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What’s the Best Prescription for ICD-10?

By Cheryl Bowling, RHIT, CCS, CHC, C-CDI

Despite several delays, the October 1, 2014, deadline now is firmly set. The countdown clock is ticking, and health care providers are mere months away from all the realities—and challenges—of an ICD-10 environment.

The transition to ICD-10 CM/PCS exerts complex pressures on health care organizations already stretched for bandwidth and budgets—from acute care facilities to large health care systems. With the need to meet ICD-10 requirements in the midst of major initiatives such as meaningful use, health care leaders face significant challenges to driving productivity, meeting compliance, and minimizing costs—all while delivering quality patient care.

According to HIMSS, health care organizations may feel the following impacts due to ICD-10:

• increased provider queries;
• decreased coder productivity;
• increased delays in processing authorizations;
• increased claim rejections and denials;
• improper reimbursement; and
• slowed and/or reduced cash flow.

Now more than ever, accurate and efficient coding will become critical to HIM. Unexpected backlogs, staff and management turnover, and increasingly complex compliance standards can seem overwhelming for HIM departments. Overcoming these challenges is a daunting task, but the impact can be lessened with the right support, solutions, and resources.

From external staffing support to education and training, there are several ways in which health care providers can help smooth their transition to ICD-10.

Education and Training Programs
With the addition of nearly 60,000 codes, the new ICD-10 code sets incorporate greater specificity and clinical detail, resulting in the need for improvements in the quality and usefulness of coded data. In other words, ICD-10 stands primarily to impact the time, skills, and resources of HIM and coding professionals. Since coder productivity drives billing, health care leadership’s investment in a comprehensive ICD-10 education and training program can’t be understated.

A comprehensive education and training program can help assess the current skill levels of an organization’s HIM and coding staff while targeting ICD-10–based improvement needs. According to AHIMA, coders will need approximately 50 hours of training to successfully transition to ICD-10.

For organizations that haven’t yet begun an ICD-10 education and training program, aggressive assessment and implementation steps taken now may help avoid costly transition issues. Education programs, based on assessment results, should be tailored to each area of expertise for ICD-10–impacted staff (outpatient, inpatient, HIM technicians, HIM directors, etc).

Training topics should include the following:

• introduction to ICD-10-CM/PCS;
• comparison and contrast of ICD-9-CM to ICD-10-CM/PCS;
• structure of ICD-10 and system organization;
• information categorized by body system (based on clinical specialty, such as cardiovascular, respiratory, digestive);
• clinical documentation impact on ICD-10 (significance of clinical documentation improvement); and
• examples of documentation with coding scenarios/exercises.

Winning the Coder War for Talent
With the clock to ICD-10 winding down and current staff facing day-to-day demands on top of ICD-10 training, experienced, credentialed coders, which already are a hard-to-come-by resource—find themselves in an increasingly competitive market with high demand. Industry analysis shows that hiring spikes for coders are expected throughout early 2014.

In addition, recent trends show that the number of retiring coding professionals exceeds the number of coding graduates, and that inexperienced, noncredentialed coders exceed the number of graduates. These trends stand to impact an organization’s productivity, reimbursement, and quality of care as they advance down the path toward ICD-10 compliance.

With an initial productivity loss of 20% to 40% anticipated for medium to large acute care facilities due to ICD-10, it’s critical that providers act now to combat potential workflow issues.

Outsourcing credentialed coders through a trusted partner is a valuable investment, one that can help organizations save time and money in the long run while minimizing risks to productivity, reimbursement, and patient safety.

Experienced coders can help perform native, dual, and computer-assisted coding; improve productivity while reducing discharged not final billed and revenue risks; relieve staffing challenges; and meet quality control and reporting requirements.

To help ensure an outsourcing firm’s coders are ready for ICD-10, health care organizations should verify that the coders are trained by a recognized training program (eg, AHIMA ICD-10 train the trainer) and have some level of hands-on ICD-10 coding exposure.

Additional Support
When it comes to the ICD-10 transition, those most impacted, including coders, physicians, nurses, and billers, will need to have a solid understanding of the ICD-10 impacts and risks, and how noncompliance can affect an organization’s revenue cycle and patient care goals. Through education and training programs as well as staff augmentation, health care organizations can improve their ability to meet ICD-10 coding and documentation requirements while reducing reimbursement risks. The time to act is now.

— Cheryl Bowling, RHIT, CCS, CHC, C-CDI, is an ICD-10–certified AHIMA trainer and compliance director at Kforce Healthcare.