By Lee Ann Bryant, Associate Product Manager, HealthStream
According to a recent survey conducted by the Workgroup for Electronic Data Interchange (WEDI), an industry leader on the use of Healthcare IT to improve the exchange of healthcare information, healthcare facilities as a whole are not on track for a smooth transition to ICD-10 on October 1, 2014. Close to 1000 industry participants were surveyed on readiness in February of this year, including 778 providers, 109 health plans, and 87 vendors.
Stanley Nachimson, Director of the NCHICA/WEDI (North Carolina Health Information and Communications Alliance) stated “… it has become clear that many entities postponed their work until much later. It remains to be seen how this postponement will affect the progress to compliance. Indications remain that significant numbers of industry participants have a considerable amount of work to do in a very short time.”
Based on survey results, there was a shift in ICD-10 timelines across all facility types. Some contributing factors to this slow progress include the change in compliance dates, competing internal priorities and other regulatory mandates.
Some key results from the survey include: 
- Almost half of the health plans expect to begin external testing by the end of this year. In the 2012 survey all health plans had expected to begin in 2013.
- About half of the providers responded that they did not know when testing would occur and over two fifths of provider respondents indicated they did not know when they would complete their impact assessment and business changes.
- About two thirds of vendors indicate they plan to begin customer review and beta testing by the end of this year. This is similar to the number who expected to begin by the end of 2012 in the prior survey.
“The survey results show that projected timeframes for testing have shifted and many organizations will not begin this task until 2014,” said Jim Daley, WEDI Chairman. “Because of the magnitude of ICD-10 it is critical that organizations complete their remediation efforts as quickly as possible in order to allow adequate time for testing.” (For a full copy of WEDI’s letter to CMS, click here.)
It is critical that providers get started with their training right away. CMS has provided numerous timelines and checklists based on facility type and size. To access the ICD-10 Implementation Timelines and Checklists, click here.
If you have not yet begun your training for ICD-10 and want more information from HealthStream on the ICD-10 Solution Suite of products we offer through our partner, Precyse, click here.
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
With so much uncertainty and overwhelming change associated with a transition to ICD-10, how could we ignore the potential risks involved?
The Centers for Medicare and Medicaid Services (CMS) offers some helpful steps that facilities can use to properly prepare and hopefully mitigate the risks involved with such an important, yet daunting, conversion. Hospitals and other healthcare organizations are advised to:
- Establish a transition plan. Outline the steps your practice intends to follow to comply with ICD-10 requirements. Establish milestones to keep your practice on track. Share your transition plan with your EHR and practice management system vendors and billing services. Talk to them about how you can set up testing before the deadline.
- Communicate with your vendors regularly; encourage them to take action now to avoid reimbursement delays. Talk to your vendors about making sure your practice management systems will be able to handle ICD-10 transactions. Ask them about their schedule for training your practice's staff on the system changes. Make sure you and your vendors allow ample time for testing ICD-10 systems.
- Identify everywhere that your practice uses ICD-9. Any function where you currently use ICD-9 will be affected by the transition to ICD-10. By taking a look at where you use ICD-9, you will see where you need to be prepared to use ICD-10 codes.
- Plan for staff training. Decide who needs training, what type of training they need, and when they need it. Anyone who will test ICD-10 systems before the transition will need training in advance so they can perform meaningful testing. Others who use ICD codes can be trained 6 to 9 months before the October 1, 2014, transition.
- Network with peers. Talking with your peers in other practices can help you to identify best practices and opportunities for sharing resources.
- Set up an emergency fund to cover potential cash-flow disruptions from claims processing. If you think you might have a serious disruption in getting claims processed after the transition, having a cash reserve on hand could be helpful.
- Process ICD-9 transactions before the deadline. Get claims with ICD-9 transactions processed before the deadline to avoid facing a major backlog after the October 1, 2014, ICD-10 transition.
Click here to see how HealthStream and Precyse can help you mitigate these risks by having you and your staff ready to succeed from day 1.
