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Successful ICD-10 implementation needs governance, end user buy-in

A smooth ICD-10 transition requires the support of senior management, which controls the purse strings, as well as end users, who must see the value of the extra work they must do.

ICD-10 implementation needs executive sponsorship as well as multidisciplinary sponsorship across all departments the new coding language will touch. That's not easy, noted Deborah Neville, director of revenue cycle, coding and compliance for Elsevier. Just identifying the stakeholders involved with ICD-10 in a health care organization can be a daunting process.

This process comes as the health care industry faces a tough road to ICD-10 implementation by Oct. 1, 2013, as discussed at last month's American Health Information Managers Association's AHIMA 83rd Convention and Exhibit. This article, the third in a series, explores the challenges that providers face as they race to meet the ICD-10 deadline.

Neville recommended that providers conduct three gap analyses to get a handle on how far-reaching the ICD-10 transition will be and how much work needs to be done to make the jump from ICD-9.

  • Assess software systems. This analysis must be forward-looking, as many facilities will at least consider bringing online computer-assisted coding solutions to help cope with ICD-10 claims.
  • Determine who in the workforce needs to deal with ICD-10 codes and how some staffers' job descriptions may change during the transition. For example, some projections show that coding staffs will expand by up to 20% for ICD-10, Neville said, and there may not be outside help to meet that need. Cross-training coders may provide the answer. Consider training inpatient coders to do outpatient (or vice-versa), current procedural terminology (CPT) coders to do ICD-10 and so on.
  • Assess education needs and determine the knowledge gaps that will need to be resolved during the ICD-10 implementation process. Survey staff to understand what they know now. Set milestones and means to measure their progress toward meeting them.
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Putting together a detailed plan with such concrete data -- and remaining positive, not intimidated, about ICD-10 -- will paint a picture that senior leadership can comprehend and also make them more likely to provide implementation leaders with the resources to get the job done, Neville said. The process can also clarify a physician's role in using ICD-10 codes to provide more detailed care and diagnosis documentation.

To get physicians on board with ICD-10 education and the new procedures that come with its implementation, sell the benefits in terms they can understand. This includes gathering data to help researchers create more effective, detailed standardized care plans that will eventually improve patient outcomes. Stay away from justifying their participation in negative terms -- "it's mandated" or it's "only for payment."

If you don't expect your physicians to code, then don't teach them coding.
eborah NevilleDirector of revenue cycle, coding and compliance, Elsevier

Above all, be realistic about how much responsibility your organization is putting on physicians to manage the ICD-10 transition, Neville said. In addition, avoid the mistake that many hospitals are making when it comes to ICD-10 education-- giving physicians too much detail.

"If you don't expect your physicians to code, then don't teach them coding," Neville said. "They certainly need to have awareness of what the coding system is, but it's much better to be able to show them different scenarios and 'this is how you document it.'"

While physician participation will be needed at certain points in the claims process, it's up to coders -- with help from senior leadership, if necessary -- to open those lines of communication.

"[Physicians] went to school to treat patients," Neville said, adding that senior leadership needs to back up their coding staff by validating the importance of their roles to clinical staff. "It's up to the facility to say, 'If we really need to have a clarification on something, there's an importance behind that question.'"

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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