing so effectively:

1. Successful change management requires early planning. Right now, most organizations are busy with meaningful use of electronic health records (EHRs), HIPAA 5010 standards and other internal projects. That’s why the push to prepare for ICD-10 must come from senior leadership. The management of major changes such as ICD-10 should always start from the top, with leaders forming a steering committee to guide the overall process. The committee should create a schedule with fi rm deadlines, benchmarks and consistent updates on challenges and progress. 2. Payers are already arming themselves with data. Payers are working with accounting fi rms and corporate consultants to determine how much the ICD-10 transition will cost them and how to cut future payments to prevent fi nancial losses. Payers, in other words, are arming themselves with data. Hospitals and other healthcare organizations that don’t prepare the same way could suffer in their next contract negotiations. 3. Training and preparation can take a bite out of your bot- tom line. ICD-10 will take a bite out of budgets for the next few years. Organizations must build budgets that include costs associated with software updates, education and training, consulting services, forms reprints and even temporary staffi ng. According to a recent “ICD10Watch” article based on Canada’s transition to ICD-10, there’s never enough time for training. It states that productivity may not fully recover for many years, but the more training a staff receives the better chance hospitals have of minimiz- ing this productivity loss. 4. ICD-10 will dramatically affect reimbursement. Under- standing current billing is the fi rst step toward anticipating the changes. Organizations should: 1. Pinpoint their top claims; 2. Review how they are coded in ICD-9 vs. ICD- 10; 3. See how the coding affects DRG assignment; then 4. Evaluate the resulting reimbursement to project revenue gains or losses. Tools exist now that allow organizations to code live claims in both the ICD-9 and ICD-10 code sets simultaneously. Dual coding offers insight into reimburse- ment changes and revenue projections, and it also identifi es critical documentation training needs.

28 February 2012 Jim Jacobs Bonnie Cassidy

5. Physicians need time to improve documentation. It is no secret that providers will need to deliver more detailed clinical documentation to code accurately in ICD-10. The earlier physicians can become disciplined with providing patient information, the better an organization’s coding – and reimbursement – will be during the transition. 6. ICD-10 codes affect the entire organization. ICD-10 is not only an issue for coders and health information man- agement (HIM) professionals. Training and testing will be required for all employees who work with data based on diagnosis and/or procedure codes. That includes providers, as well as anyone who processes, bills, collects or reports based on those codes. 7. Training won’t be one-size-fi ts-all. Effective ICD-10 train- ing will be dependent upon multiple variables for health systems of different sizes and disciplines. Even coders, for example, will approach training with different skill sets. Some will have academic training with a medical sciences foundation and strong anatomy/physiology knowledge, while others will have learned on the job. Executives should plan to provide tailored education programs. An early impact assessment can help deter- mine what level of training will be required.

Jim Jacobs is senior vice president, product management and HIM, at QuadraMed. Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, is the vice president of HIM Innovation for

8. No compliance, no re- imbursement. Stage 1 of

QuadraMed and also currently serves as president of the American Health Information Management Association (AHIMA) board of directors. For more on QuadraMed:

meaningful use is achieved through self-attestation. ICD- 10 compliance, however, will have to be proven on transac- tions starting Oct. 1, 2013. Proving compliance at a later date is not a fi scally viable option. 9. The deadline will not be delayed. All indicators say there will be no “grace period” for ICD-10 compliance, as has sometimes been the case with past federal regulations. 10. Next version is around the corner. It has taken 35 years to move to ICD-10 in the U.S., while other countries already have moved to ICD-11. However, future code updates promise to be much more frequent as the health- care industry increasingly realizes the benefi ts of robust healthcare data.


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