By Lee Ann Bryant, Associate Product Manager, HealthStream
Many think ICD-10 is only a coding problem, but the true challenge of ICD-10 is the need for increasing specificity and granularity in documentation in order to receive optimal reimbursement, meet all reporting requirements and most accurately reflect the level of care provided.
The term “Clinical Documentation Improvement (CDI)” has been used in the healthcare information management (HIM) industry for decades, yet never has it played a more crucial role than it does right now or that it will in years to come. The speed with which physicians adapt to reimbursement documentation requirements and guidelines has a direct impact on the rate of improvement of an organization’s overall workflow quality and productivity and also its ability to enhance cash flow and receive appropriate revenues for work performed. The upcoming conversion to ICD-10 makes this even more important. Improving CDI workflow processes to advance documentation quality and accuracy is of paramount importance as organizations prepare for the ICD-10 environment and the other challenges that lie ahead in the near future.
Documentation has always been necessary for the communication between the providers caring for a patient. But the need for increasing specificity has evolved along with industry trends.
Current Challenges and Trends
As the healthcare industry continues to evolve, there are global drivers and industry trends that are creating ongoing challenges:
- Increased government reform: With initiatives like the Accountable Care Act, Meaningful Use, Pay for Performance and National Agency Reporting, never before have healthcare providers been so exposed to the public on the quality of care they provide.
- Globalization: Travel and migration, prevention of epidemics and medical tourism are creating new challenges to the healthcare industry.
- Aging population: People are living longer and, as a result, more complex healthcare is needed, coupled with shrinking reimbursement.
- Economic recession: The healthcare industry is being asked to provide better quality but with less resources; facilities have less money to spend on innovation and providers continue to consolidate.
- Growth of data: The healthcare industry is rich in data but information poor; as medical knowledge grows, there is an increased need for comparative data, however EMRs are not built to analyze data.
As a result of these trends, the challenge is to reduce costs while enhancing the quality of care. Specific challenges include:
- Quality: Provide consistent and accurate documentation that provides the specificity necessary for ICD-10and reduces exposures for fraud and abuse.
- Financial: Reduce labor costs, denials and DNFB while optimizing reimbursements.
- Strategic: Create clinical data integration to support IT, HIM and financial goals.
- Human Resources: Resource management monitoring, outsourcing and role consolidation all create unique challenges, in addition to the need to educate employees not only on ICD-10 but on other initiatives like MU, value-based purchasing, etc.
This white paper includes:
- The Evolution of CDI
- Current Healthcare Challenges and Trends
- The Need for Increased Specificity and Granularity in Documentation
- The 3 Main Groups affected by ICD-10: Physicians/Providers, CDI Specialists and Coders
- Key Processes Related to CDI
- The role Technology will play in supporting a successful CDI program of the future
Download the White Paper Here.
By Lee Ann Bryant, Associate Product Manager, HealthStream
With small and medium practices in mind, CMS has put together the following checklist of ICD-10 tasks, including estimated timeframes for each task. Depending on your organization, many of these tasks can be performed on a compressed timeline or performed at the same time as other tasks. This checklist is designed to provide a viable path forward for organizations just beginning to prepare for ICD-10. CMS encourages those who are ahead of this schedule to continue their progress forward.
Planning, Communication, and Assessment -- Actions to Take Immediately
To prepare for testing, make sure you have completed the following activities. If you have already completed these tasks, review the information to make sure you did not overlook an important step.
- Review ICD-10 resources from CMS, trade associations, payers, and vendors
- Inform your staff/colleagues of upcoming changes (1 month)
- Create an ICD-10 project team (1-2 days)
- Identify how ICD-10 will affect your practice (1-2 months)
- How will ICD-10 affect your people and processes? To find out, ask all staff members how/where they use/see ICD-9
- Include ICD-10 as you plan for projects like meaningful use of electronic health records
- Develop and complete an ICD-10 project plan for your practice (1-2 weeks)
- Identify each task, including deadline and who is responsible
- Develop plan for communicating with staff and business partners about ICD-10
- Estimate and secure budget (potential costs include updates to practice management systems, new coding guides and superbills, staff training) (2 months)
- Ask your payers and vendors—software/systems, clearinghouses, billing services—about ICD-10 readiness (2 months)
- Review trading partner agreements
- Ask about systems changes, a timeline, costs, and testing plans
- Ask when they will start testing, how long they will need, and how you and other clients will be involved
- Select/retain vendor(s)
- Review changes in documentation requirements and educate staff by looking at frequently used ICD-9 codes and new ICD-10 codes (ongoing)
For the full ICD-10 Implementation Guide for Small and Medium Practices, click here.
