Do You Have ICD-10 Tunnel Vision?

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Do You Have ICD-10 Tunnel Vision?

As the healthcare industry readies itself for a full roll out on October 1, 2015, most folks are surprisingly calm, perhaps too calm in the face of what will surely be monumental changes in documentation, coding, coder training and information systems.

Could providers have ICD-10 tunnel vision? That is, they are narrowly focused on two areas: Training coders and making sure their IT systems support ICD-10 codes. The common perception is "if I have those in place, I am done."

It's a good start, but frankly it is not enough given the complexities of ICD-10. Forget about training and systems remediation for a moment and let's look at the reality of ICD-10 and how it dictates where we need to focus. Consider this: On the diagnosis side, we are moving from nearly 14,000 to close to 70,000 codes in less than a year. Procedure codes will jump from 4,000 to more than 70,000. This is a dramatic change, and according to some estimates will reduce productivity by 50 percent or more.

It's not surprising when you consider the added specificity with ICD-10 that is resulting in extra documentation and coding. CABG procedures are a prime example. If you perform one today, there are four codes from which to choose. With ICD-10 this number blows up to nearly 1,300.

What does it take to eliminate tunnel vision?

The first step is having the right information. Now is the time to assess your top ICD-10 vulnerabilities and analyze the data on your cost of doing business in an ICD-10 world. Get command of these two areas and you are ready to design a smarter, target-rich ICD-10 plan.

Consider this: On the diagnosis side, we are moving from nearly 14,000 to close to 70,000 codes in less than a year. Procedure codes will jump from 4,000 to more than 70,000.

1. Redesign your ICD-10 roadmap

To start, you must know the true revenue impact of ICD-10 across your organization and by service line. Drill down to your major cost centers. For example, you may know the cost of coder training, but what about awareness training for all non-clinical staff? Another key metric to determine is the reimbursement difference between what you receive today in an ICD-9 environment vs. moving forward with ICD-10? One approach is to perform an analysis of your top 15 DRGs and your top diagnoses per payer to see how they really map out in the ICD-10 environment. Having these assessments allows for better planning and will give you an advantage when renegotiating managed care contracts.

Furthermore, every organization needs to estimate productivity losses and how ICD-10 will affect billing processes, cash flow and other areas. One thing we have learned from other countries that use an easier version of ICD-10 is that we can expect a 20-25 percent permanent loss in productivity. Knowing this gives you time now to boost productivity by doing things like introducing computer assisted coding for coders and EHR templates to help providers document correctly.

2. Create a comprehensive coder workforce

There may be an ongoing coder bidding war, but there are plenty of ways to mitigate its effect and build a thriving, satisfied coder workforce. Start by considering new opportunities for maintaining a full coder pipeline, including working with coding outsourcing vendors and partnering with universities to bring new coders into your organization. Also consider working on programs to move outpatient coders to inpatient coders.

At the same time, make sure you are providing the right support and incentives to motivate coders to stay on as they are shepherded through the steepest learning curve in their careers. Look at compensation plans and bump up hourly rates to levels higher commensurate with completed ICD-10 training and quality rates. Also, offer creative incentives such as quarterly bonuses with a lump-sum payout for coders who stay on one-year post ICD-10 implementation.

Coders also must have the right training foundation, including anatomy and physiology education and a plan for dual coding after ICD-10 is implemented for non-compliant or exempt payers. Also, most people don't consider that on the procedure side only the inpatient coding is changing under ICD-10. Outpatient is staying with CPT codes. This means you may not need to go through the time and expense of putting all of your coders through training on the procedural side.

3. Master all ICD-10 communications

When it comes to system remediation, it is a lot more than making sure your systems just support the ICD-10 code. They must also be able to transfer data back and forth. Moreover, internal systems need to communicate with external systems such as clearinghouses and payers that accept data from your systems. Having a communication plan in place is crucial. Most organizations have an internal plan, but you also need to prepare for how you will talk with your vendors and other organizations to make sure you are all in sync with your ICD-10 activities.

Ultimately, harnessing ICD-10's impact, is about taking the time today to make the unpredictable as predictable as possible. Know your revenue hits and organizational gaps. Doing this critical early work will put you on a solid path to developing long-term ICD-10 best practices.