The granddaddy of coding switches, Y2K on steroids and a hospital's worst nightmare — these phrases and more have described ICD-10 and the potential problems it could cause for a hospital. However, the Oct. 1, 2013, deadline for all hospitals to utilize ICD-10 is not going away, and hospitals have to be in the process of making the transition, says Kerry Stark, senior director of revenue cycle management services at VHA. "Some experts say, 'If they haven't already started, it's almost too late,'" he adds.
In order for the transition to go smoothly, he says hospitals must start with a basic assessment and establishment of an ICD-10 committee. This committee, which most likely will fall under the hospital CFO's supervision, ought to be comprised of several factions of hospital personnel with distinct responsibilities. Converting to ICD-10 is not something the health information management department or the finance department can do on its own. This project will require participation and effort from numerous levels of the hospital staff in a coordinated manner.
Financial personnel
A hospital's CFO most likely will be the supervisor of the entire ICD-10 transitional project. The CFO must understand the total costs of the project — which range from a couple million dollars to as much as $100 million for very large health systems — and budget for each year accordingly, Mr. Stark says.
From there, the entire financial staff must understand that even though all healthcare organizations must use ICD-10 by Oct. 1, 2013, not everyone will be using them efficiently or correctly. Payors might be reimbursing hospitals on the ICD-9 and ICD-10 systems simultaneously for a while, and this could lead to botched reimbursements. "The drop in productivity can be a very costly situation for the first six months or year after the transition takes place," Mr. Stark says. Catching trends in accounts receivable now can hopefully alleviate problems after the switch, but in the end, financial personnel must be steadfast in monitoring payments initially because there will be a lag in backend production, he adds.
Technology personnel
"When you look at all the different touch points from an IT perspective, it's truly a massive undertaking," Mr. Stark says. The chief information officer must have a handle on several different aspects. For example, there must be a robust inventory procedure of all IT systems throughout the organization. Hospitals must record which IT systems are used on a regular basis, which ones might be affected by the ICD-10 conversion and which systems could be altered by a change in coding, billing and claims.
From there, the IT personnel must communicate with their IT systems vendors, Mr. Stark says. Many vendors are still trying to ensure their systems are updated and ICD-10 compliant, but hospitals need to give themselves a full year to test their systems with ICD-10. If a hospital waits until the last minute to communicate with vendors and the vendor is not ready, it will only give hospitals more headaches, he says. The last thing a hospital will want to do before the ICD-10 conversion is make a large-scale switch to another IT system, which will only lead to more training and spent capital.
Clinical personnel
The chief medical officer, chief nursing officer and several other top clinical leaders must help lead the charge in the conversion to ICD-10 because clinical documentation — the cornerstone of proper coding — will be changing drastically, Mr. Stark says. ICD-10 offers more specificity in coding, and physicians, nurses and clinical personnel have to adapt. "Going from 17,000 codes to more than 140,000 codes sounds like a coding issue, and the first reaction is, 'Maybe we'll be OK; we just have to get our coding staff retrained, and our IT systems vendors will take care of the rest,'" Mr. Stark says. "What physicians may not understand is that clinical documentation is also changing. The physicians are going to have to learn a new system."
Health information management personnel
HIM professionals obviously must be active and willing participants in the switch because coding will become significantly more specific. Hospitals must be ready to retrain coders in anatomy, physiology and other medical terminology through training modules to guarantee nothing will be lost between future documentation and coding, Mr. Stark says. Coders that have not had retraining in several years might have a tough time, but hospitals must take this step.
However, Mr. Stark warns that the average age of coders is high, and some coders may decide to retire instead of going through the rigors of training. With a shortage of coders already present in the country, Mr. Stark says outsourcing may make sense for hospitals facing a short HIM staff.
Compliance personnel
HIPAA Version 5010 must be implemented by Jan. 1, 2012, and it is somewhat of a precursor to how ICD-10 may go. Compliance employees must make sure that all parties involved stay within the bounds of HIPAA transactions and monitor the overall progress of the project to stay in line with the compliance dates. "They really will be managing this whole process and making sure the organization as a whole will be ready to meet this deadline," Mr. Stark says.
