The following is a guest blog post by Daniel M. Flanagan, Executive Consultant, Beacon Partners.
While some organizations have relaxed their approach to ICD-10 readiness given the October 1, 2015 extension, recent polls show that the majority of healthcare organizations remain woefully unprepared. About 60% of healthcare systems and 96% of physician practices have not begun end-to-end testing according to recent surveys conducted by the College of Healthcare Information Management Executives (CHIME) and Navicure, a leading claims clearinghouse. A lack of testing puts the ICD-10 transition at the greatest risk of failure.
ICD-10 readiness planning should remain a top priority because conducting a comprehensive gap analysis and the resulting remediation work will correct system vulnerabilities that will improve revenue cycle performance today. However, systems performance improvement is time and resource-intensive and cannot be achieved at the last minute.
Below are five often overlooked transition planning steps:
- Update and complete your IT system inventory. We have helped several healthcare organizations prepare for ICD-10 and a common vulnerability is the absence of a complete and accurate IT inventory. Nearly one-third of organizations do not keep an inventory, and, of those that do, most are inaccurate. Many contain systems that are no longer in use and fail to reflect new or recently upgraded applications. Only a few organizations have had a complete IT inventory that accurately reflects all systems requiring end-to-end testing. We often discover code-sensitive “orphan” applications and systems implemented by end-users without the IT department’s review and approval, which must be added to the inventory. An accurate IT inventory is critical to determine the extent of testing required, and to budget the time and expense needed to complete it.
- Review the number and functionality of all interfaces. Revenue cycle interfaces often contain the most critical code processing gaps and represent an organization’s greatest transition risk. For example, workflow analysis sometimes reveals unreliable processing of ICD-9 codes by billing system or other interfaces. Extensive remediation is needed after the readiness assessment is completed in such cases. Highly unreliable manual systems are also often used to process code, which impacts work that should be handled electronically. When conducting a workflow analysis, we sometimes find that experienced revenue cycle system end-users disagree about the design and functionality of long-standing systems and interfaces. Friction can arise between end-users and IT application specialists when interfaces do not work or appear not to work properly. Such issues can often be resolved quickly and objectively when a workflow analysis is performed early in the readiness planning process.
- Enlist the support of system end-users early to identify performance gaps and devise solutions. Readiness requires that any system that stores, processes, or uses diagnosis codes be identified and tested. However, it is easy to overlook some important performance gaps. In the majority of cases, end-users can readily identify performance gaps and recommend potential, practical solutions. End-users can also be valuable in identifying potential solutions. Involving end-users as early as possible in transition planning can avert wasted time. For instance CDI, case management, as well as QA operating and reporting systems are heavily code-driven, but can be tough to “see,” especially if work is performed on paper. Enlisting end-users to identify code-impacted systems is a great way to ensure nothing is missed.
- Set a date to begin testing and verify that payers, clearinghouses, IT vendors, and others tied to your revenue cycle are ICD-10 compliant. End-to-end testing is vital to confirm ICD-10 readiness. Without testing, problem areas are not recognized and will not get fixed, which places the transition at the greatest of failure. Request that each payer and vendor confirm system compliance in writing and set a date when testing will begin. In addition, we always recommend that our clients call and, if possible, visit key payers to confirm their readiness. A payer’s inability to commit to a testing date is a warning sign that warrants immediate follow-up.
- Align transition efforts and resources with top priority goals. Transition planning will highlight performance improvement opportunities across a range of systems — including IT, revenue cycle, clinical documentation, quality assurance, and EMR. The variety of performance improvement opportunities sometimes results in an organization creating more goals than needed for a successful transition. Supplemental initiatives can be overwhelming to achieve with restricted resources in a limited timeframe. The key is to identify “mission critical” transition objectives and allocate scarce resources accordingly. Define clear objectives and create a detailed plan to monitor progress for achieving each goal. For example:
- Revenue cycle performance: Create benchmarks and dashboards for Key Performance Indicators (KPIs) that routinely report system performance now and after ICD-10 go-live.
- IT: Validate system interfaces and upgrades, and perform testing to ensure confirmation of claim submission data flow. Testing results will provide valuable guidance to remediation efforts.
- Clinical documentation: Establish a Clinical Documentation Improvement Program (CDIP) to audit provider documentation and coding. The initiative should be designed to provide ongoing training, as well as measure progress while ensuring data integrity, medical necessity, and billing compliance.
Although the deadline may have shifted, healthcare organizations need to stay on track to make the necessary IT and systems changes needed to optimize performance now and in the future.
About Daniel M. Flanagan
Daniel M. Flanagan is a seasoned healthcare executive with 28 years of leadership experience in the health system, physician practice and managed care fields. His primary interest has been performance improvement, especially in revenue cycle operations, improvement plan development and implementation and strategic planning, budgeting and implementation. Mr. Flanagan understands the challenges posed by today’s environment and is experienced in helping clients identify and capitalize upon opportunities to improve organizational performance.