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  • July 13 2012

    What do the Mayan calendar and the ICD-10 transition date have in common? They both prophesize the end of the world, and both deadlines have been extended past their original date. OK, transitioning to ICD-10 doesn't mean the end of the world, but it does represent one the biggest changes ever to hit the health care industry. So let’s take a minute to revisit that foundational step in the preparatory process - the comprehensive assessment of risks and impact. 

    Have you included all that you need for a comprehensive assessment? A comprehensive assessment includes a review of the impact of ICD-10 on operational workflow, technology and people. It also includes how transition activities integrate with competing projects that are likely on your road map. It might seem like a daunting task considering the complexity of this change and the sheer number of processes it will touch, but putting a comprehensive plan in place is the first step to a successful transition. The goal of the assessment is to identify gaps in operational and technical capabilities, current readiness and potential risks. The assessment should provide the road map to preparation for the proposed transition date of October 1, 2014. The three primary focus areas for the assessment are operations, financial and technology.

    Let’s start with operations. The operations assessment starts with a review of functional processes such as clinical care, clinical documentation, registration, coding, billing and payer relationships. The goal is to identify and inventory which functional processes actively utilize ICD-9 today to determine if the enhanced specificity required for ICD-10 will necessitate a change in these processes. The revenue cycle process is the area with the greatest impact, but don’t underestimate the impact that clinical processes will have on your revenue cycle. A complete walkthrough from registration and scheduling to the ordering processes, clinical documentation, coding, billing and reimbursement is a critical element of the operations review. Anticipate and plan for process improvement efforts over the next two years to ensure that you are driving efficiencies in your organization and are prepared for the productivity hit associated with the transition to ICD-10.

    The financial review will include a quantitative analysis of the impact on coding and reimbursement due to ICD-10 coding. The financial impact analysis consists of reviewing claims data to identify potential impact on Diagnosis Related Group (DRG) assignment, diagnosis groupings, Case Mix Index and managed care contracts. A readiness assessment includes reviewing revenue cycle metrics such as Discharged Not Final Billed (DNFB), accounts receivable stats by payer and initial denial rate. The expectation is that cash flow and collections will be impacted during the transition, so it will be critical to assure that processes are in place to actively report and manage the impact on revenue. It won’t be acceptable to simply report at the end of the month that collections have been impacted. Prudent management will require preparation, active management and timely intervention to minimize the impact on cash flow.

    The technology assessment begins with the inventory of vendor systems and applications, as well as interfaces and trading partners. The vendor inventory should include even those systems that are not maintained by the IT group including: small research databases, clinical registries and regulatory reporting that may be present in your organization. Once you have an inventory of the applications that are potentially affected by ICD-10, you will want to reach out to your vendors to understand their level of readiness, including what code level supports ICD-10, and if there is an upgrade required. It's also important to determine configuration activities that may need to take place leading up to the transition and the timing for when those changes should be done. If there is one lesson to be learned from the 5010 transition, it’s that there should be more emphasis on testing the system prior to the transition date.

    Last but not least, it is imperative to assess the impact on people. Like Y2K, the ICD-10 transition happens on the same date for everyone. Anticipate that certain resources, such as coders, will become a scarce resource so your HR staff will need to have a strategy in place to recruit and train staff. Unlike Y2K, the software remediation process requires that staff with clinical knowledge be involved in the software remediation effort. Therefore, clinical resources will need to be identified and budgeted for early to assure that preparation is done correctly and testing is thorough and complete.

    Once you have completed your comprehensive assessment for ICD-10, you should have a good idea of the work effort that will be required over the next 2 years. Outcomes from the assessment should include an initial budget, financial analysis, governance structure and a detailed project plan. Also realize that you will likely uncover additional requirements as you progress through you transition, so be flexible in your approach and keep the plan updated along the way. October 1, 2014, seems like a long way away, but in reality, its right around the corner.

    Randy Hawk helps position health care organizations to proactively respond to the current and future health care economy. This includes providing education and comprehensive strategies for surviving and thriving post American Recovery and Reinvestment Act of 2009 and Patient Protection and Affordable Care Act of 2010. Hawk joined the team after four years with Cerner helping to develop innovative solutions for employers’ self-funded health benefit plans. Hawk coordinated the business relationships with the national PPO networks, pharmacy benefits management companies, regulatory compliance and claims clearinghouses. Hawk’s experience prior to joining Cerner is a broad mix that includes positions in hospital administration, medical group management and managed health care. His managed care background includes senior leadership positions with several regional health plans in California, New Mexico, Kansas and Missouri.

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1 Comment(s)

in response to A comprehensive ICD-10 assessment

Thiago daLuz

3/22/2013 10:06:38 AM

I'm STILL stressed out about the dual icd-9 and icd-10 capability. I'm really paranoid about transferring data, mostly because of experience keeping records in multiple fields. And I don't trust the government to take adequate care of these important assets.