Instead of using complex mathematical equations full of Greek symbols to explain queuing theory as it relates to ICD-10, I’m going to use an analogy we can all understand: traffic jams. When ICD-10 claim arrival rates remain the same and the time it takes to code each claim increases, the claims process will back up like the freeway at rush hour.
At a recent meeting of finance executives from major hospitals in New England, the consensus was that physician documentation would be a self-correcting problem. The executives’ theory was that if coders were unable to match the documentation to an ICD-10 code, they would simply ask the physician for clarification, which in turn would provide the training.
Let's think about this. How long does it take to get an answer from a busy physician?
I highly recommend we start the training process now, or we are going to be in 5 o’clock traffic when ICD-10 comes down the pike.
To prevent ICD-10 gridlock:
1. Perform a gap analysis to determine where the documentation falls short. This doesn't cure all the issues, but it can make the difference between coming to a complete standstill or moving more slowly than you'd like for awhile.
2. Determine which ICD-9 codes matter most. Usually, they are the codes connected to the most revenue.
3. Determine where these ICD-9 codes are used.
4. Focus education on the gap, and the gap only. Not every physician needs to know how to document every code, and some already know. Segment your physicians and prioritize the ICD-10 training to make sure they know the new codes and documentation requirements for the codes they use most, starting with the codes/documentation connected to the most revenue.
We at Hayes are working with our clients now to resolve the ICD-10 training and documentation issue before it becomes a crisis. Since our clients typically have between 200 and 1,000 providers, they are at high risk for ICD-10 gridlock. Some are counting on various technologies to mitigate the documentation problem. However, if the documentation is lacking, not even Watson will be able to determine the correct ICD-10 code!
Robert Freedman is an advisor at Hayes Management Consulting, specializing in coding accuracy processes and solutions.