Cortnie Simmons, MHA, RHIA, CCS, CDIP and Managing Director of Education Services for himagine solutions recently sat down for a discussion on ICD-10 implementation plans and what every ICD-10 preparation checklist needs to cover.
Before we talk about ICD-10 Checklists, can you talk about some of the potential risks organizations face as they transition to ICD-10?
CS: There are several risks related to the ICD-10 transition. The most prevalent issues include unprepared processes that need to be changed and amended for ICD-10, the inability to properly assign codes in ICD-10 due to lack of training, documentation issues, and systems that are unable to handle the needs of ICD-10.
How can an ICD-10 Implementation Plan help to minimize the transition risks you just described?
CS: Planning is one of the most important project management and time management techniques for any major project. With ICD-10 being such a large project with many large potential impacts, proper planning is essential. Each organization will have unique areas that need to be addressed due to dissimilar systems, processes, or people. An implementation plan will allow organizations to be thoroughly prepared for the areas that need to be addressed during the transition and accountable for each action item. It should include the action items, responsible party(ies), timelines, and progress updates. It is important that any plan is managed properly and carefully to ensure that risks are identified and action plans and root causes are determined and executed to ensure success.
With that said, what goes into an ICD-10 Preparation Checklist?
CS: In my role as Managing Director of Education Services, I review checklists with my clients all the time. I advise that all organizations gearing up for the transition to ICD-10 create a preparation checklist. Your checklist should include at least 5 items:
1. Create an Education Plan for Stakeholders: Each individual that has stake in the ICD-10 transition needs to be identified within the organization. Once identified the importance will be determining at what level of ICD-10 education is needed for each of the stakeholders. I suggest grouping them into rankings as simple as HIGH, MEDIUM, and LOW. With HIGH being those that need an expert level of training and LOW being those that only need training that will keep them aware of key points of the transition. Once identified it will be important to determine the educational activities that are necessary in order to prepare each stakeholder to be successful in their roles in the ICD-10 environment.
2. Start and Complete Education and Training Activities: Education and training activities should align with the education plan you created. Your start and completion dates should be determined based on other initiatives within the organization. Will you be dual coding? If so, you likely will need to complete education efforts prior to the start so that you maximize your results with proper documentation and coding.
3. Complete Plans for Dual Coding (if your organization plans to Dual Code): Dual coding allows for multiple things. First of all, it is for practice in the ICD-10 environment to ensure that coding and documentation is meeting the standards of what will be necessary. This will allow you to see what additional education needs to be done with coders. In addition it allows coders to get use to coding in the system and increase productivity that will likely suffer in the ICD-10 environment during the transition. Dual coding also allows for an understanding of any reimbursement changes in the ICD-10 system in advance of October 1st. Other things to think about include: How many coders will participate? How much dual coding will be expected? Are they doing 5 records a day or 5 per week? Are you prepared for the decreased in productivity and how will that be handled? Who is reviewing results and providing education on the findings to ensure adjustments and compliance? All of these questions need to be included in the plans as well as monitoring to determine if adjustments need to be made.
4. Determine The Need for Additional Resources: One of the key things that has been discussed over the last few years that we have been moving to ICD-10 is that additional resources may be necessary. This is due to the likelihood that it will take longer to code a record in ICD-10 than in ICD-9. It will be important to make sure that you understand what your productivity standards are today and determine how these will be affected in the ICD-10 environment.
5. Conduct Education and Training Validation Activities: Validation is always important for any training. You want to ensure that your stakeholders have received and grasped the education and training that has been provided. Validation can be accomplished through dual coding however in addition to that you should have a plan in place after October 1st to ensure that proper coding and documentation is being provided. Make sure that you have planned post implementation or transition reviews to be ahead of improper coding, inappropriate, unclear, or ambiguous documentation and potential denials.
No matter where you organization stands on the road to ICD-10, it's important to stay focused on the goals ahead. Although preparation can seem overwhelming at times, your organization can still be ready for the transition with the cooperation of your team and by utilizing outside resources for training where needed. How do you feel about the transition to ICD-10? Learn more about my thoughts on the transition in my previous post ICD-10 Education from a Trainer's Perspective.