From the Consultant’s Corner 5/30/11

ICD-10: Roadmap to a Successful Transition

The transition from ICD-9 to ICD-10 codes is a massive undertaking for all healthcare organizations. It’s a matter of sheer magnitude, of course: diagnosis codes are critical to nearly all patient care and revenue cycle activities. Add to that the additional burden facilities face implementing ICD-10 Procedure Coding System.

With any project this large, success requires carefully mapping out each phase of the journey. In the case of ICD-10, I suggest taking a five-phased approach: 1) program development; 2) impact assessment; 3) project and implementation planning; 4) implementation; and 5) stabilization and optimization. Here’s a look at the key elements in each phase:

Phase 1: Program Development

The very first step is to establish a governance team responsible for oversight of the ICD-10 conversion. It should include representatives from: revenue cycle (hospital and professional, if your organization has both); coding/HIM; clinical informatics and clinical documentation; IT (patient access, clinical and revenue cycle applications); training; and compliance.

You may have one person wearing many of these representative hats in some organizations. That’s OK. Just make sure each of these functional areas is considered in your ICD-10 planning. Your project plan should include a timeline and resource requirements by functional area.

Phase 2: Impact Assessment

Your assessment should focus on understanding the training needed to bring everyone up to speed on ICD-10 requirements. Again, make sure to conduct your assessment by functional area: systems, billing and reporting requirements, and training requirements. Once you’ve assessed each area separately, though, it’s critical that you then aggregate them to create an enterprise-wide view of overall impact. You should end up with a documented inventory of all IT applications.

Phase 3: Project and Implementation Planning

After impact assessment, carry out a separate vendor readiness assessment. The goal is to identify all vendors and interfaces affected by the ICD-10 conversion, then contact the vendors to see if upgrades or other changes are necessary to meet ICD-10 requirements. Any associated costs must be documented, and vendors should be asked to provide you with their ICD-10 test plans.

Phase 4: Implementation

With an implementation that includes as many “moving parts” as ICD-10, it’s important to clearly identify expectations and measure your progress toward them. Among the implementation tasks you’ll need to monitor are:

• System updates (e.g., templates, electronic and paper claims/remits, and reports) and upgrades
• Physician documentation training
• HIM/coding training
• Revenue cycle staff training
• Interface modifications
• Unit testing
• Integrated testing
• Development of new reports

Expect a pretty complex testing plan. In addition to internal testing, you’ll need to test with external parties including payers, clearinghouses, and other EDI partners. And unless you use a home-grown IT solution, you’ll depend on vendors for ICD-10 updates. Don’t underestimate the time and effort vendor coordination and testing will take! Develop a testing schedule that ensures each type of EDI transaction you use processes correctly before the Oct. 1, 2013 compliance date.

Documentation and coding training should be performed in the months prior to implementation, and will be important for reducing coding errors and claims denials after go-live. Once you’ve converted to ICD-10, it’ll be essential to conduct real-time monitoring of clinical documentation, HIM and coding productivity, interface error logs, claim edits, claim denials, remittances, physician productivity, patient visit/encounter volumes, and more.

Phase 5: Stabilization and Optimization

For a successful transition to ICD-10, metrics will be key. Tracking performance metrics throughout implementation is the only way you’ll be able to spot and fix any potential difficulties.

Perhaps the best part of the whole ICD-10 implementation is the opportunity for improvement that it brings you. Think about it: You’ve already created a representative governance team. You’ve already developed a dialog with your vendors and payers. You’ve already started identifying and tracking vital performance metrics.

You’ve already done the legwork. Now, combine your metrics with your avenues of communication to do more than just implement ICD-10. Use them to develop and optimize future goals through additional training, workflow redesign and system modifications.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.