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ICD-10 has arrived. Now what?

  • Jeff Goldstein, MD, MS FACHE
  • 10/06/2015

For most healthcare providers, October 1, 2015 did not signal falling leaves and cooler temperatures. They were focused on ICD-10, a reality which will significantly affect hospitals and physician practices now and well into the future.

For those getting a late start

At a recent assessment, I asked if the organization had educated staff, worked with vendors to verify, install and test ICD-10 upgrades, audited ICD-10 coding for accuracy, and sent test data from their billing system to their clearing house for payment testing. I also asked if there was any consideration for delegation of responsibilities to managers who would know best how to address these concerns. Unfortunately, even though the deadline was looming, each question was answered with “No.”

Allscripts conducted a comprehensive onsite survey to identify key ICD-10 readiness deficiencies and, from this, developed a prioritized remediation program. With very limited time remaining until October 1, the plan addressed what the organization should do immediately and what it could address after ICD-10 started.

Even now that the deadline is upon us, the priority areas and associated actions for organizations remain the same:

1.Education: Use a dual education approach, including both classroom and online training with the latter primarily for the medical staff. For an online tool, Allscripts Experiential Learning program enables users to access the lessons when it best suits their availability and provides feedback to the leadership of who took which lessons and individual scores upon completion of the lesson.

2. IT Readiness: IT must validate all installed software products to meet ICD-10 standards, test relevant interfaces and establish a timetable with defined completion goals. In addition, IT should be responsible for establishing ICD-10 testing schedules through the billing clearinghouse with the organization’s top three payers.

3. Coding: In the organization above, coding is outsourced and this same company also managed all Clinical Documentation Improvement (CDI) queries to the medical staff. Finance took the lead in requiring this company to conduct an outside quality audit for coding accuracy and CDI statistics, and has requested more frequent reporting on high value-high frequency diagnoses by departments and providers.

4. Documentation: With the wide degree of variability in documentation noted across providers, locating and identifying key diagnostic information is a difficult task. Allscripts provides templates that combine a structured note with the ability to enter free text for additional details. Another helpful tool is Allscripts Health Issues Manager (HIM), which enables the provider to quickly select the most appropriate ICD-10 code and build the patient’s problem list.

While these four action items cover a wide scope of the critical tasks needed for ICD-10, organizations must continue to address these areas and others, such as provider communication and data exchange across different systems. Even with a late start in preparing for ICD-10, organizations can still have a realistic plan that focuses on the immediate essentials for ICD-10 together with a long-term strategy for maintaining ICD-10 compliance.

Looking beyond October 1

The Centers for Medicare & Medicaid Services (CMS) has announced a number of initiatives and programs that rely on the same level of detailed documentation required by ICD-10, such as Value-Based Care, Bundled Payments, Episodes of Care (including the Comprehensive Care for Joint Replacement (CCJR) program scheduled to begin in January 2016) and Pay for Outcomes. These initiatives collectively reflect the intent of CMS, and eventually other payers, to migrate away from a service-based payment model to one that looks at cost containment, outcomes and quality as the basis for payment.

Ready or not, ICD-10 is here. Even if you have not yet addressed the four critical issues – education, IT readiness, coding and documentation – all is not lost. Allscripts can help you quickly get on track to minimize denials and reimbursement delays and set your organization up for long-term success.

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About the author

Jeff Goldstein MD, MS FACHE is an internationally recognized leader in the development and implementation of electronic health data systems in achieving quality care that assures safe and cost-effective services to meet the immediate and long-term goals of both patients and providers. He has worked with hospitals, health systems and governmental agencies in designing integrated systems that look at the continuum of care and how best to align the clinical, operational and financial imperatives to achieve defined outcomes.

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