- Posted by wpcoadmin2018
- On November 9, 2018
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According to the Centers for Medicare and Medicaid Services (CMS), “The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology, and preventive services.”1 The U.S. health care system lags significantly behind in ICD-10 adoption when compared to other industrialized nations. According to the Agency for Healthcare Research and Quality’s (AHRQ) Canada, Australia, New Zealand, and many European and Asian countries successfully implemented ICD-10 over a decade ago. However, the agency notes the US system has lagged behind other country’s efforts in modernizing their coding system.
When combined with other policy efforts to modernize the administrative and information management side of health care such as the HITECH Act (2009) and The Affordable Care Act (2010), the move to transition to ICD-10 dovetails into existing efforts to make collecting and analyzing patient data easier so that it can be used for population health management efforts. By adopting ICD-10, providers can capture more nuanced information about patient health when compared to the older ICD-9-CM system. For example, ICD-10 employs more coding options, incorporating approximately 68,000 available codes (with the ability to add new ones), whereas ICD-9’s 13,000 codes limited the use of additions. Further, unlike ICD-9, ICD-10 supports the use of combination codes (expressed as a simple, single code) to classify multiple diagnoses or a diagnosis of a complication. The updated version also allows coding on multiple diagnoses whereas ICD-9 only allowed a single diagnosis code. ICD-10 also provides an enhanced ability to detect fraud and waste, facilitate reimbursement that is more accurate, and reduce institutional and provider risk through quality monitoring and analysis. Besides its role in increasing providers’ ability to deliver care efficiently and effectively, the enhanced coding system also enables public health surveillance and reporting. With the enhanced ability to monitor the health of patient populations, researchers in private and public health can better track diseases, engage in improved diagnosis of chronic illness, and better understand the underlying causes and complications of disease.
Despite the impending change, a massive number of providers have not adopted the new standard. This resistance to change persists because ICD-9 is inconsistent with current medical practice, the new technology, and preventive services. Notwithstanding, the older codes incompatibility with modern medical practice, the move to ICD-10 is a matter of economic necessity for the health care industry. According to estimates from CMS, another year of ICD-10 implementation delay could cost anywhere between $1 billion and $6.6 billion across the healthcare industry.2 Despite the apparent benefits, industry groups are concerned that the flurry of changes implemented over the last few years has become a significant burden on providers, given all of the other reforms implemented as part of the Affordable Care Act. Despite these reservations, policy makers appear to have set a firm commitment to the October 1, 2015 deadline.
In light of the impending compliance date, early and thorough training is essential for a successful transition to ICD-10. Due to its complexity and granularity, failure to proactively plan and implement an ICD-10 training program well ahead of the transition can cause significant disruptions in cash flow, and could compromise patient care quality. Due to the more complex coding system, providers should consider implementing a well-planned ICD-10 training program immediately in order to mitigate the potential for lost productivity.
In light of the impending ICD-10 transition, what steps can HHAs take to smooth out the learning curve among staff and make the transition to ICD-10 hiccup-free (or as close to hiccup-free as possible)? An effective transition strategy involves shoring up human and technological resources. Put simply, HHAs should think in terms of investing in staff training and establishing or improving their technology infrastructure to meet the demands of the ICD-10 coding system.
The American Health Information Management Association emphasizes in a 2011 article that an active planning and preparation process are vital to a successful implementation to ICD-10. “A smooth, successful transition by the compliance date of October 1, 2013, requires a well-planned and well-managed implementation process. Proper planning and preparation are critical so that organizations can leverage their ICD-10 investments and move beyond mere compliance to achieve strategic advantage.”3 Although published in the early stages of the healthcare system-wide move to ICD-10, this advice still rings true, early and thorough preparation is crucial to minimizing transition-related disruptions.
Effective staff education rests on the foundation of having a clear training plan. Knowing what objectives the staff training should achieve and how your agency will reach those goals provides a clear way to measure progress. It is unlikely your staff will be “ICD-10 gurus” after a few trainings. However, setting attainable goals, whereby your team will come away with a solid functional knowledge of ICD-10, thus enabling them to refine their skills through working ICD-10 on a daily basis.
Learning is hardly ever a linear process in that people learn at different rates often through trial and error. Based on this fact, it was important to create a supportive environment where staff can access knowledge to answer questions on ICD-10 and can obtain continuing education to develop their skills. Continuing education opportunities can come in the form of short topical seminars taught by outsiders or appointing a staff member to become a resident expert on a certain aspect of ICD-10 to lead the training.
Technology and Systems Upgrades
A critical part of preparation your agency for ICD-10 involves evaluating your agency’s information technology system’s ability to handle the new codes. One way to determine this quickly is to contact your
software vendor about their technology’s compatibility with ICD-10. The vendor is in the best position to provide support regarding the steps to take to achieve ICD-10 compatibility. Based on the vendor’s response, information systems will have to be either updated or replaced in order to become ICD-10-ready. With potential software compatibility in mind, it is important to be proactive in auditing your agency’s information technology resources. Without a full functioning information technology system, a company can expect any number of costly delays and lost productivity. Thus having a technology strategy to meet the ICD-10 transition may be the most efficient investment your agency can make in light of return on investment.
Collaborate, Collaborate, Collaborate
The obvious benefits of ICD-10 rest in its ability to provide more nuanced data to providers. However, if the coding quality suffers or different departments or work groups within your agency are not aligned on coding procedures any potential benefits could be negated. Preparing and implementing for ICD-10 is a group activity. It is important to share responsibility across your agency and ensure that all staff can align their coding procedures and are willing to include the vendor in making sure coding quality is maintained.
Reevaluate and Retool
The best-laid plans often are not executed without the occasional snag. The ICD-10 transition falls under this rule as well. If the new coding system is not being implemented as intended it may be necessary to follow up with a post-implementation evaluation to troubleshoot problems, such as claims denials or coding backlogs. If trouble areas begin to appear based that were not present prior to ICD-10 implementation, logic will dictate that something in the implementation process has resulted in this problem. In this situation, troubleshoot the problem by working with staff or external entities until the identified problem is resolved. If a problem repeatedly appears it is possible that corrective action either through additional training, changes in how your information technology is being used or tweaking coding procedures may resolve the problem.
Some may view the ICD-10 transition as a distraction from the business of providing health care services. Yes, it is an inconvenience, but it is an inconvenience that when approached with the mentality that implementing ICD-10 can improve your agency’s ability to provide better and more cost-efficient services. With this upside in mind, an agency who can approach the transition with a well thought out human resources and technology plan can make the best out of a momentous change in the business of health care.