H.I.M. On 10: ICD-10
In For the Record’s August 2015 eNewsExclusive, I offered up predictions for assessing coders in ICD-10. Now with implementation behind us, coder assessments have become even more important and critical.
Specific benefits of conducting ICD-10 coder accuracy and productivity assessments include the following:
- Identify specific coder knowledge gaps and areas of team weakness.
- Target areas for coder refresher training and physician education opportunities.
- Recognize individual coder strengths for case assignment and coder specialization.
Read the full article for proven strategies to efficiently and effectively assess coder performance in ICD-10.
In the July issue of the Journal of AHIMA, our company experts authored an article entitled Closing the Loop on Quality and CDI. The article explores the relationship between clinical documentation and quality reporting.
Here are three strategies highlighted in the article that can be used by hospitals to build a quality-driven CDI team.
- Rebrand CDI as clinical documentation integrity. Quality-focused CDI is all about the integrity and accuracy of the data. Make sure providers understand CDI is not about increasing revenue for the hospital even though it may be an indirect byproduct of quality enhancement.
- Align CDI with coding and quality. In many organizations, CDI, coding, and quality staff report to entirely different departments. Even though silos may exist, organizations should strive to break down the walls that prohibit collaboration and communication. Consider forming a task force including the HIM, nursing, quality, and CDI departments, and a physician champion.
- Be mindful of CDI specialists’ limitations; successful programs are a team effort. As CDI specialists are asked to also review quality elements, consider hiring additional staff or implementing technology tools.
To read the full Journal of AHIMA article, click here.
CMS completed its second round of ICD-10 end-to-end testing April 27-May 1, and the results are in. The good news is that more than 88% of the 23,138 ICD-10 test claims passed with flying colors. Only 2% of rejections occurred as a result of ICD-10 coding errors. In fact, CMS cited various non-ICD-10-related errors as being the culprit of most testing denials.
These errors include incorrect NPI, Health Insurance Claim Number, or Submitter ID; dates of service outside the range valid for testing; invalid HCPCS codes; and invalid place of service.
This second round of testing comes in the wake of an almost equally successful first round held January 26-February 3, 2015 during which 81% of claims passed through CMS’ billing systems. I summarized two learning points for HIM and revenue cycle in my earlier blog on first round testing.
HIM input invaluable in testing efforts
Successful ICD-10 testing would not be possible without HIM’s expertise and input behind the scenes. HIM professionals provide the manually ICD-10-coded claims that make testing possible. They also help identify the types of cases most critical to an organization—those that would leave the organization financially vulnerable if not vetted thoroughly.
Two ways to continue momentum
CMS’ end-to-end testing provides valuable insight into potential denials and productivity bottlenecks. The final round will take place July 20-24, 2015. The agency plans to review applications for its last round of testing and select participants by June 12. Here are two ways to continue testing momentum and remain fully engaged in your organization’s ICD-10 journey.
- If your organization participated in the past, consider testing again to verify remediation of any errors identified with your systems, clearinghouse, documentation, coding, or billing claims process during the first round.
- If your organization hasn’t yet participated, now is the time to do so. HIM can lead the charge and rally support for this important opportunity!
Lend a helping hand to physicians
Finally, another survey was conducted by NueMD, a popular physician software company and results were released. In this survey, four specific areas of physician business concern were identified. This chart highlights areas where HIM professionals can help support their organization’s owned, managed and affiliated physicians over the next four months.
Training and education by specialty is a key area for HIM support in the days ahead. Certainly this summer is an important time for all HIM experts to “lean in” to ICD-10!
Last month, I wrote an article, “50 Shades of Coding: Tips for Taming ICD-10 Knowledge Loss”, describing the impact of ICD-10 delays on coder training, knowledge and accuracy, and provided practical tips and techniques to get coder knowledge back on track in 2015.
After two delays and two years of uncertainty that has left most clinical coders woefully behind in ICD-10 knowledge and hands-on experience, coders are being pulled away from ICD-10 training and pushed back into ICD-9 production.
Like most coding companies and hospitals, we invested a significant amount of time and money into training our coders for ICD-10. Over 150 coders were trained and tested in late 2013 and early 2014. After the most recent delay, these coders were shifted back to ICD-9.
To counter knowledge loss and accuracy issues, the following three steps should be taken today:
- Reduce the amount of workload shift.
- Ramp up learning and focus for ICD-10
- Continually assess coders in preparation for Oct. 1, 2015 and identify specific strengths and weaknesses.
The degree of knowledge knowledge loss caused by the 2014 delay is significant. Prepare accordingly by retraining coders by placing a great deal of emphasis on hands-on practice with real cases. Apply ICD-10 theory to the real world through dual coding and use dual-coded cases for testing, measuring productivity and gauging accuracy. It is recommended that ICD-10 mentoring programs begin now and continue for the next 12 months.
For more practical tips and techniques, read the full article here: ICD-10 Monitor: 50 Shades of Coding: Tips for Taming ICD-10 Knowledge Loss
Over 2,500 healthcare organizations participated in the first of three rounds of end-to-end testing for ICD-10 during January 2015. Different from acknowledgement testing conducted last year, last month’s end-to-end testing performed by CMS is expected to yield important insights for hospitals to know and understand as the October 1, 2015 deadline approaches.
