ICD-10 implementation and planning has been a like a dust storm looming on the horizon: swirling, unpredictable, and a somewhat painful experience. Because of its erratic nature, for the most part, we have all been focused on the challenges of meeting the deadline. We’ve been preparing, planning, allocating resources, testing, tweaking, and testing again. But what most of us haven’t been planning for are the days and weeks post October 1.
A few weeks into October, organizations will begin to see the positive and negative impact of the new coding practices and outcomes on their revenue cycle. With a large-scale transition like ICD-10, and the massive volumes of cases now being coded using the new system, there will be gaps—no matter how well prepared your organization is, we all must carefully examine our plans and processes.
This is the time to embrace ICD-10 in terms of people, process, and technology. Re-examine your workflow and plans to measure the accuracy, quality, and productivity around the new code set. Here are some recommended steps for mitigating the ICD-10 impact and maintaining data integrity post October 1:
All codes are not equal.
Hospitals and providers need to implement regular audits to evaluate the accuracy of the ICD-10 codes and determine the areas of greatest impact on their organization. With this auditing schedule (I suggest daily and weekly at the beginning, and then transition into monthly), you should also define your metrics for monitoring, as well as a project plan that includes resources and tools, timelines, and specific reports or deliverables. Post October 1, you can use these audits to determine the areas of highest impact, and create a plan for prioritizing and targeting those key areas that are causing the most concern: clinical specialty, physician, CDI needs, or coders, to mention a few.
Work with your physicians.
Once you’ve identified the key areas of high-impact denials, meet with your physicians and clinical documentation specialists to review the required clinical documentation needs for ICD-10 coding best practices. Targeted training and increased awareness about enhanced specificity on a patient’s current conditions reflected in the clinical documentation, or the tests and procedures being performed as a result, can have a profound outcome—both on the continuity of care as well as on compliance, quality scores, and reimbursement. For instance, improving the appropriate and precise clinical documentation for a patient with congestive heart failure will not have the same impact as documenting a patient admitted with severe nausea and vomiting. Reporting and analytics tools can be helpful for identifying clinical specialties and/ or particular physicians whose documentation may be lacking the proper levels of specificity.
Measure, measure, measure.
While some clinical documentation improvement metrics are available, currently there are no industry benchmarks for ICD-10 productivity and/or accuracy. Meet with your team of coders, coding trainers, auditors, clinical documentation specialists (CDSs), and determine your expected turn-around times for discharge processing and coding, discharged but not final billed (DNFB) and days in medical accounts receivable (AR). Create your own ICD-10 accuracy and productivity targets and metrics and be sure to share with the coding team so everyone is well informed of the evaluation and auditing methods that you will be deploying under ICD-10. Infuse continuous quality improvement (CQI) into your cycle of identifying, reviewing, and evaluating each step; and use your reporting tools and audits to track progress, identify areas for further improvement, retool remediation strategies, and share feedback. This is in addition to tracking metrics such as your diagnosis-related groups (DRGs), case mix index (CMI), and severity of illness (SOI), of course!
There undoubtedly will be hiccups here and there, but having pertinent clinical documentation appropriately entered by physicians at the point-of-care is still the best way to tackle ICD-10-related challenges, in addition to providing tremendous relief to both coders and CDSs, and simultaneously reducing physician frustration levels associated with the querying process. Tools such as computer-assisted physician documentation (CAPD) and computer-assisted clinical documentation improvement (CA-CDI) can be extremely useful, particularly if your organization has narrow bandwidth of staff. The outcome that results from having technology-enabled solutions of real-time specificity physician prompting can help to improve clinical documentation integrity and boost your outcomes reporting that can have a real impact on institutional as well as professional credibility.
While October 1 is an important day for us all, what is even more significant is what will happen in the days and months following the compliance date. ICD-10 is a powerful reporting system that will help improve the accuracy of the patient record and ensure quality care. Making sure your organization has a post-transition strategy in place will help you quickly address any unplanned associated complications.