Hayes Review: December 2009

Don’t Stop Preparing for ICD -10!

By Susan Hopper and Anita Johnson

Yes, CMS has extended the implementation date for ICD-10 CM. But do not set aside your preparation plans! Now is the time to plan and budget for the next several years for the upgrades and implementation of ICD-10 for your electronic health records and billing systems.

The new ICD-10 implementation replaces ICD-9 for diagnosis and introduces the newly commissioned ICD-10 PCS (Procedure Coding System), which replaces volume 3 of ICD-9 CM for coding of procedures.  Your ICD planning should include these activities:

• Assess the impact of the directives on your organization.
• Evaluate the approaches and timing of solutions of your affected vendors. It is not too soon to begin preliminary and ongoing discussions to identify their plans and timing for ICD-10 activities.
• Audit your organization’s current billing and coding systems and workflows.
• Arrange for outside consulting services early to ensure quality assistance. Waiting until the last minute may limit resources available to you.

In addition to ICD-10 implementation, other federal health IT issues need to be addressed during the same timeframe.  Your organization should identify and evaluate the impact of the federal stimulus package, ARRA (American Recovery and Reinvestment Act).  For example, it is possible your organization may need to prepare for ICD-10 transition, and may also be involved with other health information technology initiatives.  Hayes is available to assist your organization in these multiple areas. The ICD-10 component is addressed here.

Prepare your organization
Start education programs for organizational leadership, clinical directors and board members by presenting:

• Comparisons between ICD-9 and ICD-10
• Mandated timetables, incentives and penalties
• Impacts on patients, physicians, staff and systems

Develop strategic planning, establish project goals and set measurable objectives to guide decision making. Identify the timing of systems upgrades through 2013 to plan and manage your resources.

Prepare physicians
Evaluate improvements needed and a strategy for physician education regarding proper documentation and the ICD-10 impact on patient care. Inaccurate documentation standards can impact reimbursement contract agreements with some carriers as well as patient care. 

• Develop education programs and materials to assist physician educations and transition and requirements for ICD-10.
• Evaluate workflows and optimize processes (during the transition) to ensure quality time for patients and manage treatment plans.

Prepare billers and coders
Devote time to the development of a training program for billers/coders. The transition from ICD-9 to ICD-10 will require an appropriate supply of coders.  It is important to plan for an adequate workforce to work both old and new charges, and to provide uninterrupted coverage and productivity during the training and transition phases. Training coders and billing office staff for ICD-10 will require the development of new curriculum and publication of program materials for both the transition and for new staff hired after implementation. Specifically, you will need to:

• Translate clinical charts and notes to accurate codes.
• Identify the differences between old and new coding systems.
• Develop curriculum job aides and conduct training programs.
• Determine whether additional temporary staffing may be warranted. Since there are more codes, it may take coders longer to effectively code after the cutoff date.
• Improve reimbursement by improving ICD-10 coding skills.

Plan your system changes
Start a budget and begin reviewing changes to super bills, encounter forms and the cost of additional staff during the transition. You should evaluate impact of changes and gap analysis for existing:

• Charge slips (fee ticket, encounter forms and superbills)
• Dictionaries and tables
• Interface mapping (downstream and upstream)
• Output and reporting for ICD9, ICD10 and both (for reporting across cut-off period)
• Others such as DRGs, APCs, APGs, P4P, cases, referrals, screens, edits, workfiles and orders

Hayes consultants are available to help you transition to ICD-10. We can also assess your revenue cycle to make sure that you are receiving the correct payments in a timely manner from payers, and that there is limited cash flow disruption during upgrades of electronic medical records and billing systems for ICD-10 implementation.

Call us at 617-559-0404 or email us at info@hayesmanagement.com to find out how Hayes can help.

Susan Hopper, Hayes Healthcare Consultant, has 25 years of management and consulting experience, specializing in complex project management. She is also a subject matter expert on front desk systems and workflow.

Anita Johnson is Hayes’ Director, Western Region. She has more than 28 years of healthcare information technology experience and management experience with an emphasis on revenue cycle management. Anita is also a Certified Professional Coder.