You’re doing everything you can to be ICD-10 ready, but what about your vendor?  While most hospitals expect to meet ICD-10 requirements by October 2014, a recent study by the American Hospital Association (AHA) reveals that hospitals see timely vendor upgrades as one of the largest external threats to implementation.  With more than 5,000 hospitals and many more physicians’ practices transitioning to ICD-10 simultaneously, everyone is feeling the crunch – especially facilities that may have anticipated an additional extension.

Physicians may start feeling the effects sooner than originally anticipated.  Just last week, the Centers for Medicare and Medicaid (CMS) announced that beginning April 1, 2014, it will no longer accept the current Medicare paper claim form, which is being updated to reflect ICD-10 codes.  This means those physicians who currently use this form will need to switch to the new version (CMS-1500, version 02/12) in which is embedded a requirement for supporting a component of ICD-10 early.  This change will, without a doubt, offer them some insight into the challenges that organizations will face come the October 2014 transition deadline.

And so the pressure is on to be ICD-10 ready sooner rather than later, and while hospitals may be doing everything within their control to be ready on time, vendor readiness and other external factors may put them at risk.

Timely Vendor Upgrades                                                                         

“Timely vendor upgrades” was cited as one of the largest external threats to ICD-10 implementation in the AHA study, with 81 percent of hospitals rating it as a moderate to very significant risk factor.  Much like nutrition is to the body, these codes are critical to the overall health and wellbeing of the organization, therefore vendor readiness is essential to successful ICD-10 transition.  There are two essential parts to ensuring vendor ICD-10 readiness: software readiness and a vendor’s ability to support providers through the process. A few questions to consider include:

  • Does your vendor have a solid track record for timely software releases, implementations and training?  Peer ratings are one resource that provides some additional information that can help assess vendor readiness.
  • Does your current encoder support ICD-10-CM/PCS?  If not, moving to an ICD-10 ready version sooner than later gives more flexibility in the transition.
  • If using computer-assisted coding (CAC) software, when will it support ICD-10?  Many providers are looking to CAC to help offset coding productivity losses, and manage ICD-10 code sets, so it’s important to consider when ICD-10 will be available, as well as the strength of a Natural Language Processing (NLP) engine’s ontology so it can handle the increased complexity.

The move to ICD-10 involves significant planning, which should include risk mitigation for external threats, and planning for continued partnership after October 2014.  Now is the time to ensure your organization has the right ingredients necessary to continue nourishing its successful growth.

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  • http://journal.ahima.org/2013/03/01/ten-more-questions-for-cac-vendors/ Bonnie Cassidy

    GREAT post!
    Here are ten questions to ask your CAC Vendor.Evaluating CAC solutions may seem challenging at first. In addition to the standard request for information (RFI) or request for proposal (RFP) vendor questions, the following questions can be used as a reference when evaluating CAC solutions:

    1. Describe how the NLP/CLU engine that powers the CAC learns, grows, and improves code assignment accuracy over time. How does it model concepts and relationships, and what is the size and strength of its ontology?
    2. Does the CAC application auto-suggest both ICD-9 and ICD-10-CM/PCS simultaneously for the same encounter in one view for the coder?
    3. Does the system contain all interfaces needed to provide the coder with a single workspace view and access to clinical documents that are needed for the encoder, CAC, and clinical documentation improvement (CDI)?
    4. Does the CAC auto-suggest outpatient codes for both ICD-9 and ICD-10 CM/PCS? Please provide each clinical areas covered (i.e., laboratory, radiological/imaging, same day surgery, cardiology, rehab, etc.).
    5/ Describe the CAC (NLP engine) software’s ability to generate HCPCS and CPT codes, provide coding edits for medical necessity (local coverage determinations and national coverage determinations), and integrate with the charge description master. Are early warning indicators provided when documentation is insufficient to code in ICD-10?
    6. Describe the coding management tools of the system, such as the ability to:
    a) Generate comprehensive management reports related to case mix trending and (coding or CDI) physician query management
    b) Customize workflow queues across a department or a system
    c) Report on encoder, CAC, and CDI access, utilization, productivity, and other activities
    Is there an integrated HIM software program that supports: a)
    a) Documentation improvement for the physician
    b) Documentation improvement for case management and/or clinical documentation specialists
    c) Computer-assisted coding
    d) Compliance features in CDI, CAC, and encoder
    e) Compliance audit reports (i.e., RAC audits) for inpatient and outpatient claims
    7. Describe the patient data flow and your associated product application from pre-admission to registration/admission to CDI and/or concurrent coding to CAC to encoder/coder validation to abstracting and billing to reconciliation to compliance reporting and auditing
    8. Does the system enable simultaneous coding and grouping or grouping interfaced? What about auto shuffle capabilities?
    9. Does the system provide anywhere, anytime access to complete ICD-9 and ICD-10 coding guidelines and coding clinic references based on selected code set?
    10. Can the system workflow be configured to eliminate toggling among various screens/systems in order to access documentation necessary to validate demographics and to perform encoder, CAC, and CDI activities and processes? Please describe.

Regina Hall

About Regina Hall

Regina Hall is a Sr. Product/Solutions Marketing Manager for the Nuance Clintegrity Quality and Coding solutions. She has over 20 years of healthcare communications, public relations, change management, continuous quality improvement experience with commercial and government organizations including Inova Health System, the Medical University of South Carolina, The Advanced Medical Technology Association (AdvaMed), the Bureau of Navy Medicine and 3M Health Information Systems. Ms. Hall has a Bachelor’s of Science Health Administration from James Madison University, and Masters in Health Administration and Health Information Administration from the Medical University of South Carolina.