AMA Pushes Back Again…The Real Issue

The American Medical Association, not satisfied with HHS’s push-back of the ICD-10 deadline to October 1, 2014, has protested again. Perhaps one of the reasons for their continued dissent is lack of guidance and support.

While much has been published about the implementation of ICD-10 for hospitals, the body of knowledge for physician practices and medical groups is sorely lacking. Vendor upon vendor is assisting hospitals, but who is helping the docs?

I readily admit the move from ICD-9 to ICD-10 is a huge undertaking. However, only diagnosis codes change for practices and groups, not procedure codes. And while physician payment is not driven by diagnoses codes, they are still required to show medical necessity. This is where practices must be thoroughly prepared to make the leap.

Specialty Matters

Family practice, hospitalists and internal medicine groups may have a more difficult time converting from ICD-9 to ICD-10. Specialists will find the transition much easier. Why?

Generalists see a large variety of patient conditions. So their documentation and support staff must be educated in all anatomy, physiology and disease processes—while specialists treat a limited sub-set of the patient population. Therefore their documentation needs to be refined in only a few key areas. And staff only needs to focus on one or two body systems.

To get started, CMS has prepared ICD-10CM information on their website. Now is a good time for practices to test the water with what to expect; and begin developing a training plan, even for single practitioner practices

Tips from TrustHCS

Our experts have also provided some tips for practices and groups to ease the transition to ICD-10. We’re always available to help and support your efforts. We’ll make the move to ICD-10 easier…really!

• Practices owned, managed or affiliated with a hospital should reach out for guidance and resources.
• A targeted, specific training approach is the most cost effective and practical strategy for specialty practices.
• Train in small increments and preferably have another physician involved for peer-to-peer support.
• Deepen your staffs’ biomedical knowledge, particularly in the body systems that you treat.
• Take a tailored step-by-step approach and do a thorough ICD-10 assessment and planning early.
• A period of parallel testing with both I-10 and I-9 codes is recommended if at all possible.
• Work with like practices, payers and hospitals as a regional consortium on the I-10 issues facing you all.

Start Your Engines…Again

May is an important month for starts. The greatest two minutes in sports starts in May. The fastest two hours of racing starts in May. And perhaps the green flag on ICD-10 will drop in May.

In my March 7, 2012, blog post, “What to do Regardless. 5 ICD-10 Steps to Continue.”, I suggested a one-year delay for ICD-10 would give providers the right amount of time to prepare, train and test.  Perhaps Secretary Sebelius read my blog. Or perhaps not. Either way, a one year delay is the best solution for our entire industry; and TrustHCS strongly supports this recommendation.

So as you sit through a 30-day rain delay (comment period), go ahead and re-adjust your ICD-10 schedule and race-day strategy, with a 2014 checkered flag in mind. Here are some suggestions.

Procrastinators

If your organization hasn’t started the race towards ICD-10, the one-year delay is an answer to prayer.  The additional 12 months gives you time to catch up and get your engines started.  If your organization is still a rookie, here are three critical steps to take right now.

• Establish a multi-disciplinary committee.
• Create an organization-wide inventory of all software applications that house an ICD-9 code. Ask if systems will be ready for ICD-10 and when.
• Conduct an overall ICD-10 readiness assessment of your entire organization.

Back of the Pack

Perhaps you started the race but find yourself back in the pack. The additional year provides you with much-needed breathing room and reduces your stress in 2012. Use the extra time to:

• Fine-tune your ICD-10 plan and budget.
• Begin a CDI program if you don’t already have one; or integrate the one you have into your ICD-10 team.
• Meet with your payers and vendors to discuss dates for system readiness and testing.
• Plan and budget for a period of parallel coding in ICD-9 and ICD-10 to assess documentation or coding deficiencies and how they will impact your cash flow.

On the Lead Lap

Congratulations. You’ve made significant strides toward ICD-10 and are well-positioned to take the lead. Here are a few ways to guarantee a smooth transition.

• Continue to test systems and payor transactions.
• Extend your CDI and training efforts; particularly with physicians.
• Implement new technologies like computer-assisted-coding (CAC) to offset expected drops in coder productivity.
• Review and update all your documentation forms and templates; especially those within your EHR to ensure your clinicians capture the specificity needed for ICD-10.

All great race teams experience delays. Rain, crashes and time-outs are common. So do what the best racers do; keep your engine warm, put on fresh tires, take on more fuel, and be ready when the green flag drops.