By Lee Ann Bryant, Associate Product Manager, HealthStream
Although nearly all healthcare providers are aware of the October 1, 2014 deadline, studies show that most are unprepared for this transition. Recognizing that these changes require widespread education and planning initiatives beyond just the coding population, CMS (Centers for Medicare and Medicaid Services) provides a timeline for preparation between now and the “go-live” date of October 1, 2014.
Transition and Testing (March 2013 to September 2014 )
- March 1, 2013 – December 31, 2013: Conduct high-level training on ICD-10 for clinicians and coders to prepare for testing…e.g., clinical documentation, software updates (ongoing)
- April 1, 2013: Start testing ICD-10 codes and systems with your practice’s coding, billing, and clinical staff (9 months)
- Use ICD-10 codes for diagnoses your practice sees most often
- Test data and reports for accuracy
- Monitor vendor an
d payer preparedness, identify and address gaps (ongoing)
- October 1, 2013: Begin testing claims and other transactions using ICD-10 codes with business trading partners such as payers, clearinghouses, and billing services (10 months minimum)
- January 1, 2014 – April 1, 2014: Review coder and clinician preparation; begin detailed ICD-10 coding training (6-9 months)
- Work with vendors to complete transition to production-ready ICD-10 systems
Complete Transition/Full Compliance (October 1, 2014)
- Complete ICD-10 transition for full compliance
- ICD-9 codes continue to be used for services provided before October 1, 2014
- ICD-10 codes required for services provided on or after October 1, 2014
- Monitor systems and correct errors if needed
While this timeline is a good high-level guide for what your organization should be focusing on now, it does not provide guidance on the day-to-day task of educating all necessary staff for this transition. With more than 50 affected populations in a healthcare facility, the ICD-10 transition is a great one and shouldn’t be taken lightly. ICD-10 is coming – are you ready?
For more information on how to get your organization and staff on track and ready to succeed from day one, click 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!
By Lee Ann Bryant, Associate Product Manager, HealthStream
The impending shift to ICD-10 comes with many challenges as well as opportunities. The old adage "don't believe everything you hear" certainly stands true as we rapidly approach what has come to be seen as a healthcare phenomenon. While a successful transition does require a tremendous amount of education and training, our focus should remain on the benefits to both the employee as well as the organization.
In a recent article, Thomas Ormondroyd of Precyse Learning Solutions has debunked some of the most prevalent "myths" associated with ICD-10 that ultimately have led to a lack of enthusiasm around its implementation.
Myth #1: The increase in documentation required by ICD-10 will involve a huge amount of added content to the medical record.
Reality: In most cases, ICD-10 will require just a few more words per condition documented.
The good news is that physicians already know this information as part of the clinical story based on their encounters with the patient or the encounters reported to them by ancillary departments - all they need to do is make sure that they actually document this information. And physicians may already be aware of the new terminology required due to changes in clinical practice. A good example of this is asthma. Physicians already should be using clinical criteria to establish the stage of the asthma; ICD-10 now allows documenting and coding of these stages.
Myth #2: All codes in ICD-10-CM will be complex, seven-character codes.
Reality: There are three-character codes in ICD-10-CM, and the most common code length is four characters; therefore, in many cases, the ICD-10-CM code actually will be shorter than its ICD-9-CM counterpart.
Click here to continue reading this article: "Dispelling Some Myths About ICD-10."
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.
HealthStream's partner Precyse, a leader in health information management (HIM) technologies and services, leading up to the AHIMA 2012 Annual Conference and Exposition, released the following open letter from Chris Powell, President of Precyse, to all healthcare colleagues regarding the announced ICD-10 final rule. The open letter, answering a critical question at this hour: "How do we reinvigorate our planned ICD-10 implementation roadmaps?" is available below. AHIMA attendees are encouraged to visit Precyse (Booth #236) or HealthStream (Booth #437) to continue the ICD-10 conversation.
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Healthcare Colleagues,
On August 24, the CMS published a rule finalizing the compliance deadline for converting to the ICD-10 system of diagnostic and procedural coding to Oct. 1, 2014 from Oct. 1, 2013. HHS said the extra time would allow healthcare organizations - especially small organizations - adequate time to get prepare for the changeover.
