As a Regional Coding Director (RCD), I oversee coding staff in multiple facilities in the Southeast and Midwest. In this role, I have the ability to compare and contrast how facilities of varying sizes have prepared for the transition to ICD-10. In addition, my experience as a former HIM Manager has given me a unique understanding of some of the challenges and decisions that management will face in the coming months.
No one really knows for sure what the true impacts of ICD-10 will be. However, I believe we can make some pretty accurate predictions based on the challenges that HIM professionals are currently facing. Here are my predictions for what life after the transition to ICD-10:
Impact on Providers:
Providers, by far, have the most at stake in the transition to ICD-10. The goal for most providers is to undergo the transition without noticeable impacts to level of care and service while reducing delays in revenue and denials.
Unfortunately, as a provider, you can be sure that Increased A/R, delays in revenue and increases in denials and underpayments are almost guaranteed. Even if coders at your facility are dual coding, coding completely in ICD-10 is still untested up to this point. However, you can manage the degree to which these challenges effect your bottom line.
My recommendation to managers is to identify the key individuals that have the ability to act quickly and respond to the new trends. Utilize your auditors, senior coders, and CDI Specialists to respond to denials and compile action plans.
As an RCD, I’ve advised the clients I work with to be proactive about identifying these individuals and establishing a “Plan B” for reconciling denials. This is a challenge that providers can be one-step ahead of with a little thought put into action.
Impact on Workforce:
Productivity Issues: Initial decreases in productivity will be around 40% depending on your system infrastructure. Ongoing productivity levels for many facilities that have been engaged in dual coding have remained at a 20% deficit after several months. This will result in coding backlogs unless you have a plan for additional staff or a vendor partner to help with the additional volumes. A backlog will also be seen in CDI as there will be an increases in queries. Many facilities have put a hold on time off for the month of October to help combat the decreased productivity.
To address the increased queries, a communication plan with your physician team will need to be put in place now and include the reason for the increased volume as well as the expected turn-around time for completion.
Turnover: Staff turnover has been a common theme among many facilities as the job market has grown more competitive. Rumors that many coders would opt to retire have not proven true but turnover between organizations is rampant. Moving towards recruitment and retention incentives to attract and retain talent have proven the most effective. If you have already attracted and trained great coders, now is not the time to lose them.
As a former HIM Manager, I certainly have felt the pain of losing great employees and understand the challenge of finding and retaining great talent. Losing coding talent during the transition to ICD-10 can be a devastating prospect for sure.
As an RCD, I have made in a point to communicate with my team of coders as often as possible. In addition to the recruitment and incentives laid out before them, I know from experience that having support in the field from a fellow colleague can make the difference in day-to-day employment experience for coders. Make sure you are communicating with your team of coders. Be prepared to answer questions or point them toward helpful resources. Your coders are your front-line defense in the transition to ICD-10.
ICD-9 training did not stop at the point implementation, the same will be true for ICD-10. Training will be an ongoing initiative as reimbursement values and denial data is analyzed.
My advice is to include these trainers on your denial team so they can effectively target their communication to the new trends.
One last bit of advice . . . schedule some time off! It’s likely that there will be very little time off in the final quarter of the year. Go ahead and plan a long weekend off in September. Even just a day or two away from the job can help ease your stress and give you the space you need to form a new perspective regarding your challenges.
What are your predictions for life after ICD-10? I'd love to hear from you in the comments.