Stoltenberg Consulting: ICD-10 Brings Expected & Unexpected Challenges

The ICD-10 deadline is less than a year away. That means organizations need to prepare for the transition – and then some, according to Joncé Smith, Soarian Financials Practice Director at Stoltenberg Consulting, a Pittsburgh-based health IT consulting firm.

Sure enough, to get ready for the changeover, which is slated to take place on October 1, 2014, healthcare organization leaders should take many of the same steps that are associated with any major organizational change or technology implementation:

  • Establish a transition team and develop a work plan with timeline that identifies tasks and milestones. 
  • Fully assess how ICD-10 will affect your organization.  Consider first where you use and rely on ICD-9 codes – medical records/coding, billing, authorizations/pre-certifications, physician orders, super bills, encounter forms, clinical documentation and electronic health record (EHR).   Be sure to include effects this change will bring to interfaces of sending and receiving systems and reporting databases or other tools.
  • Communicate the plan, timeline, and new system changes and processes to your organization.  Ensure leadership and staff understand the extent of the effort the transition will require.
  • Set up a budget for software upgrades, license costs, hardware, staff training, revision of forms, workflow changes and risk mitigation.
  • Talk with your payers, billing and IT staff, and software vendors on their state of readiness. Ask your external organizations for a copy of their transition plan with their dates.  Evaluate how each could affect your organization and work plan.
  • Coordinate your ICD-10 transition plans with trading partners.  Evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
  • Include an emergency fund within your budget to cover unexpected costs and possible payer reimbursement delays. This is the largest change ever undertaken to date within the healthcare industry.  You should expect and plan for disruptions in your revenue cycle.
  • Set up timelines and processes for both internal and external testing levels.
  • Create a detailed transition matrix for the transition.  Identify tasks, their owner, start and end dates, entry and exit criteria, predecessor and dependencies.  Consider staffing a support desk, which is specifically charged to help end users with the new code set, for 60 to 90 days after October 1.
  •  Create a risk inventory by department or internal/external function.  Identify the chance it will occur, the impact on the organization, and ways to avoid or mitigate the risk (training, alternate process or build of cash or increased line of credit).  Include risks by vendors and payers. 

Even though taking these steps will help organizations successfully move toward the transition, leaders also need to consider the fact that the transition to ICD-10 is not a typical IT project. All patient centric systems will be affected simultaneously by this change, and they will have to concurrently run both ICD-9 and ICD-10 code sets during the first few months. And, therefore, leaders need to start to think outside the box.  More specifically, healthcare professionals need to take into account the following ICD-10 specific considerations:

* Time is of the essence.  “The project has a definitive, unmovable deadline. Though the date was extended a few months ago, I do not look for that to happen again.  And, to adequately prepare for the change, it should typically take about 20 months. As a result, if organizations are not yet started or are behind in the process, they will most likely need to bring in consultants or ancillary staff to help move the transition to ICD-10 into a higher gear,” Smith says.

*Training needs will eclipse the typical. “While many leaders are concentrating on getting their systems ready for ICD-10, they also need to consider that they will have a large number of end-users who will need to understand the codes.  The composition of this contingency is quite diverse.  Everyone from coders and registrars to physicians and nurses will need training on the new codes.  And, they will all need to be ready to transition at once – on October 1, 2014.  As such, leaders need to start implementing training programs that will reach all of these end-users, which could mean scheduling several training sessions to accommodate the schedules of busy healthcare professionals,” Smith points out.

* Questions (lots of them) will come – and will need to be answered.  “During the transition from ICD-9 to ICD-10, staff members will likely have difficulty finding the correct new codes and understanding the structure of the new codes. Without proper assistance and guidance, this will have a direct and immediate negative impact on the revenue cycle. As such, organizational leaders might want to consider setting up a help desk to answer the deluge of expected inquiries,” Smith suggests.

* The transition will have an impact on multiple IT systems. “You need to prepare your downstream systems. While many healthcare organizations are zeroing in on their billing systems to update ICD-10, the change will also be felt in a variety of other systems including admissions, lab, radiology and pharmacy.  As a result, organizations need to devote the IT resources to make the changes to these systems as well.  The challenge goes beyond the typical single system implementation as it has an impact on multiple systems all at once,” Smith cautions. 

* Organizations won’t be able to wash their hands of ICD-9 completely on October 1, 2014. “Organizations will need to maintain a dual environment for a few months as many of the claims made under ICD-9 before October 1 are likely to bounce between providers and payers before actually being resolved.  As such, providers and payers will still need to be able to work with ICD-9 codes for a few months after the transition,” Smith says.