You’re conducting internal and external testing. You’re working with vendors to ensure IT systems are ICD-10-ready. Your coders are learning a new coding system while revenue cycle staff updates billing processes. Everything seems to be going well, but a key piece of the puzzle – clinical documentation – can stall your ICD-10 plan’s progression and potentially endanger cash flow after October 1.
While installing IT system updates and revamping revenue cycle processes are critical, clinical documentation is perhaps the most foundational element to ICD-10 success. The new level of detail required in documentation can only be achieved through physician preparedness, yet getting physicians to commit to the necessary training can be difficult.
When you ask any physician why he or she chose such a demanding profession, the answer is inevitably the same: a desire to treat patients and help them become healthier. During the past several years though, physicians have added multiple other initiatives to their agenda. They’re learning new technology to achieve Meaningful Use, adopting new behaviors to engage with patients, participating in the Physician Quality Reporting System (PQRS) and transitioning to value-based reimbursement.
In the midst of these many demands, ICD-10 may be taking a back seat. During these final months before Oct. 1, healthcare organizations can take four steps to make sure their physicians are thoroughly prepared for ICD-10.
1. Sell ICD-10’s financial and clinical value The healthcare industry has been bombarded with ICD-10 messages eliciting fear: Coding errors and denials will be at an all-time high. You stand to lose a great deal of revenue. These messages, of course, have merit. But what about the positive side of ICD-10? After all, it’s the global standard for classifying diagnoses. Endorsed by the World Health Organization (WHO), it is used in most industrialized countries throughout the world, leaving the U.S. behind the curve.
With ICD-10, more specific medical documentation will provide a clearer and more accurate depiction of the patient’s health. This accuracy will help payers and will also reduce opportunities for misinterpretation by auditors and other third parties. As a result, organizations may be able to avoid or prevail a Recovery Audit Contractor (RAC) review and other audits.
Clinical benefits are numerous, too: the greater level of clinical detail in medical records can promote better, more aligned care among a patient’s many clinicians. Physicians can also use analytics to gain insight into population health and update protocols accordingly. ICD-10 also gives more detail about adverse events, complications and hospital-acquired infections. Promoting these clinical benefits alongside the financial can motivate physicians to escalate ICD-10’s importance in their full to-do lists.
2. Prioritize what physicians need to know the most Considering they’d rather be caring for patients, it’s natural for physicians to be frustrated with the new demands on their time. Being empathetic – both in your attitude as well as your ICD-10 plan – can go a long way when asking for more of their time. For instance, by determining your most frequently used codes, you can focus their training on the diagnoses that have usage and will likely have the greatest revenue impact. You can research your EHR to find common clinical diagnoses or use tools created for this purpose such as the ICD-10 Analyzer™, which provides a snapshot of frequently used and high revenue-producing codes. Physicians realize learning ICD-10’s detailed and extensive system can be time-consuming; therefore, they’ll likely appreciate a manageable training plan that allows them to focus their efforts.
3. Illustrate the changes – and their impact Some physicians may still be unconvinced that ICD-10 is any different than an annual ICD-9 update. Convince them by showing a few examples of your organization’s frequently used ICD-9 codes, how they map to ICD-10, and the deeper, richer and broader information that will be required by the updated codes. This exercise can illustrate two points: First, ICD-10 is more than just a diagnosis code update and therefore has a substantial learning curve. Second, the new level of detail in clinical documentation can facilitate enhanced, efficient and coordinated care via more informed patient care decisions and data for initiatives related to standardized protocols, value-based care and population health.
4. Leverage ICD-10 efforts for other priority initiatives With many initiatives vying for physicians’ time, it may be helpful to leverage your ICD-10 clinical documentation review for other strategic priorities as well. This will not only allow you to make headway in multiple projects, but also show physicians you’re being mindful of their time. Reviewing clinical documentation with your physicians is a best practice that can reveal whether current coding is adequate while fueling other strategic initiatives such as preparing for value-based reimbursements, reducing the risk of audits and transitioning to ICD-10.
With just months remaining, healthcare organizations have limited working days to prepare for the ICD-10 transition on Oct. 1. Asking physicians and staff to approach the ICD-10 transition with enthusiasm may be going too far. But getting them to see it as a positive change can facilitate teamwork, collaboration and success – and in the long run, help your organization achieve much more than preparedness for a new coding system.
Ken Bradley is vice president of strategic planning and regulatory compliance at Navicure.