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Time's slipping away: Late-stage ICD-10 implementation checklist tips

As healthcare-wide implementation of ICD-10 closes in, AHIMA convention speakers offer a checklist of tips for minding those last-minute details.

ATLANTA -- ICD-10 implementation will happen throughout U.S. healthcare facilities on Oct. 1, 2014. There will be no further deadline extensions, Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner said. Theoretically, most healthcare systems should be in the middle to late stages of multi-year testing and implementation plans by now.

So what i's are left to dot and t's are left to cross during this home stretch before hospitals and payers flip the ICD-10 switch? A panel of speakers at the 85th American Health Information Management Association Convention & Exhibit offered a handful of tips -- some of which you might not have considered -- to attendees.

Here's a checklist, combining presentation points from Christine Armstrong, principal at Deloitte Consulting LLP; Danielle Reno, Sutter Health ICD-10 program director; Virginia Sullivan, ICD-10 program director for Scripps Health; and Chris O'Dell, revenue cycle manager for Lucile Packard Children's Hospital.

  1. Remember, one failed test can blow a timeline. While your implementation schedule may seem to be on time at the moment, be prepared for late vendor delivery of ICD-10 software support or a failed payer data exchange test. Testing, failed testing, retesting and validation can completely wreck your timeline, so if they occur, be ready to devote extra resources in order to catch up.
  2. Review payer contracts and make sure ICD-10 verbiage is included in the next revision. First, review which ones are expiring between now and Oct. 1 and confirm those payers will renew with ICD-10 written into the terms. Then review the ones that aren't due to expire before Oct. 1 and get them amended to reflect the ICD-10 change.
  3. Test coders, docs using your own claims. Many ICD-10 training modules use dummy claims to teach physicians and coders the new language and new documentation methods. Use material from your own claims to train coders and physicians to give them practice on real-life scenarios they'll encounter after ICD-10 goes live.
  4. Get a picture of what will happen by analyzing October 2013 claims data. What claims do you expect will be the first ones you'll roll out? Look at October 2013 data to create a seasonally adjusted forecast of what October 2014 claims will look like. Then, work with payers to see what the prism of their acceptance/denial engine will do to those same claims coded in ICD-10.
  5. Consider using risk assessments if you haven't already. An ICD-10 risk assessment should not only consider technology and payer problems that might occur, but risks to finance such as cash flow, investment to correct denied claims, extra coder support to fight denials, software technical support, and ultimately denied claims for which payment is never recouped. Being prepared for problems will help you solve them more nimbly.
  6. Make go-live July 1. The ultimate test environment is go-live. Many providers will have to submit claims in both ICD-9 and ICD-10 for a few weeks or even longer as smaller payers work out their system snafus. Turn on this "hybrid" environment using both coding languages three months early so you can anticipate and correct problems on your end of the transactions.
  7. If you're testing with payers, make sure computer-assisted coding systems (CACS) are online first. Even if payers are demanding claims-throughput testing, if you're implementing a CACS, don't bother with payer testing until that's up and running.
  8. Increase staffing. In anticipation of ICD-10 problems, forward-thinking providers are staffing up IT departments, clinical documentation specialists and coding staff. Ignore this trend at your own facility's potential revenue-cycle peril.

That recommendation for increasing coding staff should not be taken lightly or shrugged off by the chief financial officer. "[Expect] about a 50% decrease in coder productivity," Armstrong said. "And that can go on for six to nine months, or up to a year depending on how quickly your staff catches on to ICD-10."

Let us know what you think about the story; email Don Fluckinger, news director or contact @DonFluckinger on Twitter.

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