August 09, 2011
US Federal Government, which has earmarked October 1, 2013 as the deadline, has sought to replace the 30-year-old ICD-9 with the radical ICD-10 – believed to be harbinger of sweeping changes across all facets of healthcare organizations: providers, staff, processes, insurance carriers, and systems and technology.
But, given the experience in other countries – UK, France, Australia, Germany, and Canada, which prior to adopting ICD-10 in 1995, 1996, 1998, 2000, and 2001 respectively, had to wait as long as 5 years for achieving successful implementation of ICD-10 – it is only expected that the incubatory period from 2010 to 2013 is going to be spent on implementation alone across the length and breadth of the U.S. healthcare system.
Further, transition involving multiple constituents – ICD-10 CM, used in both inpatient and outpatient settings, replacing ICD-9-CM volumes 1 and 2; ICD-10-PCS replacing ICD-9-CM volume 3 for use in inpatient settings only; and, more importantly, the implementation of the HIPAA compliant 5010 standard, a prerequisite to ICD-10 since the current HIPAA 4010 standard does not support ICD-10 codes – is sure going to make it excruciation for all covered entities, including health plans, healthcare clearinghouses and most healthcare providers.
Fortunately, experiences historically in other nations should both be an indicator of challenges that lie on the way, as well as guidelines for realizing smooth transition by the deadline of October 1, 2013. Combining these experiences with the following implementation guidelines should not only make the transition less excruciating but also enable an early interoperable health data exchange in the US, and improve the ability to measure medical processes and outcomes:
Analyzing the chasm between the current system and the demands of ICD-10 system
One of the important tasks prior to implementing the ICD-10 is to analyze the gap between the current system – both technical as well as human – and the projected demand of ICD-10 system. Fundamentally the areas that require a re-look are technology, including interface and interoperability requirements; education and Training; workflow and organizational processes, including clinical documentation, health Information management (HIM) department, clinical service areas and back-office administrative and billing functions and processes, coding productivity and workflow, data quality, data and information reporting – internal and external, and revenue cycle processes and workflow.
Having analyzed the gap with respect to the above parameter above, there comes the need to align the requisites in line with the ICD-10 demands
Education and Training
Having analyzed the areas to be upgraded in line with the demands, the next step is to educate and train the human resources that actually are going to be impacted. Primarily, the following sections of manpower are going to be in need of the education and training in line with the
Health Information Management (HIM) professionals (regardless of departmental affiliation or the presence of centralized or decentralized coding practices)
Administrative and front office staff such as Registration or Scheduling departments
Clinical staff - physicians and all other allied health professionals who may document the patient health record
Revenue Cycle and Business office support staff, including contract managers, documentation reviewers and corporate compliance officers
Finance Department staff
Departmental and other management staff including quality and utilization management, performance improvement and other key areas that may use or report ICD codes
Clinical Documentation Improvement
Educating and training your staff alone is not going to make any difference unless there is considerable improvement in clinical documentation, which, along with successful compliance with HIPAA norms, enables best coding practices as per ICD-10. Hence, the resources spent on education and training should reflect on the quality of clinical documentation.
Tactful Management of Revenue Cycle
ICD-10, being exhaustive and stringent, has the potential to negatively impact your revenue cycle, with the billing reimbursement taking far more time to realize, or frequent reports of denials. A better proactive processing system that can tactfully solve ICD-10 intricacies will be indispensable.
Upgrading Information Management and Technology
Successful implementation requires a matching deployment of technology application and system in congruence with ICD-10 demands. Therefore, healthcare organizations should look installing advanced systems, and at integrating them across all functional points within the organization.
Post Implementation Review
Implementing alone will not yield the desirable objectives; there will be regular review and audit of the implementation, which will not only ensure revenue optimization, but also and quality data dissemination for research and archiving.
With such an arduous task ahead, physicians or hospitals can safely resort to availing services of medical billers who are proactive and prepared with material-requisites for ICD-10.
MedicalBillersandcoders.com (www.medicalbillersandcoders.com), with a long-standing reputation of being the largest consortium of medical billers in the U.S., is a preferable catalyst in smooth transition to ICD-10.