Guest Post by: Joan L. Usher, BS, RHIA, COS-C, ACE
Medicare Certified Home Health Agencies need to implement their ICD-10 preparedness plans now. This is the single largest change the health care system has seen since the inception of Medicare. Changing to ICD-10 is not a simple coding change: it impacts every department in the organization. Follow these 5 steps to develop your agency’s ICD-10 preparedness plan.
Establish a Steering Committee with key players from major departments. The ease and success of the transition relies heavily on strong leadership support.
Assess the impact on all departments. This step is crucial in determining which items need to be completed pre-ICD-10, including testing of claim submissions with ICD-10 codes, redesign of EHR screen, or paper documents to capture documentation needed. Consider vendor and payer readiness. Determine how to operate dual systems, and for how long. Assess coder’s knowledge of the current coding model. Assess whether the coding model will work under the increased specificity of ICD-10.
Determine which staff members need education, and in how much detail. Start with a general training session on the Overview of ICD-10. Billing staff will need to understand how to read a code while QI staff may need extensive training. Will coding staff need an Anatomy & Physiology refresher? How much education will need to be provided to all clinical staff to ensure they can provide the detailed narrative description of the diagnoses selected? Comprehensive education should occur at least 6 months before going “live”.
Assess the impact on workflow processes when ICD-10 is implemented. Remember, it is not just the coding department but other departments that rely on codes such as billing, prior authorizations/UR. Will productivity be decreased? Expect cash flow to slow due to a delay in the payer’s systems/readiness.
After implementing the changes, determine whether the agency’s case mix has been affected by the coding change. Is staff selecting the correct ICD-10 code based on documentation? Is documentation sufficient to support the code selected?
Preparedness will require a substantial time commitment to understand the scope of the change and how it affects your agency. Adequate planning will allow for a smoother transition. “By failing to prepare, you are preparing to fail.” ― Benjamin Franklin