Countdown To ICD-10

Compiled by Scott Westcott, Contributing Writer

After repeated delays, it now appears ICD-10 will become a reality Oct. 1. As the clock ticks, healthcare providers are focused on testing and preparing physicians and staff for the changes.

When it comes to ICD-10, healthcare providers couldn’t be blamed for adopting an “I’ll-believe-when-I-see-it” mindset. After all, the ICD-10 deadline has been delayed twice already, and some are suggesting we skip over ICD-10 and wait to implement ICD-11. That said, most in the industry think this time the deadline is for real. Bolstering that belief is the fact the House and Senate passed the Medicare Access and CHIP Reauthorization Act, which repeals the Sustainable Growth Rate Formula, but does not include any ICD-10 delays.

Most healthcare providers are now working under the assumption that it’s not a matter of if ICD-10 will be a reality, but when. At hospitals and medical practices large and small, the focus is on preparing for a new coding set that promises to be more complex than the existing system.

IT plays an essential role in the preparation process, as providers leverage new technology and solutions in advance of the change. Recently, Maranda Wilson, senior application analyst with East Alabama Medical Center, shared her perspective on getting ready for the Oct. 1, 2015 go-live date.

Q. How did last year’s ICD-10 delay impact your preparation efforts?

A: At East Alabama, we were ready last year, so when we heard of the delay by Congress we used it to our advantage to look for ways to be even more prepared. We viewed it as one more year to test to determine if there is anything we may have missed. So we were actually excited by the prospect of more time. In particular, we used the time to do additional testing with our vendors just to make sure everyone we do business with was prepared for the transition too. We deal with deadlines every day and never know for sure when a project will go live, so it is best to just keep focused on being prepared and not pay too much attention to delays that might occur.

Q. Since you are already on track, what are your top priorities?

A: Right now, our top priority is communicating and working with our vendors to make sure they are on board. We have about 30 vendors we work with, and we have completed successful testing with 24 of them. If a vendor isn’t on board by October, the changes will still occur. We don’t have full control over this — we just keep pushing them and are confident we will be well-positioned with all of our vendors when October arrives. Another priority is the education we will provide to our staff and physicians. For that, we just need to finalize the last few pieces of the puzzle.

Q. Where do you still have work to do?

A: Even before we were sure the delay might be approved, we continued planning and never stopped working toward our goal. We kept going as if the go-live date was October 2014. And when the delay did officially occur, we did not slow down. We added to what we were able to do to prepare. We have done mock cutover events to make sure we are ready and looked for areas that might need improvement. These mock events are the closest thing to the real go-live experience, so we can identify any issues that might not be as apparent during the routine planning process.

Q: What aspect of your preparation has been the most challenging, and what concerns you most about the pending ICD-10 transition?

A: The biggest challenge has been vendor readiness, mainly because, to a great extent, it is out of our control. We send data to and receive data from numerous vendors every day, so it is critical they are ready and have a plan. One of the big questions with ICD-10 is whether or not the commercial payors are ready. The bigger payors have a plan, but it is difficult to test with the smaller payor companies. I think this is a big unknown throughout the entire country. We are doing our best to make sure our vendors are prepared along with us. We meet internally on a weekly basis to discuss this, and from these meetings, we plan our approach with the vendors we are still having issues with. This includes conference calls, emails, face-to- face meetings — whatever we can do to keep communications open and continue to make progress.

Q: What technologies have been instrumental thus far in your ICD-10 transition strategy?

A: We are using Cerner as our main hospital EHR, and they have provided the Cerner Interrogator app solution, which pinpoints everywhere we have an ICD-9 code and red flags it. Without that Interrogator, it would be very hard to have a starting point for preparing for the cutover and the precompliance steps that need to be taken. Interrogator is capable of sorting through tons of data and can locate ICD-9 codes anywhere in the current system. Cerner’s cutover and precompliance plan walks us step-by-step through what we will face the night we go live.

Q: What third-party support will you leverage to facilitate your ICD-10 transition?

A: We use a third-party coding company, and I anticipate the need for more coding support. My role is IT-focused, but we have six other teams involved that may rely on third-party support to one degree or another. ICD-10 is much more complex than ICD-9. For example, if there is one code for a broken right arm, there could be multiple codes for that injury with the new coding system. It is like learning a different language and it is going to generate a lot more data, so there will need to be additional support.

Q: What processes will you need to modify before the October ICD-10 transition?

A: Processes definitely will change. We are currently working with Cerner to deploy a solution called Diagnosis Assistant. This solution will be very helpful for providing step-by-step guidance for our end users. It does the “digging” for you and then identifies a specific code for ICD-10. We also are working with clinical documentation specialists who can work with physicians to make sure the proper forms and documents are filled out correctly so we get the proper reimbursement.

Q: What advice would you offer other healthcare providers as the ICD-10 transition date looms closer?

A: Test everything you can test, and then test again. It also is important to make sure you have strong buy-in and support from leadership. One of the biggest reasons we have stayed ahead of the game is we have a steering committee that provides great support. Get the right people involved from leadership, get the physicians involved, and get the end users involved. Create a plan, document the process, and stay organized. Also, talk to people at other health systems, and don’t hesitate to reach out for help.