ICD-10 is the largest mandate in U.S. healthcare history, and it will require diligent, comprehensive actions to be fully prepared for the transition. This is the first post in a four-part series that explores successful strategies in key areas of ICD-10 readiness: general approach, governance, education and standardization of documentation.
Benjamin Franklin once wrote, “…nothing in this world is certain except death and taxes.” Most of us in the healthcare industry agree it’s time to add ICD-10 to this list. On October 1, 2015, the United States will join 25 other countries in using ICD-10, the version that has been the standard for coding diseases, findings, medical complaints, causes and conditions of illness and injury since 1995.
When CMS announced last year that it would delay ICD-10 until 2015, the healthcare industry breathed a collective sigh of relief. Unfortunately, much of the industry has not used this extra time to further readiness. In a September 2014 letter to HHS Secretary Sylvia Burwell, Jim Daley, the chairman of Workgroup for Electronic Data Interchange (WEDI) stated:
“It appears the delay has negatively impacted provider progress, causing two-thirds of provider respondents to slow down efforts or place them on hold…while the delay provides more time for the transition to ICD-10, many organizations are not taking full advantage of this additional time.”
The organizations that are taking full advantage of this additional time to prepare recognize that ICD-10 is already here.
The biggest challenges in ICD-10 preparation
No coding system mandates that you have to use an electronic documentation system. However, with more than 68,000 Clinical Modifications (CM) codes and 76,000 Procedure Coding System (PCS) codes, an electronic health record (EHR) greatly simplifies aligning the correct code to the service(s) provided.
The problem many organizations continue to face is that no matter how comprehensive an EHR is, it is only as good as the information entered into it. Coding and Billing must be able to work together to retrieve clinical information and produce a clean and accurate claim. Or, as one of my CFO friends said, “For me to keep my job, I need to be able to quickly drop a bill that will be paid and doesn’t leave ‘money on the table’ due to under coding.”
As one of Allscripts’ principal consultants working with our clients on ICD-10 readiness, I see a wide range of diversity in how hospitals and health systems respond to the task. Perhaps the biggest challenge is that few organizations have truly embraced the concept that ICD-10 affects every part of the organization.
ICD-10 workflows start at registration and continue up to the moment the patient is discharged from the hospital or goes home from the physician’s office. Too often organizations consider ICD-10 as an “IT problem” or a “Medical Records matter,” when in fact the touch points involved in ICD-10 are significantly greater.
To put this in perspective, I consistently see three major themes that emerge during our assessments:
While these areas are not unique to ICD-10 readiness, each one has a number of critical elements that need to be in place to be ready for October 1. Over the coming weeks my ICD-10 blog post series will explore each area in more detail and steps that can lead to a successful transition into ICD-10.
If you’d like to learn more about how Allscripts can help you prepare your revenue cycle for ICD-10 and beyond, contact us.