Three overlooked operational areas you may have missed during the initial ICD-10 impact assessment that ICD-10 teams should take a second look at
ICD-10 is not just a coding problem. The impact extends way beyond HIM. As HIM professionals, you understand this. But does the rest of your organization?
With a year delay, savvy HIM professionals and ICD-10 teams should take a second look at every operational area that enters, shares, uses, or reports ICD-9 codes. Here are three nooks and crannies you may have missed during the initial impact assessment:
1. Owned or Affiliated Physician Practices
For hospitals that own or contract with physicians, alignment of all groups toward the goal of a successful ICD-10 implementation is critical. This means that readiness assessments need to be thorough and identify all possible gaps. Once gaps are identified, detailed plans need to be developed to address the gaps and structured project management needs to be in place. Look closely at all technology interfaces, patient registration points and clinical documentation sharing. And consider cross mapping to ICD-9 codes for ongoing data tracking after October 2014.
2. EHR Documentation Templates
EHRs must support ICD-10. And they should be part of your complete IT system checklist. But there’s more to EHR readiness than development timelines, version levels and system testing. The electronic documentation templates within EHRs must also be prepared for ICD-10.
Specific narrative within EHRs must support CDI initiatives as well as coding. Begin by assessing documentation menus, check boxes and radial buttons associated with high dollar and high volume DRGs. Will additional clinical details or terms need to be captured? If so, educate clinicians about the changes and then update EHR templates accordingly. This important step fills documentation gaps and ensures case mix index doesn’t fall in areas delivering highest organizational revenue.
3. Payer Interoperability
All processes that involve ICD-9 codes, including pre-authorization for procedures, will be impacted by ICD-10. Even a small hiccup between other systems and organizations has the potential to create reimbursement delays and patient care logjams.
Make sure your payers will be able to process claims accurately and timely! Begin end-to-end testing with all payers as quickly as possible. We predict that payer interoperability may represent one of the biggest “gotchas” of ICD-10.
Image credit: Clinical Innovation