If you would like more information on how HealthStream and Precyse can help your organization prepare for ICD-10, click here.
As the healthcare industry draws closer to the go-live date, ICD-10 remains a polarizing topic among healthcare professionals. While some healthcare organizations are actively preparing for a strategic rollout, others are, more or less, bracing for impact. In April 2012, the Centers for Medicaid & Medicare Services (CMS) extended the ICD-10 (the International Classification of Diseases, tenth revision) implementation deadline to October 1, 2014 at the request of some physicians, hospitals, and other industry stakeholders. Since then, the American Medical Association (AMA), in partnership with other groups, has urged CMS to eliminate ICD- 10 implementation altogether due to the significant administrative and financial burden it imposes on physicians. There is no sign this will happen, however, or indication of any further postponement. In fact, the acting CMS Administrator, Marilyn Tavenner, has recently stated, “Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10. Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments.”
ICD-10 Complements Our More Advanced Healthcare System 
There are many differing opinions concerning the transition to ICD-10. But, in reality, ICD-10 is necessary to all levels of a technologically progressive healthcare system. Given the magnitude of change happening in the U.S. healthcare delivery system, ICD-10 is a natural and necessary advancement that will address the critical gaps and operating flaws inherent in ICD-9, which was developed over 30 years ago. Since then, healthcare science and technology have greatly advanced, making ICD-9 inadequate to deal with the advances in healthcare. Moreover, the content of the ICD-9 Clinical Modification (CM) was not designed to be used as a data system for disease management, nor was it intended to support reimbursement of medical services. ICD-9 is an antiquated classification that has a puzzling mixture of code descriptions—some very specific, and others that are so broad they fail to even identify the site of the disorder. Today, we have a system that does not always fully capture the severity of our patients’ illnesses, which prevents physicians from receiving full credit for the care performed in quality reporting.
Implementing ICD-10 is a Physician Challenge. Focusing on ICD-10’s Benefits is Important.
To be sure, implementing ICD-10 is a major undertaking for all healthcare professionals, who are faced with many other challenges, including meeting the requirements of Meaningful Use legislation. ICD- 10 compels greater specificity in documentation practices; it also involves a new coding classification system and an increase from 17,000 to more than 140,000 codes. It is estimated that ICD-10 implementation costs will range between $83,000 and $2.7 million, depending on the healthcare organization or physician practice size, according to the AMA. The Advisory Board Company calculates that the three-year incremental impact of ICD-10 could range from $2.5 to $7.1 million for a typical 250-bed hospital, with coder productivity decreasing by close to 20% and physician productivity taking a 10% to 20% hit due to significant increases in queries.
This white paper includes:
- Clinical Roots: How Physicians Shaped ICD-10
- Why Physicians Should Care About ICD-10
- How ICD-10 Data Will Benefit Physicians
- What’s the Physician Return on Investment (ROI) for ICD-10?
- Case Study: Applying ICD-10 to Crohn’s Disease
- A Guide to Taking Control of ICD-10
- A List of Major ICD-10 Documentation Changes
Download the White Paper Here.
By Lee Ann Bryant, Associate Product Manager, HealthStream
The decision has been made to move forward with your ICD-10 education and training, but the transition process is just beginning. Some lingering questions might be…
- “Where will we look for our education?”
- “How will we manage all of these changes while ensuring our employees are getting the education required?”
- “What resources are out there than can help us on this journey?”