According to CMS, the results of January testing will be made public in late February 2015. At this point, two things are certain.
More healthcare provider organizations needed for end-to-end testing
The need for more testing participants became clear when CMS extended the deadline for healthcare providers to volunteer for the April 2015 round of end-to-end testing. At this point, volunteer organizations have been selected are should be receiving notifications from their MACs and Common Electronic Data Interchange (CEDI). A third round of testing will occur in July 2015.
Washington is wary of another failed technology implementation in healthcare following the well-publicized, botched rollout of Healthcare.gov. Healthcare providers can do their part in making the ICD-10 transition a success by actively preparing and testing with CMS. Now is the time to get involved and get testing.
Test with real cases and dual coding
End-to-end testing is most effective and accurate when conducted using real cases that have been dual-coded in both ICD-9 and ICD-10. The use of real, dual-coded cases (versus generic equivalency mappings-GEMS) sheds light on important documentation gaps, coder knowledge deficiencies, system interface failings, and claims submission flaws. Furthermore, testing with real cases provides valuable feedback for CDI and coding teams. It identifies an organization’s specific vulnerabilities for revenue loss and claims denials under ICD-10.
Optimism High for Meeting October 2015 Deadline
My personal optimism level for ICD-10 is high. Six of the seven witnesses speaking during the February 11, 2015 U.S. House Energy & Commerce Subcommittee on Health hearing were ICD-10 proponents. Together they rallied together in support of meeting the October 1, 2015 implementation goals.
Time will tell, but based on a myriad of activity, progress and positive coverage, it appears that 2015 will be our year!!!!!
When hospitals ratcheted up their coding resources in 2014 for the implementation of ICD-10, they also began evaluating international coding options for back-up support. Some providers directly contracted with offshore coding teams. Others partnered with U.S. based coding companies with International presences to “test the waters” in India, Philippines, Israel, the Caribbean and more.
Certainly, the one-year delay gave all parties additional time to experiment, evaluate and experience what Thomas Friedman originally coined “Globalization 3.0.” In his best-selling book,The World is Flat: A Brief History of the Twenty First Century, Friedman clarifies, “I did not mean that the world is getting equal. I said that more people in more places can now compete, connect and collaborate with equal power and equal tools than ever before.” That’s why an Indian in Bangalore can take care of the office work of American doctors or read the X-rays of German hospitals. And considering the existing coding shortage, this is a good thing.
Most hospitals have dipped their toes into international waters and worked with offshore coding teams. What have we learned? Here are three “global” points to keep in mind:
1. You Open Up the World
Once you open up access to the world, the world has access to you. For healthcare providers, overseas opportunities are not just about purchasing a service; they are also about providing professional expertise.
From IT directors to administrators and managers, U.S. healthcare professionals are migrating to other countries for higher pay, deeper incentives and to gain international experience. Even U.S. healthcare organizations, such asCleveland Clinic andJohn’s Hopkins, are now service providers for global hospitals.
TAKEWAY: Your best coders will probably explore overseas opportunities.
2. Organizational Structures are Changing to Achieve Triple Aim
New executive mindsets around HIM have emerged now that records are electronic. Coding departments are transitioning to revenue cycle. HIM operations are being pushed to IT. Hospitals are leaning their organizations as one step towards achieving the Triple Aim. Stronger integration of coding, revenue cycle and clinical documentation improvement (CDI) is essential to streamline processes and reduce redundancy.
According toForbes, the healthcare sector is now the “nation’s largest private-sector industry sector, accounting for 13 percent of the total U.S. workforce.” But according to aJune 2014 Modern Healthcare article, fewer hospitals have positive margins and most are facing financial squeeze with a total of 61.3% of organizations in Modern Healthcare’s analysis witnessing operational margin deterioration over the previous year.
Certainly, executive attention must be focused on new and innovative ways to develop staff while also balancing quality and cost. The coding department is no exception. Correct departmental alignment leans your organization. New coder staffing, reporting and development models must be considered.
TAKEWAY: Oversees coding resources should be seriously evaluated to avoid ICD-10 coding backlogs, address ICD-10 coding productivity decreases, and also mitigate the already existing shortages of qualified coders.
3. Healthcare Becomes Business
Most hospitals are still in the mindset of healthcare being a service. With accountable care, pay-for-performance and healthcare reform, new business-minded experts will succeed. In HIM particularly, it’s time to shift from a crisis management director to a strategic business developer. ICD-10 is HIM’s moment to shine and grab the reigns of dramatic industry change.
In order to garner executive respect and complete their ICD-10 journey, HIM professionals must become strategic thinkers, communicate at all levels, and accurately identify exact costs and benefits for every step of ICD-10; before, during and after implementation.
TAKEWAY: Plan properly. Level up your business acumen. Take the time to track, manage and revise your ICD-10 budget every step of the way.
ICD-10 Fuels Change
Now’s the time for HIM Directors to learn more about offshore coding services under the helm of their trusted U.S. coding companies.U.S. led coding teams with operations in India, Philippines, Israel and the Caribbean stand ready to receive cases and code charts in ICD-9, ICD-10 and CPT.
The 2014 delay in ICD-10 implementation extended training time for offshore teams and provided additional opportunities for testing. These teams are technology-savvy, they are established components of U.S. based coding companies, and they are a valuable resource that should not be overlooked.