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ICD-10 Delay Doesn’t Dampen Spirits at Summit

By Jane Bonewell, RHIT

Nearly 200 HIM professionals met in Washington, D.C., last month to hear the latest information regarding ICD-10 and how to effectively move ahead despite the delay. While attendees certainly were disappointed with the April 1 delay announcement, they focused on silver linings and next steps. As Godwin Odia, PhD, NHA, RHIA, senior health insurance specialist for the states Medicaid programs, mentioned, “HIM professionals are great at adjusting and moving ahead.”

And that’s exactly what attendees are doing. Most organizations represented already had decided to continue with their ICD-10 initiatives, meet on a regular basis, and include continued programs for ICD-10 readiness in their 2015 budgets. The following are my key takeaways from the 2014 ICD-10-CM/PCS and Computer-Assisted Coding (CAC) Summit.

HIM Efforts Praised
The delay came as a surprise to everyone, even speakers from AHIMA, Health and Human Services, and the American Medical Association. Most in attendance had spent substantial time, money, and resources on preparing for the October 1, 2014, implementation of ICD-10. However, that work wasn’t for naught.

Speakers and attendees confirmed that during 2013 and 2014 implementation preparations, many organizational workflows were assessed and changes made to improve data accuracy and departmental efficiencies. Speakers focused on improvements already made in denials processing and review, patient access, human resources, and clinical coding.

Other speakers discussed how information systems had been inventoried, providing a concise listing of current versions and needed upgrades. Reports have been inventoried, cleaned up, eliminated, or integrated into other mechanisms, thereby decreasing the number of reports to ultimately convert to ICD-10. The flow of codes throughout the various departments and systems has been reviewed, which served to educate key personnel across the entire organization.

The general consensus was that HIM efforts so far have not been wasted. All steps taken toward greater coding accuracy and documentation specificity in ICD-10 also boost revenue integrity and coding results in ICD-9. HIM’s diligence over the past two years has raised executive awareness and garnered organizational buy-in for the conversion. Now the entire health care industry has received a 12-month gift of time. The greatest question at the summit was where to focus HIM efforts now.

Silver Linings Identified
Speakers reflected on three specific areas for HIM focus aimed at achieving maximum return on ICD-10 investments while making the most of the additional preparation time.

Research CAC
While the exact percentage of efficiency gains vary, CAC systems will help organizations mitigate coder productivity drops associated with ICD-10. During the summit, I heard that a properly installed CAC can increase productivity from 14% to 35%.

The delay gives organizations that elect to implement a CAC system more time to review software and determine which vendor is best for their institutions. The extra time also allows for complete coder education and a more focused system implementation, as coder bandwidth won’t be fully diverted to ICD-10 until 2015.

However, speakers did reiterate that CAC implementation is complex and time-consuming. Organizations electing to implement CAC have more than one year to do so and should use their time wisely. Research must be done before choosing a CAC system.

Keep Practicing Through Dual Coding
ICD-10 is an entirely new language for coders. Many already have learned it and are becoming fluent. However, if coders don’t continue speaking the new language, they will lose it. Attendees were encouraged to continue practicing during the delay. Even if it’s just a few cases each week, practice through dual coding will help mitigate the productivity decrease anticipated due to ICD-10 implementation.

Dual coding now can take place over a longer time period, allowing for further education of the coding staff as well as dispersing coder downtime. Continued dual coding also supports more targeted clinical documentation improvement (CDI) efforts and specialty-directed physician training for ICD-10. Opportunities for ongoing education will benefit both the organization and the physician practices.

Speakers emphasized the need for an expert ICD-10 auditor as an ideal opening for ICD-10 trainers over the coming months. This expert can work with existing coding teams to audit dual-coding efforts, stop the spread of poor coding habits, and develop new ICD-10 coding guidelines. For organizations that can’t have a resident coding expert on hand, they should reach out to their vendor for support during this practice time. It is essential for the coding staff to have consistent, accurate feedback.

Solve the Physician Conundrum
Physician involvement has been a challenge for most organizations. This point was reiterated in three physician-led sessions during the summit. Since physicians weren’t taught how to document correctly in medical school, they’re probably the least prepared for ICD-10.

Regardless of setting, getting physician buy-in for ICD-10 documentation changes represents a steep hurdle for HIM professionals and their CDI peers to overcome. The delay gives everyone extra time to address physician-related concerns.

Speakers shared helpful tips to encourage physician awareness and engagement during the delay, including the following advice for HIM professionals:

• Work together with physicians and their office staff to minimize uncertainty and anxiety surrounding ICD-10.

• Use existing ICD-10–trained professionals to help physician practices and clinics prepare for ICD-10.

• Work with physician groups at a slower pace and focus only on the documentation tweaks necessary for each specialty or practice. Many specialties have few key documentation changes to make.

• Identify the specialties that will see a larger impact (eg, orthopedics, obstetrics, mental health). Focus on increasing these physicians’ comfort levels by helping them understand their specific documentation needs.

• Strengthen physician advisor relationships and get physician documentation champions firmly engaged.

In addition to physician practices, rural hospitals and critical access hospitals were identified as a market segment in dire need of extra HIM help. Speakers suggested that the delay gives HIM professionals the opportunity to build relationships with these facilities, especially when they’re a part of an organization’s referral system.

Rural health and critical access hospitals have distinct needs and fewer resources available for implementing ICD-10. If they experience a financial decline due to inaccurate coding, outdated systems, or lack of education, their business viability is at risk. Small communities rely on these facilities for medical care. Failure to reach out and offer assistance during the delay would be a great disservice.

CDI Receives Greatest Boost
Finally, CDI initiatives once again were the focus of attention among summit attendees. CDI staff support for ICD-10 implementation is crucial. As the medical staff’s frontline educators, CDI specialists must understand and be able to communicate the new documentation demands of ICD-10.

Speakers repeatedly noted that if CDI specialists also have coding experience, they will have a definite advantage in improving documentation and preparing physicians for ICD-10. The key takeaway here: Invest in CDI staff.

State of the Union
At the time of the summit, the new date for ICD-10 implementation had not yet been announced. During Denise Buenning’s closing keynote session, the acting deputy director of the Office of E-Health Standards and Services for the Centers for Medicare & Medicaid Services (CMS) simply stated, “Regulatory language is being drafted, and we are working toward getting the word out.” That word came on May 1, with the CMS’ announcement of a forthcoming interim final rule that would set the new compliance date for October 1, 2015.

With the new date known, my recommendation to my HIM peers, colleagues, and customers is to stay the course. Use the time to continue the good work already started. Make improvements to processes, assess systems to improve productivity, involve CDI, and support your medical staff. And most importantly, practice, practice, practice.

— Jane Bonewell, RHIT, is senior consultant for The Haugen Consulting Group. She has 30 years of HIM and IT experience, serving in management positions in coding, quality assurance, revenue cycle, HIM, and IT.