When the transition to ICD-10 officially begins on October 1, 2014, those in the US healthcare industry will be in a position to benefit greatly from lessons learned by our neighbors inCanada, who also recently made the transition between 2001 and 2004. Canadians already experienced similar transition situations to what the United States will be facing according to Cindy Grant, Certified Healthcare Information Manager (CHIM) and ICD-10 practice lead at TELUS Health Solutions in Toronto,Ontario; and Kerry Johnson, MAEd, CHIM, senior lecturer and HIM instructional coordinator at the University of Ontario, Institute of Technology in Oshawa,Ontario. Coders in Canada struggled most with anatomy and physiology, not the coding logic itself. "It wasn't so much the coding system and how the codes work," says Johnson. "We found them struggling with anatomy and physiology and understanding what exactly the intervention was, including determining the root operation."
Training physicians was also an essential part of ICD-10 implementation success. In most cases, it’s not necessary to retrain physicians as "ICD-10 coders," but it is critical that all physicians understand the new codes and the changes required in documentation that will become necessary to support the codes and billing.
So whether you’re a coder or a provider, here are the five major lessons we can learn from the prior experience of our neighbors to the north:
Lesson #1: Don't underestimate the amount of education coders need. ICD-10 implementation requires a significant investment in coder education as well as an ongoing assessment of coder skills. "Coding staff will need to completely unlearn what they know now and relearn almost a complete new skill set," according to Grant. She says, "If you think you've estimated the right amount of training time, probably increase it by another third."
Lesson #2: Conduct internal audits of clinical documentation. A comprehensive comparison documentation audit can represent a crucial first step in an organization's readiness assessment. Re-code a sample patient record using ICD-10; the results will identify the areas that need improvement necessary to support the increased complexity and dimensions of ICD-10.
Lesson #3: Accurately gauge current biller/coder productivity. Coding and billing managers must understand current productivity to prepare for any future changes with ICD-10. Some questions that might be asked are:
- How do current and future documentation practices affect productivity, and what will be the anticipated impacts when ICD-10 goes into effect?
- How might the practice’s EHR help streamline and capture clinical data that can improve current productivity?
Lesson #4: Decide how and when you will need to hire additional staff. Hiring additional staff now will help prevent a scramble for limited resources later as other practices and hospitals make similar decisions and begin to vie for those same candidates.
Lesson #5: Manage your revenue cycle and financial impacts. This includes the whole process cycle, from treating the patient to collecting the reimbursement. Work with your CPA or practice manager to fully understand the financial impact that October 1, 2014 will bring, and ensure that you have cash reserves in place to cover the practice for all the delayed payments, or at the very least, an accessible cash line from your bank.
Providers who procrastinate on this and assume that HHS will again postpone the implementation date are taking a huge chance. ICD-10 will take months of training and significant upgrades to existing hardware and software. in fact, the best bet is to hire a billing service like Medical Billing Resources, with certified ICD-10 trainers to either educate you and your staff, or simply outsource your billing altogether.
Once October 1, 2014 arrives, you're still not done. You will be looking at documentation errors, process errors, educational shortcomings, and of course reimbursement problems. Don't think the pain is over once you successfully transmit your first claim; it’s just one big hurdle you’ve overcome, and there will be many more to follow.