While improving documentation is at the forefront, it is a mere fraction of what facilities must factor in to this evolution. Adapting to and managing change, providing training and on-going testing, and revenue planning – these are all aspects that must be considered and will feel the impact of the transition to ICD-10. Aside from the actual education, there is so much to learn!
With our growing Resource Library, see how HealthStream and Precyse are quickly becoming your thought leaders when it comes to managing such a transition – from beginning to end. Here you will have access to webinars, white papers, articles, course demos and pricing requests and more!
Click here to check out HealthStream’s ICD-10 Resource Library, and see how it can help you with the ICD-10 journey today!
The transition from ICD-9 (the International Classification of Diseases, ninth revision) to ICD-10 codes is quickly approaching. Originally, the U.S. healthcare industry was required by the Department of Health and Human Services (HHS) to switch to ICD-10 codes by October 1, 2013. However, there now has been a final adjustment by the Centers for Medicaid & Medicare Services (CMS) to extend the ICD-10 implementation deadline to October 1, 2014. The extension was a reaction to intense pressure from the American Medical Association (AMA), hospitals, and others who reported that they need more time to implement the extensive changes.
Why ICD-10? Better Healthcare Outcomes and Patient Safety.
The overhaul is long overdue in light of the vast changes in the U.S. healthcare system since ICD-9 was first released more than three decades ago. During that time, there has been a dramatic rise in chronic conditions, compounded by an aging baby boomer population. Moreover, the last decade has witnessed a national movement to improve quality outcomes and patient safety. Now, government and private payers are demanding to know more about patient care and outcomes information as they roll out aggressive pay-for-performance (P4P) programs, many of which are already tied to reimbursement rates and bonuses. ICD-10 will provide updated medical terminology and a new level of detail about diseases and clinical procedures in today’s climate of intense healthcare reform.
ICD-10 is Just One Among Competing Priorities for Hospitals
As deadlines loom, many hospital leaders admit their organizations aren’t prepared for the ICD-10 transition. In fact, only 26 percent of organizations were part-way through ICD-10 preparation, according to a July 2011 survey of healthcare leaders. Lack of readiness could lead to significant challenges, considering that ICD-10 is on par with the magnitude of HIPAA and Y2K. It’s not a surprise that hospitals are lagging behind given their push to comply with other multimillion-dollar government initiatives, including the roll out of electronic health records (EHR) projects that meet “Meaningful Use” criteria and qualify for financial incentives under the American Recovery and Reinvestment Act of 2009.
Our white paper, The Race is on for ICD-10 Implementation, was written by HealthStream's Christian Oliver, Associate Vice President for Catalog and Courseware. The paper details:
- How ICD-10 Compliance can Support Innovation
- The Risks of Non-compliance
- ICD-10’s Impact on Hospitals
- How Focusing on Education Can Put Hospitals in the ICD-10 Driver’s Seat
- How to Build an ICD-10 Training Program
- The Impact of ICD-10 on Physicians
Download HealthStream's Free ICD-10 White Paper White Paper.
Learn more about HealthStream's ICD-10 training solutions from our partner, Precyse.
Earlier this week, HealthStream Training Partner and ICD-10 Expert Precyse issued a press release advising clients and prospects that the proposed HHS delay is an opportunity for healthcare organizations to further prepare for the coding transition.
Full text of the press release is below:
Precyse Advises Providers to Continue ICD-10 Preparations in Spite of CMS Delay
Delay provides opportunity to refocus, prepare, train and get it right.
April 9, 2012–Health and Human Services (HHS) Secretary Kathleen G. Sebelius today announced a proposed rule that would delay the compliance date for the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) from Oct. 1, 2013, to Oct. 1, 2014.
When HHS originally announced its intent to delay ICD-10 on Feb. 16, 2012, Precyse carefully reviewed the implications of the announcement and the need to advise its more than 1,000 clients who relied on its management, staffing and technology solutions and professional advice in health information management matters. Precyse advised its clients to stay the course and continue their ICD-10 preparations, and continues to advance that position.
