ICD-10 Is Two Years Away; Will You Be Ready? (Part I)

Monday was t-minus two years to when all healthcare providers will be required to turn the switch from ICD-9 to ICD-10. And while 24 months may seem far in the future, it isn’t. For those who have yet to begin their ICD-10 migration project, what follows is a project plan outlining the steps you can expect to take between now and Oct. 1, 2014.

This timeline has been adapted from recommendations by HIMSS and American Health Information Management Association as well as others.

In brief, your migration project will look something like this:

Preliminary Phase (Now – October 31, 2012)

Phase 1: Assessment
Financial impact assessment (Nov. 1, 2012-March 31, 2013)
Staff/Partners, processes, and technology impact assessment (Nov. 1, 2012-May 31, 2013)
Training assessment (April 1, 2013-June-30, 2013)

Phase 2: Design and Implementation
Business process changes (June 1, 2013-Dec. 31, 2013)
Internal Testing and Validation (June 1, 2013-March 31, 2014)
External testing and Validation (June 1, 2013-Sept. 30, 2014)

Go Live (Oct. 1, 2014)

Follow-up and Evaluation (Oct. 2, 2014 – ongoing)

Today’s article covers the preliminary and assessment phases. Tomorrow’s article will cover the design and implementation phase, go-live, and the project follow-up and evaluation.

Preliminary Phase
As with any large project, there are certain steps your organization must take before the real work begins. First, the project needs a sponsor or champion, the higher up in the organization the better. For a project with the potential impact of ICD-10 conversion, it would be folly to have a project sponsor who, at the very least, was not a direct report of your CEO.

The project will also require a capable project manager, and for an initiative of this magnitude, it should be someone who in the past has commanded the respect of all departments within the organization and who has project management experience. If your organization has no one with PM experience, look outside. If you do outsource project management, make absolutely certain that individual is paired with someone in your organization who, as stated before, has earned the respect of those in other departments.

Assemble a project team of stakeholders in the project that includes key individuals from coders, IT, revenue cycle, and clinical staff. The preliminary phase is also the time to hire an ICD-10 migration consultant if you plan to do so.

When should you start your preliminary phase? Start now, if you haven’t started already. Many organizations are finalizing their capital budgets for Fiscal 2013, and you certainly don’t want to be caught short. Migrating to ICD-10 is a big job and will change the way many of your staff and partners works.

Phase 1: Assessment
The assessment phase is to identify who has to do what when so you can build your project plan, identify how your workflow will change, and design your business processes and technology landscape.

Financial impact assessment

insidePatientFinance covered this step in depth in another article, which you can find here.

Staff/Outsource Partners, Processes, and Technology Impact Assessment

This step is a survey of your organization’s current staff/outsource partners, business processes, and technology landscape that touch ICD-coded data in any way. This includes the staff/outsource partners and systems that directly use ICD-9 today and those that are affected by its use, notably those downstream in the workflow. The objective of this phase is to produce a report that identifies who or what will be affected by the migration.

HIMSS/AHIMA has created the following list of the people, processes and technology that will be affected, which is great place to start. Remember that some on this list may be outsource partners, and as they are outside your organization’s direct control, you will also be responsible for acquiring their readiness plans, identifying potential costs of the migration, and identifying areas to minimize operational disruptions.

People

Coders. Must learn new codes, manage increased queries;
Physicians. Adopt new ways of documenting in the record;
Clinicians. Enhance clinical documentation in the record;
Information Technology. Mnage increased workload with more scarce resources;
Financial Management. Learn new codes, manage reduced revenue cycle productivity.
Business Office. Understand new system upgrades/changes to billing system, clearinghouse, etc.
Practice Management. Review implementation plans and potential impact of system changes (case flow disruptions, increased costs, etc.)

Processes Affected

Technology. Reporting, data entry, data warehouse, decision support, research;
Revenue cycle. Pre-authorization, eligibility, echeduling, admitting/registration, charges, coding, claims/billing, collections/follow-up, payment posting, denials management, payer contracting; education/training;
Patient care. Clinical documentation, quality improvement, case management;
Financial management. Business analytics, modeling.

Technology

Information system applications (commercial and in-house developed);
Contracts for commercial information system applications;
Interfaces; Inputs (forms & file imports);
Outputs (reports & file exports);
Biomedical devices;
Data repositories.

Training assessment
During this step you must conduct skill assessments of of your staff that will be affected by the ICD-10 migration and identify what training will be necessary.

Again, what follows are affected people, processes, and technology identified by HIMSS/AHIMA:

People

Staff from pre-registration through billing will require different types of education;
Medical staff and other clinicians may need documentation education to facilitate complete ICD-10 coding.

Processes