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Don’t Delay ICD-10 Plans, Experts Say

Health and Human Services (HHS) Secretary Kathleen G. Sebelius recently announced a proposed rule that would delay the compliance date for ICD-10 from Oct. 1, 2013 to Oct. 1, 2014.

In light of the proposed one-year delay, AHIMA and Precyse encouraged organizations to remain focused on their implementation efforts.

“Our preference is for no delay in ICD-10 implementation and compliance,” says AHIMA’s CEO Lynne Thomas Gordon, MBA, RHIA, FACHE, “but we are gratified that HHS is recognizing the hard work and efforts already expended in the implementation process and has decided to keep the extension to essentially the shortest period possible—just one year.”   

Thomas Gordon also noted that AHIMA’s call for HIPAA covered entities to continue their ICD-10-CM/PCS implementation was justified when looking at the HHS analysis.  “The transition to ICD-10 is inevitable and remains the future for coding classification systems.  We are sorry to see that our members and organizations following HHS’ initial calendar may suffer from the delay, as will our many higher education colleges and universities that changed their curricula to meet this same requirement date.”

“We are empathetic to the pressures many small providers and practices have meeting the current requirements,” Thomas Gordon says, “but a continued delay and uncertainty in the implementation date is in no one’s best interest.  Further delays in our nation’s efforts to implement electronic health records and information exchange will only increase costs in the long run and result in lost benefits from having health information available where and when it is needed.”

“AHIMA and its component state organizations will continue to be a valuable and comprehensive resource in providing assistance to small providers, practices and others that need support in implementation and training necessary to achieve full compliance,” Thomas Gordon says.

When HHS originally announced its intent to delay ICD-10, Precyse carefully reviewed the implications of the announcement and the need to advise its clients who relied on its management, staffing and technology solutions and professional advice in HIM matters. Precyse advised its clients to stay the course and continue their ICD-10 preparations, and continues to advance that position.

"We're telling our current and prospective clients that now is not the time to procrastinate. This delay provides them the opportunity to refocus their efforts and get it right," says Chris Powell, president of Precyse. "Precyse believes this delay will allow providers the time they need to improve their clinical documentation processes and build a strong foundation for process improvement. In addition, the delay allows payers to prepare for the change and enables providers to focus on technology implementations and more thorough testing with their vendors."

Precyse believes that now is an excellent time for providers to increase their clinical documentation training programs for physicians and other caregivers. Medical coders frequently face incomplete or vague records that are inconsistent or missing information. This results in increased physician queries and a decrease in coder productivity. If this is happening now with ICD-9, it will only worsen with ICD-10, which is far more complex in its requirements for specificity and completeness. It is important that providers take this extra time to develop processes, guidance, and support to improve their clinical documentation. Studies have shown that even minor documentation improvement changes will create obvious financial and nonfinancial rewards: fewer claims denials, reduced RAC audit exposure, improved case mix index, and improved cash flows. Most important, however, is that patient care is improved when chart notes are complete and better data is available for analytics and comparative studies. Providers should target high volume specialties in their organizations that will be most impacted by ICD-10 and train those physician specialists in proper documentation while training the coding team on accurate coding; then, move to the next specialty for training.

The proposed delay also offers the provider the opportunity to assess the flow of their information across their organization and develop a plan to address gaps through process improvement and technology. Precyse advises clients to invest in automated systems that streamline the entire clinical documentation process. ICD-10 is not just about retraining medical coders—it's about capturing better data to create a more complete and useful set of codes, which is crucial in a fully automated EMR environment.

Precyse recognizes the promise of future innovations such as automated speech recognition, computer assisted coding using natural language comprehension, and clinical decision support tools—but also notes that realizing their full promise in the future will require that current users will need to improve the way in which they interact with and use their systems today. Providers should develop workflow platforms and applications that allow healthcare providers to do their jobs more efficiently and effectively.

Take this time to not only invest in the training of coders but also intensify the training for those who will use the data. Now is a great time to improve the basic skills of coders in their ICD-9 knowledge that will also be required in ICD-10. The transition to ICD-10 has pushed healthcare to appropriately invest in training coders as skilled knowledge workers. As part of its own ICD-10 preparations commencing in 2010, Precyse assessed the coding skills of its coders to evaluate their ICD-10 readiness. Precyse found that in order to successfully prepare its coders to become certified in ICD-10, Precyse would need to invest in additional training related to anatomy, physiology, and pathopharmacology, as well as opportunities to improve their understanding of coding system logic and principles.

Precyse invested in and developed comprehensive and multifaceted training programs that can be delivered via virtual webinars or through its online Precyse University, while developing individual training plans for every coder. As Precyse's clients began to deploy these training programs, many have noted improvements in case mix index, improved coding compliance audit results, increased coder retention and satisfaction, and improved coder recruiting metrics for new coder recruits who are eager to develop and perfect their skills. Providers should perform side-by-side ICD-9 and ICD-10 coding analysis, assess the documentation and coding gaps of coders and other caregivers and target training based on these findings.

"Precyse is an innovation company that listens carefully to our clients and prospects; every day we challenge ourselves to come back to our clients with solutions that solve their business problems while improving patient care and outcomes," Powell says. "We don't believe that an ICD-10 implementation delay changes our goals. We pledge to our clients and future prospects that we will never stop innovating and improving even in the midst of very challenging times."

Sources: AHIMA, Precyse