"We're telling our current and prospective clients that now is not the time to procrastinate. This delay provides them the opportunity to refocus their efforts and get it right," said Chris Powell, president of Precyse. "Precyse believes this delay will allow providers the time they need to improve their clinical documentation processes and build a strong foundation for process improvement. In addition, the delay allows payers to prepare for the change and enables providers to focus on technology implementations and more thorough testing with their vendors."
Clinical Documentation Improvement (CDI) Program:
Precyse believes that now is an excellent time for providers to increase their clinical documentation training programs for physicians and other caregivers. Provider Action Item: Target high volume specialties in your organization that will be most impacted by ICD-10 and train those physician specialists in proper documentation while training the coding team on accurate coding; then, move to the next specialty for training.
Process Improvement Program:
The proposed delay also offers the provider an opportunity to assess the flow of their information across their organization and develop a plan to address gaps through process improvement and technology. Provider Action Item: Develop workflow platforms and applications that allow healthcare providers to do their jobs more efficiently and effectively.
Training and Development:
Take this time to not only invest in the training of coders but also intensify the training for those who will use the data. Provider Action Item: Perform side-by-side ICD-9 and ICD-10 coding analysis, assess the documentation and coding gaps of coders and other caregivers and target training based on these findings.
"Precyse is an innovation company that listens carefully to our clients and prospects; every day we challenge ourselves to come back to our clients with solutions that solve their business problems while improving patient care and outcomes," Powell continued. "We don't believe that an ICD-10 implementation delay changes our goals. We pledge to our clients and future prospects that we will never stop innovating and improving even in the midst of very challenging times."
Learn about HealthStream's ICD-10 Training Suite from Precyse.
It’s become apparent that there will likely be a delay in the ICD-10 implementation deadline beyond the original October 2013 date. This leaves many healthcare organizations asking themselves: Should IT Department and staff move forward with a planned ICD-10 implementation? Our partner Precyse supports and operates Healthcare Information Management (HIM) and coding departments for a number of hospitals; we asked them how providers should be preparing and responding. Should they move ahead with implementing ICD-10 and all the necessary training?
As an answer, Chris Powell, the President of Precyse, recommends that organizations continue to move ahead and take advantage of some additional breathing room in the following ways:
1. Improve Documentation. Increase your clinical documentation training programs for physicians and other caregivers. You should develop processes, guidance and support for improved clinical documentation. If you improve documentation skills, you will create obvious financial and non-financial rewards: fewer denials, reduced audit issues, etc. Why? Patient care benefits from more complete chart notes and improved data for analysis and comparison.
2. Enhance Training and Development. Invest in ICD-10 training for coders and data users. Additional training is ideal in anatomy, physiology, and pathopharmacology, as well as related understanding of coding system logic and principles. This should yield a better case mix index for hospitals, improved coding compliance, increased retention, and better new coder recruits eager to develop and perfect their skills. Side-by-side ICD-9 and ICD-10 coding comparisons can allow you to assess documentation and coding gaps and target training to them.
3. Give Process Improvements a Strong Foundation. Develop a plan to address information flow gaps through process improvement and technology. Use systems that streamline the clinical documentation process. ICD-10 provides better data about patients and their treatments, as well as vast opportunities for improving how data is captured and processed. This is crucial in a fully automated EMR environment. The goal is for the health care information management/information technology community to use its skills to innovate for clinicians. We must develop workflow platforms and applications that allow health care providers to do their jobs more efficiently and effectively. We do not want to add more time and complexity to an already burdensome process.
HealthStream offers ICD-10 training from our partner Precyse. Recognizing that ICD-10 changes require widespread education initiatives beyond just the coding population, Precyse, a leader in health information management (HIM) services and technologies, has developed specific learning tracks to meet all of your ICD-10 training and education needs. Designed by some of the most experienced coders, clinicians, and HIM professionals in the industry, the Precyse method dissects the system and provides education to each of the over 40 impacted populations. From coders and physicians to case managers, nurses, and administrative staff, the Precyse ICD-10 Training Solution Suite will prepare your facility and staff for this transition so that they are productive and successful on day one.
Learn more about the Precyse ICD-10 Training Suite.