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Assess, Implement, Evaluate: ICD-10: Going Back to the Basics; a Workflow Perspective
Written by Maria Bounos, RN, MPH      
Monday, 23 May 2011 

When I began to think about writing this article series on the impact of technology and ICD-10, I thought about how I would approach the mammoth task of transition if I was leading an ICD-10 governing team. I immediately thought about applying a workflow process that resonates with me and reflects the “nursing process.”

Clinicians reading this article may chuckle to themselves, as this is a workflow that becomes second nature to nurses and can be applied across the spectrum. With ICD-10, many of you will find yourselves going “back to the basics.” Assessment, implementation and evaluation are key steps and basic elements in the nursing process.

When you think about ICD-10, think of these three elements as you attempt to wrap your head around the technology workflow processes within your organization. In the first two articles in this series, I discussed key points about the importance of risk assessment and implementation strategies for ICD-10. Now, I would like to complete the series by focusing on the significance of evaluation.  

Be Prepared; It’s Not Business as Usual

Prepare for the unexpected. Many of you more than likely still are in the risk assessment or implementation phase. Even the early adopters of ICD-10 aren’t ready to evaluate completely, yet I want you to begin to think about and prepare for Oct. 1, 2013. Will you be ready? Do you have a Plan B? You will experience challenges as you work through the implementation process. The workflow processes to be implemented from a technology perspective are fluid and subject to change, predominantly because ICD-10 is not just a coding issue but a business issue affecting your revenue cycle, payer contracts, documentation systems and other systems throughout your organization.  

What You Need to Know

Some of the challenges you will face throughout the implementation process lie among the following areas, all of which will need to be evaluated on a continuous basis.

Key Players – Understand that the key players you have identified to serve on your governing team and advisory and steering committees are fluid as well. Key players cannot be confined to one area and will need to be moved around as issues arise.

Resources – Evaluate the resources you have requested related to ICD-10.  These resources can include educational tools, information technology system inventory, database conversions, outside consultants, vendors and other human resources who can help make sure you don’t step on any toes along the way.

Documentation – During the implementation phase, expect to perform a documentation assessment. Recommendations favor using a third-party vendor or audit firm to perform this assessment. During the evaluation phase, analyze the trends and systems affected by ICD-10 and identify service lines for which documentation needs to be a focus.

Coding – Evaluate your coders’ and physicians’ readiness, and do them a favor: don’t give them a “black box” that tells them what to code, but rather give them the workflow tools they need to transition to the new coding system.

You will find that going back to the basics will be key to your coders’ success. Remember that your coders and clinicians are visual people and will need paper or electronic code books early on so they can practice working with ICD-10.

It is an expectation that coder and physician productivity will decline once ICD-10 is implemented. The numbers being predicted are a 40 percent drop for coders and a 60 percent drop for physicians. Assure that productivity is part of the evaluation process.

Vendor readiness – Evaluate where your vendors are as it relates to your system readiness timeline. Are they on target, or are they behind? Will you need to put together a Plan B should they remain behind? Recommendations include running I-9 and I-10 simultaneously before and after Oct. 1, 2013 (just how long afterwards remains in question).

Payer readiness – Evaluate every contract in which ICD-9 is mentioned and the implications of ICD-10 are apparent. Know what will be required of you as a provider as it relates to claim submission come Oct. 1, 2013.  

Government readiness – What will the rules be? What type of transmittals should be anticipated? What about national coverage determinations? In order to be proactive you will need to assign a gatekeeper for this type of information and a plan to communicate it throughout your organization. It may make sense to invest in a tool that assists you with this process.  

Financial – In Part 2 of this series, I discussed looking at your top 10 DRGs when you perform your reimbursement impact assessment. Once the results are presented, evaluate how you currently do business and what changes will need to be made to ensure that you get the reimbursement you are entitled to under ICD-10. The second piece of finance is the budget. Evaluate your budget for expected and even unexpected software and operational costs. This includes incidentals that may not have been accounted for before and after the implementation process.

Education – Evaluate where you are in the education process. Remember that ICD-10 will affect everyone with the exception of housekeeping, so make sure each staffer gets the training he or she needs to do their job under ICD-10. Most will agree that utilizing a known and accredited “train the trainer” program facilitates the ease of this daunting task.  

The undertone of ICD-10 is that it is a huge undertaking with many moving parts. Whether you manage a large or small organization you will need to be prepared. Give yourself some slack, as it’s fine to go back and tweak the process along the way — in fact, it’s expected.

ICD-10 will be a journey you will never forget, and once you get there you still will need to be prepared for the unexpected.  

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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