ICD-10 Implementation

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Significance of ICD-10 Transition and Guide for Implementation

A monumental change is marked by ICD-10 code transition across the global healthcare industry. With a massive set of codes, very huge volume of codes is found to have come into effect, making a great positive difference to the healthcare environment in the modern world. The way medical coding is performed has been transformed with ICD-10. Small and medium sized medical practices across the globe need to follow the implementation guide for getting ready to face the changes efficiently.

ICD-10 Implementation - the Financial Part

Small and medium clinics and physician practices may find implementation cost of ICD-10 excessive. Involving around USD 200,000 for small practices and USD 800,000 for medium practices, the costs are really noteworthy. This calls for diligently following the implementation guide.

Phases and Timeline of Implementation

It is essential to develop an effective implementation strategy first, that covers an evaluation of the impact on your specific practice, a budget, and a detailed timeline. Practices need to prudently check with their practice management software vendors, clearinghouse, and billing service providers about their respective compliance plans. Practices that internally handle their software development and billing processes have to plan for their coding/medical records, IT, finance, and clinical staff for coordinating the ICD-10 transition process-related efforts.

Planning for the Implementation
  • Governance establishment
  • Project management structure establishment
  • Risk management establishment
  • Plan for external partners communication
Awareness and Communication
  • Creation of a plan for communication
  • Training needs to be assessed and training plan to be developed
  • Staff meeting for discussing the impact of ICD-10
Evaluation
  • Technological impacts assessment
  • Policy and business impacts assessment
  • Vendor assessment
Functional Implementation
  • System migration strategies identification
  • Technical and business modifications implementation
  • Creating and delivering training
Testing
  • Level-1 internal testing completion
  • Level-2 external testing completion
Transition
  • Establishing and preparing production
  • Go-live environment preparation
  • Ongoing support delivery

The process of ICD-10 implementation related to small and medium sized medical practices categorize the tasks and milestones into the six major phases given below:

Planning

Establishment of project management structure

Enabling leadership to understand the significance and breadth of ICD-10 transition

Assignment of decision-making and overall responsibilities to manage the transition to a committee or a person

Comprehensive budget planning that includes costs related to training and software upgrades

Adherence to pre-defined timeline that suits your particular practice

Governance plan establishment that facilitates communication with all external partners

Ensuring that all stakeholders, internal and external are committed - physicians, vendors, clearinghouses, affiliated medical facilities, and others need to be contacted for determining their plans regarding the transition

Based on your specific practice processes, policies, and systems, additional tasks must be identified

Critical predecessors and dependencies must be identified

Task owners and resources need to be identified

Start and end dates must be estimated

Entry and exit criteria between phases need to be identified

Plan must be updated throughout the implementation of ICD-10 and even afterwards

A process for risk management must be in place

Department-wise or external/internal functions-wise risks must be identified

The chances of a risk occurring need to be identified, along with its potential impacts as well as appropriate ways of avoiding risks. Ways include alternate vendor identification, providing training, and building up increased lines of credit or cash reserves

Risk reduction action responsibility must be assigned - this includes when management must be involved via appropriate channels according to your practice structure

Awareness & Communication

Communication plan creation

Enabling external and internal stakeholders to understand their specific responsibilities towards ICD-10 implementation - the plan has to identify the following:

  • Audiences
  • Stakeholders
  • Issues
  • Messages
  • Timelines
  • Roles and responsibilities
  • Assessment techniques
  • Competence of staff and skill gaps, and ways of tailoring training individuals and user groups
  • Training needs assessment and training plan development
  • Affected team members such as physicians, physician assistants, nurse practitioners, technicians, coders, administrative staff, and vendors
  • Appropriate timing for training and certification
  • The most optimal training methods and approach specific to your practice
  • Staff meeting for discussing impacts of ICD-10 and identifying responsibilities
Awareness & Communication
  • Assessment of policy and business impacts
  • Pre-certification / Authorization
  • Referrals
  • Physician orders
  • Analytics
  • Medical record
  • Patient clinic encounter
  • Patient hospital encounter
  • Research participation
  • Contracting
  • Financial operation
  • Risk management
  • Public health reporting
  • Compliance management
  • Clinical documentation
  • Physician reimbursements
  • Technological impacts assessment
  • Evaluation of vendors
  • Management of Payer relationship
  • Inventory creation - about tools and existing vendors
  • Plan-B identification, if progress is not up to the mark
  • Vendor capability needs to be ensured
  • Acceptance criteria for vendor performance measurement
  • Dependencies and interfaces between systems must be analyzed for avoiding failures arising out of cross-system dependencies
  • Clinical test scenario evaluation development
Testing
  • System testing
  • Basic component / unit testing
  • Non-functional testing of privacy / security
  • Non-functional testing of performance
  • Regression testing
  • Using interfaces
  • Database architecture
  • Code grouping (aggregations) models
  • Hospitals
  • Payers
  • Outsourced coding or billing
  • Health information exchange
  • Test case
  • Test volume
  • Plan for error testing
  • Error checking system for reporting to stakeholders
  • Known issue reporting model
  • Acceptance criteria set
Testing
  • Create and establish production and go-live setting
  • Testing the baseline
  • System vendor conformation
  • Coding accuracy and productivity monitoring with strategies for addressing problems identified
  • Assessment of quality to be continued
  • Ongoing support to be delivered
  • Changes in clinical documentation
  • Changes and revenue cycle processes
  • Payers need to be monitored for interaction issues expected
  • Systems to be monitored and errors must be corrected
  • Contingency plans must be implemented if needed
  • Post-implementation issues to be resolved expeditiously

Providers who use ICD-10 codes can better understand their patient populations and the different conditions that affect them. Better information leads to better and informed decisions! 75Health ICD-10 helps practices and medical service providers to chart immediately with ICD-10 codes with the least efforts!

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