Be sure to introduce yourself to us at next week’s AHIMA ICD-10 Summit. We are an official sponsor and will be moderating a general session on Monday, “Three Paths to Preparedness: Providers, Payers and Vendors Speak Out on ICD-10”.

Do The Work Anyway

In the ICD-10 transition there is only one question that is relevant. Will it happen or not? If you think not, then you need read no further. Of course, you would be in the minority. Practically everyone in the healthcare industry believes the transition to ICD-10 is going to happen, the only real question is “when”.

With Y2K we actually had an advantage – the date could not change. With ICD-10 the date can…and has, again!

The AMA in its infinite wisdom flexed its muscle and pressured the government to call a time out in the process. The government, a paragon of productivity, has decided to do something. What, we do not know. When, we do not know.

To take a project of this size, which has been in the works for years, and put it on hold does a major disservice to those who are doing the work to make the transition. And unfortunately rewards those who chose to ignore it. It seems like a sorry state of affairs.

The ICD-10 deadline is not a surprise to anybody. The rest of the civilized world has been using the code set for years. The Oct. 1, 2013 deadline has been in place for years. The healthcare industry has been talking about it for years. Perhaps that is the problem.

In the healthcare industry we talk and talk and talk; and then scramble to do the work. Like students who procrastinate until the due date looms we wait until the last minute and then complain about the amount of work that needs to be done. Of course, to add credence to our arguments we state there is too much other activity going on; we couldn’t possibly fit it all in.

My observation is that healthcare has been in this state for at least 30 years and there does not seem to be any end in sight. Waiting for a respite in workload is really an argument to not do the transition, since there will not be a respite-ever.

This all being said, it is obvious to me, and many others in the industry, that there is only one logical course of action. Just Do It!

If you do the work to transition to ICD-10 and the date does not change, then you are in good shape and early. If you do the work and the date moves further out, you are blessed with more testing time, more time to insure vendors and payers are up to speed, more time to hone coder skills and minimize productivity loss, and more time to get it right.

Lastly, if you haven’t started and now are waiting for a new date, then shame on you.

What Do You Do Regardless? Five ICD-10 Steps to Continue.

The AMA lobby is strong. And U. S. government program delays are common. The two came together on February 16, 2012 when Health and Human Services Secretary, Kathleen Sebelius, announced a potential delay in the October 1, 2013 deadline for ICD-10 implementation.

The announcement, made just before the start of the HIMSS12 Annual Conference, left a lot of attendees scratching their heads and asking themselves, “now what”? Most agreed a delay of one year or less gives everyone more time to prepare, train and test. However, a delay of greater than one year spells chaos for healthcare providers and payers.

While at HIMSS, TrustHCS had the honor of sponsoring an executive roundtable on ICD-10.  During the roundtable, speakers discussed five ICD-10 projects that should be continued, full steam ahead, despite the delay. It’s a good list and worth sharing.

In general, the panel’s advice was to identify ICD-10 tasks that have collateral benefit for ICD-9 coding. These are the tasks that should be continued until such time as HHS makes another announcement regarding their plans, intentions and deadlines.

Vendor and Payer Assessments

Continue checking-in with vendors and payers to see when systems will be ready for testing. Know what the ICD-10 upgrade will cost your organization, if anything. And if your vendor simply can’t accommodate, start evaluating new systems to replace them.  Conduct ICD-10 testing with your payers whenever and wherever possible to help reduce backlogs and denials upon go live.

Clinical Documentation Improvement

Any improvement in clinical documentation specificity and granularity will help support better, higher quality coding.  And reduce time wasted querying physicians. Coders can only code what is documented. This same core principle applies in ICD-10. CDI programs must be continued regardless of a delay.

Coder BioMedical Training

While educating coders in the finer nuances of ICD-10 coding can be postponed, strengthening their knowledge of the basics can’t.  Many coders graduated from programs ten, fifteen, even twenty years ago. Medical science and our knowledge of anatomy, physiology and disease processes has grown exponentially. Now’s the time to make sure your coders are brilliant at the basics. Anatomy and physiology training should continue to be conducted: online, through a service provider or at a local community college.

Computer Assisted Coding (CAC) Technology

Coder productivity is predicted to drop by 50% during the implementation of ICD-10. And perhaps remain 10-20% below normal output for ICD-9 coding. CAC systems help offset this productivity loss by electronically “reading” the record and suggesting codes to the human coder. While CAC systems don’t replace coders, they do make them more productive and efficient.  The delay provides more time for organizations to evaluate and implement this technology.

