One of the keys to a successful transition from ICD-9 to ICD-10 is coordination, both within the hospital and outside the hospital. The pervasiveness of the code sets, from physicians' documentation to coders' sending claims to insurance companies, means healthcare leaders need to take a broad approach to this major shift in how diagnoses are recorded and categorized. Tracey Mayberry, partner at CSC Healthcare Group, explains how ICD-10 will require perhaps unprecedented levels of coordination within the healthcare industry.
Internal coordination
Although coders and staff in revenue cycle departments deal most directly with code sets, all departments in the hospital will be affected in some way by the switch, and should therefore have some level of education about ICD-10. Mr. Mayberry suggests a "tiered set of training" in which the kind of education each department receives depends on their role in the hospital. For example, physicians will need to know the level of detail ICD-10 requires in their diagnoses, while the management team should have a broad understanding that includes the key changes from ICD-9 so they can lead the planning and education.
Mr. Mayberry says hospitals should already have begun general awareness training so that hospital staff, physicians and leaders understand the magnitude of the change. Some groups, such as physicians and coders, should have ongoing and more intensive training between now and the deadline. If hospitals do not coordinate this training effectively, they could face reduced productivity, delayed payment collections, denials and regulatory penalties, he says.
External coordination
As the change to ICD-10 will affect vendors, clearing houses and payors, healthcare organizations have a responsibility to coordinate with these stakeholders to facilitate their training and testing timelines. The first step in this process, according to Mr. Mayberry, is to conduct a thorough assessment of the organization. Then, leaders should allocate resources to the appropriate areas based on the assessment. "Coordinate your plans with the vendor's, payor's and clearing house's plans to make sure that you're really engaging with the full cycle of the data and how it will travel through your organization, out and back in again so you can have a seamless performance and not have things hung up or dropped along the way," Mr. Mayberry says.
For example, hospital leaders should ask payors how they are approaching the change and what opportunities they have for testing, and then schedule a period of testing early. "Testing will be potentially a great bottleneck because most people do things at the last minute," Mr. Mayberry says. "In a given geography, all providers will want their testing done and results back in those last 90 days." To ensure the organization has adequate time to correct errors, hospitals should consider conducting training before Aug. 2013. "It will take a lot of planning and coordination across stakeholders to make sure this [transition] happens efficiently," Mr. Mayberry says.
Learn more about CSC Healthcare Group.
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Internal coordination
Although coders and staff in revenue cycle departments deal most directly with code sets, all departments in the hospital will be affected in some way by the switch, and should therefore have some level of education about ICD-10. Mr. Mayberry suggests a "tiered set of training" in which the kind of education each department receives depends on their role in the hospital. For example, physicians will need to know the level of detail ICD-10 requires in their diagnoses, while the management team should have a broad understanding that includes the key changes from ICD-9 so they can lead the planning and education.
Mr. Mayberry says hospitals should already have begun general awareness training so that hospital staff, physicians and leaders understand the magnitude of the change. Some groups, such as physicians and coders, should have ongoing and more intensive training between now and the deadline. If hospitals do not coordinate this training effectively, they could face reduced productivity, delayed payment collections, denials and regulatory penalties, he says.
External coordination
As the change to ICD-10 will affect vendors, clearing houses and payors, healthcare organizations have a responsibility to coordinate with these stakeholders to facilitate their training and testing timelines. The first step in this process, according to Mr. Mayberry, is to conduct a thorough assessment of the organization. Then, leaders should allocate resources to the appropriate areas based on the assessment. "Coordinate your plans with the vendor's, payor's and clearing house's plans to make sure that you're really engaging with the full cycle of the data and how it will travel through your organization, out and back in again so you can have a seamless performance and not have things hung up or dropped along the way," Mr. Mayberry says.
For example, hospital leaders should ask payors how they are approaching the change and what opportunities they have for testing, and then schedule a period of testing early. "Testing will be potentially a great bottleneck because most people do things at the last minute," Mr. Mayberry says. "In a given geography, all providers will want their testing done and results back in those last 90 days." To ensure the organization has adequate time to correct errors, hospitals should consider conducting training before Aug. 2013. "It will take a lot of planning and coordination across stakeholders to make sure this [transition] happens efficiently," Mr. Mayberry says.
Learn more about CSC Healthcare Group.
Related Articles on ICD-10:
Coding Resource: AAPC Anatomy and Pathophysiology Training Modules for ICD-10CMS to Host Call on ICD-10 Implementation Strategies
Meeting the Deadline: A Timeline for Hospital's ICD-10 Transition