With so many reimbursement considerations to think about with the transition to ICD-10, such as reduced cash flow and an increase in denials and audits, the best defense for healthcare systems is to know what to expect and begin preparing for the changes now.
[See also: ANI session pushes for coding accuracy to achieve quality and performance ratings.]
Greg Adams, president of consulting services at Panacea Healthcare Solutions, Inc., shared this message during an educational session Tuesday at the Healthcare Financial Management Association's ANI 2013 conference in Orlando, Fla.
"Know where you are at today. Your situation might be much different than other organizations," he said. "Data is the key to all of this."
Gayle McHenry, director of patient financial services and health information management at Carson Tahoe Health in Carson City, Nev., and Kim Charland, senior vice president of clinical consulting services at Panacea Healthcare Solutions, Inc., shared their ICD-10 transition plan at Carson Tahoe Health, which has included three important phases to focus their initiatives and keep the momentum going. Carson Tahoe Health is a non-profit healthcare system with 22 locations throughout Nevada, including clinics, a cancer center and an acute care regional medical center.
[See also: ICD-10 delay could cost healthcare industry billions.]
Phase 1: Data analytics and chart selection.
"Choose a data analytics tool, and then process and generate a report set for analyzing your hospital claims to identify potential coding and reimbursement risks associated with the transition to ICD-10. You need report sets for inpatients, outpatients and physicians," said Charland. "Quickly determine your highest reimbursement losses."
Phase 2: ICD-10 documentation and coding audit.
Charland explained that in this phase it's important to trend ICD-10 documentation gaps found by the coding audit by DRG, specialty, physician and financial impact.
"Also trend ICD-9 issues because we still have 16 months left on this system and it's hard to move on if we cannot code correctly in ICD-9," she said. "This phase is an opportunity to improve physician documentation."
Phase 3: Education and training.
"Based on your audit results, you should target ICD-10 education by specialty. From here, present high-level findings to physicians, work with clinical documentation specialists on detailed findings, and begin looking at documentation template revisions," said Charland. "It's important to see what is working and what's not working. The ultimate goal is to customize your training this way."
Adams added that many healthcare system executives seem to be most concerned about educating physicians when it comes to ICD-10, adding to the importance of beginning the three phases of implementation sooner rather than later.
"If you don't start doing all of this soon, all of a sudden the deadline will be here," he said.
[See also: ICD-10 is much more than a coding issue.]