Correction: A previous version of this story stated that "C-section" will no longer be used in ICD-10, and clinicians will have to use the phrasing “extraction of products as a result of conception." This is incorrect. "C-section" can still be used by clinicians, and clinicians do not have to use the phrasing. The phrasing "extraction of products as a result of conception" will only be part of the official ICD-10-PCS "C-section" code. Becker's Hospital Review regrets this error.
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In order for the transition to go smoothly, he says hospitals must start with a basic assessment and establishment of an ICD-10 committee. This committee, which most likely will fall under the hospital CFO's supervision, ought to be comprised of several factions of hospital personnel with distinct responsibilities. Converting to ICD-10 is not something the health information management department or the finance department can do on its own. This project will require participation and effort from numerous levels of the hospital staff in a coordinated manner.
Financial personnel
A hospital's CFO most likely will be the supervisor of the entire ICD-10 transitional project. The CFO must understand the total costs of the project — which range from a couple million dollars to as much as $100 million for very large health systems — and budget for each year accordingly, Mr. Stark says.
From there, the entire financial staff must understand that even though all healthcare organizations must use ICD-10 by Oct. 1, 2013, not everyone will be using them efficiently or correctly. Payors might be reimbursing hospitals on the ICD-9 and ICD-10 systems simultaneously for a while, and this could lead to botched reimbursements. "The drop in productivity can be a very costly situation for the first six months or year after the transition takes place," Mr. Stark says. Catching trends in accounts receivable now can hopefully alleviate problems after the switch, but in the end, financial personnel must be steadfast in monitoring payments initially because there will be a lag in backend production, he adds.
Technology personnel
"When you look at all the different touch points from an IT perspective, it's truly a massive undertaking," Mr. Stark says. The chief information officer must have a handle on several different aspects. For example, there must be a robust inventory procedure of all IT systems throughout the organization. Hospitals must record which IT systems are used on a regular basis, which ones might be affected by the ICD-10 conversion and which systems could be altered by a change in coding, billing and claims.
From there, the IT personnel must communicate with their IT systems vendors, Mr. Stark says. Many vendors are still trying to ensure their systems are updated and ICD-10 compliant, but hospitals need to give themselves a full year to test their systems with ICD-10. If a hospital waits until the last minute to communicate with vendors and the vendor is not ready, it will only give hospitals more headaches, he says. The last thing a hospital will want to do before the ICD-10 conversion is make a large-scale switch to another IT system, which will only lead to more training and spent capital.
Clinical personnel
The chief medical officer, chief nursing officer and several other top clinical leaders must help lead the charge in the conversion to ICD-10 because clinical documentation — the cornerstone of proper coding — will be changing drastically, Mr. Stark says. ICD-10 offers more specificity in coding, and physicians, nurses and clinical personnel have to adapt. "Going from 17,000 codes to more than 140,000 codes sounds like a coding issue, and the first reaction is, 'Maybe we'll be OK; we just have to get our coding staff retrained, and our IT systems vendors will take care of the rest,'" Mr. Stark says. "What physicians may not understand is that clinical documentation is also changing. The physicians are going to have to learn a new system."
Health information management personnel
HIM professionals obviously must be active and willing participants in the switch because coding will become significantly more specific. Hospitals must be ready to retrain coders in anatomy, physiology and other medical terminology through training modules to guarantee nothing will be lost between future documentation and coding, Mr. Stark says. Coders that have not had retraining in several years might have a tough time, but hospitals must take this step.
However, Mr. Stark warns that the average age of coders is high, and some coders may decide to retire instead of going through the rigors of training. With a shortage of coders already present in the country, Mr. Stark says outsourcing may make sense for hospitals facing a short HIM staff.
Compliance personnel
HIPAA Version 5010 must be implemented by Jan. 1, 2012, and it is somewhat of a precursor to how ICD-10 may go. Compliance employees must make sure that all parties involved stay within the bounds of HIPAA transactions and monitor the overall progress of the project to stay in line with the compliance dates. "They really will be managing this whole process and making sure the organization as a whole will be ready to meet this deadline," Mr. Stark says.
Correction: A previous version of this story stated that "C-section" will no longer be used in ICD-10, and clinicians will have to use the phrasing “extraction of products as a result of conception." This is incorrect. "C-section" can still be used by clinicians, and clinicians do not have to use the phrasing. The phrasing "extraction of products as a result of conception" will only be part of the official ICD-10-PCS "C-section" code. Becker's Hospital Review regrets this error.
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