Assess and Refine Your Work Plan

Conduct a methodical step-by-step review of your initial plan. This process will identify which tasks can be pushed out and which cannot. The review will also uncover other tasks that have “collateral benefit” for ICD-9. For each task in your work plan, ask yourself, “does the delay impact this task” or “does the delay not impact this task”.

Industry experts are already predicting the cost of an ICD-10 delay. Other experts are predicting law suits by providers to help recoup monies already spent. This expert simply suggests that you stay the course and keep working toward ICD-10 preparedness. We will all have to get there eventually. Better to be early than late on this one!

TrustHCS Forms Three-Year Partnership with Allegiance Health for ICD-10 Training, Coder Back-Up and Clinical Documentation Analysis

Coding Consulting Firm also Protects Hospital’s Revenue Stream with DNFB Assurance Program

Springfield, MO, September 28, 2011:  TrustHCS℠, a HIM, compliance and revenue cycle consultancy firm for hospitals, clinics and physician practices, today announces a three-year contract with Allegiance Health of Jackson, Michigan, for their complete ICD-10 Educational Services and DNFB Assurance Program. The announcement was made by Torrey Barnhouse, Chief Executive Officer for TrustHCS. TrustHCS will serve as Allegiance Health’s core ICD-10 training and coding services partner by providing:

• Coder assessments and training
• Ancillary staff training
• Back-up coding support and outsourcing services
• Clinical documentation assessments and physician training

“Allegiance Health took the right approach to ICD-10 education by creating a multi-year plan and getting started now,” mentions Barnhouse. “Based on assessment results and already identified areas of need, TrustHCS will begin training for our 22 coders in late 2011, continuing through the end of 2013, “explains Terrie Vilminot, RHIA, Director, Health Information Management, Allegiance Health.

“It is such a relief to know our training needs will be taken care of by experts allowing us to focus on the many other components of ICD-10 implementation,” mentions Vilminot. In addition, Vilminot’s coders get a jump-start on their education with advanced anatomy and physiology courses, also through TrustHCS.

“We’re employing a very prescriptive approach whereby TrustHCS will establish our training schedule, project manage the entire educational component, and customize our program,” adds Vilminot. “When trying to design what we needed to do for ICD-10 training, it wasn’t until we met with TrustHCS that our team realized this is exactly what we are looking for.”

ICD-10: We’re All in This Together!

I just left AHIMA’s Annual ICD-10 Summit in Baltimore, Maryland, the Charm City. What struck me most about this year’s meeting was the diversity of backgrounds, experiences and challenges the nearly 500 attendees brought to the table.

Whether it was the coding manager of a rural, community hospital or the corporate vice president of a 23-hospital chain, the message was clear: we are all in this together and we are all learning.

            This year’s summit brought together HIM, revenue and documentation professionals from all walks of healthcare. Even payers were eager to hear what was working, and what wasn’t. Different from years past, speakers shared actual experiences from Phase I activities. And beyond awareness campaigns and technology inventories, all aspects of ICD-10 readiness were discussed with a keen focus on the big four:

-          Project Management

-          Data Mapping

-          Clinical Documentation

-          Education and Training

            Every speaker mentioned the need for resources and strong project methodology, beginning with HIM. If there was ever a time for HIM professionals to step up to the plate and take ownership of a C-suite level project, that time is now!

            So shine up your corporate image. Brush up your project management skills. Take the helm of this immense, dynamic and powerfully political project now! And don’t be afraid to ask consultants, industry experts and your peers about their progress and plans. After all, we are all in this together.

Education shall set you free

The most important aspect of your ICD-10 transition plan is education. Pretty much everyone in the institution needs to re-tool their skill set to accommodate ICD-10. You could train the trainer and have that person or persons train everyone else, in which case you lose the productivity of both the trainer and those being trained. Or, you can outsource your training to an outside party. Timing is crucial. You do not want to do it all now and have people forget it before go-live. On the other hand, you do not want to cram it all in at the last minute. As the expression goes you can eat the elephant one bite at a time. That is, education is a multi-year process. It even continues after go-live to ensure accuracy and compliance. You may need to add people or use out-sourced resources to get you over the hump. Trust us to help you with this process. If outsourcing your ICD-10 training, here are some points to consider. Feel free to use them as you evaluate all the various training options, including TrustHCS!

