ICD-10 Approach
Approach
QHR and Kforce recognize that your ICD-10 assessment is expected to be a significant undertaking, impacting many operational departments, significant numbers of technology systems (internally and vendor supported), as well as, physicians, other clinicians and coders. We can provide an overview of impacted operations, systems, and personnel across your organization within the scope of our ICD-10 Assessment Readiness Review, specifically:
- Impacted work streams: finance, technology organization, and clinical operations, which includes revenue cycle
- Impacted systems and tools: databases, interfaces, core and ancillary systems, clinical and administrative systems, reporting tools, overall data architecture
- Vended solutions /vendor relationships: payers, outsourced services, vendor supported tools
- Major capabilities required to achieve implementation success: system upgrade, workflow / process redesign, education and training, communication, reporting, documentation readiness
- An extended team of advisors comprised of physicians, ICD-10 specialists, health care reform professionals, health care operations and finance leaders, and technology specialists to advise the you on this complex initiative
We believe a consistent overall assessment framework will deliver a robust, function-specific work plan that can be consolidated into an overall project plan or implementation roadmap. We anticipate that it will take 8 to 10 weeks to complete an Assessment Readiness Review.
Operations
The primary objectives of the Operations Workstream are to:
- Determine the training and education needs for internal and potentially external stakeholders including coders, clinical documentation specialists, physicians, revenue cycle personnel and others
- Identify process changes necessitated by ICD-10 (e.g. patient access)
- Understand the current effectiveness of your clinical documentation process for process design and education purposes
- Develop an operations risk profile to be included in the overall project heatmap.
- Develop a roadmap of all key operations activities and tasks through implementation
- Develop an operations budget of software and/or hardware costs associated with remediation
Information Technology
The primary objectives of the Information Technology work stream are to:
- Identify all systems that need to be remediated or replaced as part of the ICD-10 plan
- Identify system interdependencies for risk assessment and sequencing of implementation activities
- Determine vendor readiness and risks
- Determine hardware implications attributable to the substantial increase in data storage, transmission and user interface
- Develop an IT risk profile to be included in the overall project heatmap
- Develop a roadmap of all key IT activities and tasks through implementation
- Develop an IT budget of software and/or hardware costs associated with remediation
Finance
While not obvious to many, the finance function plays a key role in ICD-10 implementation. The primary objectives of the Finance work stream are to:
- Identify all managed care contracts which will need to contain ICD-10 provisions
- Determine the adequacy of contingency planning for potential disruptions in cash flow
- Identify IT systems used by finance that may require remediation
- Plan for reimbursement rate impact analysis (we believe that the timing of this is in 2013)
- Develop a roadmap of all key finance activities and tasks through implementation
- Plan for potential pay and benefit changes for certain personnel necessitated by tight supplies and / or high demand
- Develop a finance budget of costs associated with remediation
Clinical Documentation Review
Comprehensive and complete clinical documentation will be a basic requirement of ICD-10. Our team can conduct a current state clinical documentation improvement (CDI) review to assess the effectiveness of your current system and to determine process changes or training that may be needed as part of the ICD-10 implementation plan.
Our process starts with a sample of billed and closed Medicare inpatient claims. We will review the claims for:
- Clinical coding accuracy
- Identification of documentation deficiencies leading to missed opportunities for more accurate MS-DRG assignment and clinically appropriate reimbursement
- Quantification of lost revenue from missed clinical coding opportunities
- Quantification of hospital financial risks associated with recovery audit contractor (RAC) initiatives due to medical necessity setting issues and coding
Training and Education
Training and education related to ICD-10 is expected to be significant. Our plan is to canvas department heads of impacted stakeholders as well as physician representatives to gauge the level of training needs.
A coder baseline competency test will also be administered to gauge the level of current comprehension of the coding department so that this may be considered in the training plan.
QHR and Kforce’s training approach and the education roadmap/budget is based on the cumulative outputs of the code assessment, document assessment and interviews of staff (coders, medical staff, CNO). The approach will include any parallel coding recommendations or audits that may be required to successfully manage the transition.