"By delaying the compliance date of ICD-10 from October 1, 2013, to October 1, 2014, we are allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing," HHS said in the rule. "By allowing more time to prepare, covered entities may be able to avoid costly obstacles that would otherwise emerge while in production."
Precyse has not stopped preparing for the implementation of the new coding rules and stands ready to support and meet the needs of nearly 1,000 clients - many who rely on our management, staffing and technology solutions - through their training and implementation process. Because Precyse not only supports, but actually operates, entire HIM and coding departments for some of these clients, here are our recommendations:
1. Documentation. Increase your clinical documentation training programs for physicians and other caregivers. You should develop processes, guidance and support for improved clinical documentation under ICD-10. Improved documentation skills – even minor changes such as more specificity in their notes – create obvious financial and non-financial rewards: fewer claims denials, reduced RAC audit exposure, improved case mix index, and improved cash flows. Most important for all of us, patient care is improved when downstream clinicians can review more complete chart notes and better data is available for analytics and comparative studies. Target high volume specialties in your organization most impacted by ICD-10 and train these specialists in proper documentation while training the coding team on accurate coding; then, move to the next specialty for training.
2. Training and Development. Act now to invest in the training of your coders AND those who will use the data. Improve the basic skills of your coders in ICD-9 areas that will also be required in ICD-10. The transition to ICD-10 has pushed healthcare to appropriately invest in training our coders as skilled knowledge workers. As part of our own ICD-10 preparations, Precyse assessed the coding skills of nearly 300 coders on our staff to evaluate their ICD-10 readiness. We found additional training needs related to anatomy, physiology and pathopharmacology, as well as opportunities to improve their understanding of coding system logic and principles. So Precyse invested in and developed a comprehensive and multifaceted training program that can be delivered via virtual webinars and our online Precyse University, while developing individual training plans for every coder. This investment has paid off for Precyse clients handsomely, yielding a better case mix index for hospitals, improved coding compliance audit results, increased coder retention, and attracting new coder recruits who are eager to develop and perfect their skills. So we recommend that you perform side-by-side ICD-9 and ICD-10 coding, assessing the documentation and coding gaps and target training based on these findings.
3. Build a strong foundation for process improvement. Assess the flow of your information across your organization and develop a plan to address gaps through process improvement and technology. Invest in automated systems that streamline the entire clinical documentation process. ICD-10 was never just about re-training medical coders–it was and is about having better data about patients and their treatments, affording vast opportunities for improvement in how data are captured and processed. This leads to a more complete and useful set of codes, which is crucial in a fully automated electronic medical record environment. Today, inefficient, labor-intensive workflows abound, whether involving clinical information inputs such as dictation and transcription; service approvals, coding, physician queries, and other myriad facets involved in billing for services; or abstracting and analyzing quality indicators to improve patient care. We also recognize the promise of future innovations such as automated speech recognition, Computer Assisted Coding using Natural Language Comprehension™ (NLC), and clinical decision support tools – but know that realizing their full promise tomorrow requires that we improve how current users interact with and use their systems today. Those of us in the health care information management/information technology community must use our 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.
About Precyse ICD-10 Training via HealthStream
Precyse has developed specific learning tracks, available through the HealthStream Learning Center, 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.
Benefits of Precyse ICD-10 Training
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Maximize Reimbursement Potential
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Decrease denials and rejections
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Reduce queries and delays in billing
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Be ready for the ICD-10 deadline on October 2014
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Improve coding, billing, and reporting compliance
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Ensure documentation and coding success on Day 1
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Decrease Training Expense
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Streamline training process
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Offer specific education for each of the impacted populations
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Standardize training across the organization
Program Features
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Four core ICD-10 training tracks plus multiple specialty tracks to address the needs of all of your impacted professionals
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Precyse Animation Library illustrates anatomy and procedures in cutting-edge animations
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Precyse Arcade offers 100+ games to increase learning
Recommended For
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IT/IS
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Ancillary Providers
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Finance/PFS
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Patient Access
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Non-Physician Providers
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HIM Staff
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Senior Management
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Outpatient Coders
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Inpatient Coders
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CDI Professionals
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HIM & Coding Managers
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Physicians
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Nurses
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Case Managers
Click here to learn more about Precyse ICD-10 training