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Customer Experience and Design

Providers and the Adoption of ICD-10

There are two areas of focus in the ICD-10 conversion, each of which must be remediated/completed by October 1, 2014. Our initial thoughts, urges and efforts are towards technology or those systems that we must now use to do our jobs. Said another way, we need to update/upgrade the transactional systems, applications, and data repositories we use to conduct business and exchange transactions with our various business partners. This approach is typical. Dust off or complete (the latter in most cases) an inventory of all impacted systems, vendors, reports, databases, files, etc… Review the lists to determine the impact, work with vendors, and deploy updated versions of software and so on. Not necessarily the easiest thing to do, but we’ve all had to do this multiple times in the past and the IT folks will take care of it. Wait a minute you say! Backup, I just covered a great deal of ground too quickly on something that can weigh heavily on most organizations, given everything else going on, to handle. You’re right, I could devote blogs to just this topic alone. But I think that’s the easy part, or at least it should be.

The second area of focus, and the one of greater impact and importance, is that which covers a provider;s standard of care, clinical document standards and practices employed by its healthcare professionals in the delivery of care. It’s that which we have deployed technology to enable! What is captured in patient records and clinical documents today is driven by what’s needed in order to submit for reimbursement. Healthcare Reform has something else in mind, something longer term. We’ve begun the effort to turn the Titanic away from an instance of care focus to the longitudinal or continuum of care and the accompanying outcome. I would challenge each provider to examine their standards and to compare the current requirements for documentation of an encounter or patient services against what will be needed to adequately code a claim for ICD-10. I would be surprised if more than half the encounters coded to a bill in a hospital today under ICD-9 will have sufficiently detailed records to do so under ICD-10. The current “system” has been unduly constrained around the ICD-9 code set due to its longevity and focus on the here and now. Very few healthcare professionals can recall anything other ICD-9, nor the challenges that were experienced when it was adopted so long ago.

How to tackle this challenge? A place to start is needed. So how do you identify one? There are processes and tools in the marketplace that enable the leveraging of bills/claims for analysis looking through and ICD-9 to ICD-10 “viewer.” An organization can be enabled to use this approach to develop/refine their ICD-9/ICD-10 cross-reference, understand and examine the most frequent activities and areas of greatest revenue impact, establish priorities for Clinical Document and other standards initiatives, develop, schedule and deliver communication, training and education to the organization and drive the remediation of the supporting technology platforms and systems.

The first step is developing your organizations ICD-10 Cross-Walk. Remember, the published GEMs are fairly ambiguous “off-the-shelf” and need clarification with respect to your organization’s norms. The use of GEMs shouldn’t include on-going operations unless a partner is late in compliance and you have no choice. Even with a well-vetted cross-reference, much is still lost. Many organizations are dependent on a mix of EHR, Billing and BI solutions, each needing to use the Cross-Walk in its own way. A good solution facilitates the distribution to the point of consumption and, as needed, can provide an audit trail when use of the Cross-Walk is required in one of those urgent situations.

Long term, there will be an ability to derive benefit from the efforts required to comply with ICD-10. I would suggest that the refocus and refinement via Clinical Document Initiatives will drive better quality billings out the door, reduce your receivables with quicker reimbursements, reduce rework, particularly the amount of time lost when billing has to go back to the clinical folks for clarification, and, lastly, the diagnosis code will now be infinitely more useful for analysis and measurement, with an eye toward outcomes and the long-term well-being of the population.

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