• Past training experience
• Use of certified, experienced trainers
• Individualized training programs
• Pre-assessment, as well as ongoing progress assessments
• Available resources to deal with back-logs and productivity issues
• Multi-media tools used both on-line and on-site
• Comprehensive training for executives, physicians, coders, revenue cycle etc.

ICD-10: Tick–Tock

We are now at the beginning of February 2011 – boy that went fast. How is your ICD-10 transition plan coming? Yes, the plan that should have been done last year. Hopefully it is well underway. Your executive team has bought in and hospital-wide education and training is in progress, right?  Errr, not so much.   

You still have time and industry resources; at least for now. Top resources are getting locked in for the next three years and providers should not wait until the last minute to secure transition teams and training partners.

In fact, a recent survey done by the Missouri Health Information Management Association (MHIMA) found that much of the training and education will be done by resources external to the institution. In the survey, 72% of respondents will seek outside training for both diagnosis and procedure codes. This training will be conducted through live, in-person seminars and preceded by completion of online learning modules. But what can you do now, in 2011?

Before in-depth ICD-10 training occurs educational assessments must be conducted! They should be part of your plan and on your 2011 checklist. After all,  it is easier to get to your training destination if you know where you need to start.

Who to Assess Now?

• Clinical Coders                                           
• Internal Auditors
• Physicians

What to Assess?

• Knowledge
• Staffing
• Potential Staff Shortages
• Potential Productivity Drop

How to Assess?

• Recommend AHIMA online assessment
• External Audit to Establish Benchmark
• Review CDI Efforts

Your ICD-10 educational plan must be coordinated, well thought out and occur over a time. We all know that the only way to eat the elephant is one bite at a time; assessments are the first bite.

The TrustHCS team is geared up and willing and able to help, whether you need a high level assessment and awareness plan or training at the most detailed, individual level. For survey results see: http://www.mohima.org/eAlert/MHIMAealertnewsletter.pdf

ICD-10 Education: Five Ideas to Consider Now

The most important aspect of your ICD-10 transition plan is EDUCATION. Pretty much everyone in the institution needs to re-tool their skill set to accommodate ICD-10. Many hospitals are planning to use a train-the-trainer approach whereby several key people get trained and, in turn, they train everyone else. In fact, AHIMA recently announced an “Ambassador” program based on a train-the-trainer methodology.

The problem with this approach is that you lose the productivity of both the trainer and those being trained. Secondly, timing is of great concern. You can’t afford to do ICD-10 training too early and have people forget it before go-live. On the other hand, you can’t cram it all in at the last minute. Yes it’s true: ICD-10 education and training is going to cause some unique challenges. And demand some new, out-of-the box ideas.

As the expression goes you can eat the elephant one bite at a time. ICD-10 training should be the same. That is, ICD-10 education is a multi-year process. It even continues after go-live to ensure accuracy and compliance. Here are some other practical tips for successful ICD-10 education. Start planning now and line up your training resources while you can. Finally, let us know if we can help!

-          ICD-10 education should be a multi-year process

-          Use a multi-media approach: paper, virtual, webinars, conference calls, presentations, self-paced, workshops, etc.

-          For physicians, address unique preferences and needs.

-          Hire trained, accredited educators and assign them 100% to the education task. AHIMA has the only official program at this time.

-          Outsource training if needed and purchase or contract for outside resources to get the job done.

External Coding Audits: Make the Most of Yours

Time and time again I meet with HIM Directors who fail to realize the full benefit of an external coding audit. Most of the time it’s because audit or recommendations aren’t implemented and corrective actions aren’t taken. Time gets spent. Money gets wasted. But a return on investment is never achieved.

External coding audits require HIM management time, coding resources and a significant piece of the departmental budget. Merely completing an audit accomplishes very little unless HIM directors take a serious look at auditor recommendations, correct deficiencies and improve processes.

Here are three ways to ensure your organization gets the most from your next external coding audit.

• Prepare for the audit (set clear goals, secure executive support, prepare coders, and identify cases)
• Manage the audit (communicate and coordinate with IT, coding management and auditors)
• Review and implement recommendations (conduct exit interviews, use final report as action list, conduct education based on findings, measure improvement)

While some external auditors are now conducted remotely, most are still performed on-site at the hospital or physician practice location. If external auditors come on-site, here are a few final tips to help ease the process and expedite results:

To read more about making the most of external coding audits, visit my article on this topic at: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_043989.hcsp?dDocName=bok1_043989