Eight Steps to ICD-10 Success
The announcement of a proposed delay to the implementation of ICD-10-CM/PCS caused a shudder across the healthcare industry in February 2012. Many organizations and providers were well down the path of ICD-10 education and training when the possible delay was announced.
Now that the date’s been announced, some organizations are sticking with their original training plan and budget, and taking advantage of the delay to stretch out the dates and accommodate the 2014 schedule. Other organizations are using the additional year as a time to provide greater training with more practical, hands-on experience. Still others have made the decision to completely stop the ICD-10 implementation process, including diverting resources and re-allocating funds.
In her Monday afternoon presentation “So Much Training, So Little Time: Training the Entire HIM Department in 12 Months,” HRS Coding’s Elizabeth Stewart, RHIA, CCS presented eight steps to planning and providing essential training and education for the “Big C” coders—those individuals whose primary role is either coding or clinical documentation improvement (CDI).
Eight Steps to Coding Success
Step one involves assessing the coding department. Also assess workflow, systems, and other related processes. The transition to ICD-10 provides an ideal opportunity to streamline processes. This may ease the transition to ICD-10. Stewart warned that you should take care to identify your current gaps—they’re not likely to go away with the implementation of ICD-10. If paradigm shifts will be needed in staffing and work relationships, you’ll also need to provide training to support those changes.
Step two is assessing the coder. Stewart asserted it’s important to focus on the true impact areas for your organization. To be successful, the education plan must address areas that are actually needed. “Adult learners will not retain anything they don’t think will be useful to them in the future,” warned Stewart. Assessment begins with their knowledge of the biomedical sciences, including Anatomy & Physiology, Pathophysiology, and Medical Terminology, followed by coding training. She suggested considering integrated assessment and education systems—they may make it easier to create an educational plan and measure the success of training.
Step three is developing a timeline and budget. This is crucial to the overall success of ICD-10 implementation. The timeline should include key milestones related to both education and training. She recommended “working backwards from your destination to determine your path.”
In the budgeting process, multiple factors should be considered:
- Education and training costs including the delivery component of the training. This may include face-to-face training, online training or a combination of several different types.
- Staffing coverage required to maintain the day-to-day coding operations during coder training and during the transition phase
- Re-engineering of the overall coding function. This may include creating a centralized department, utilizing telecommuting or possibly incorporating the pro-fee component into the processes of the department
- Salary increases and retention bonuses in this time of transition for both coding professionals as well as CDI professionals
- Work space changes to support additional staff, and/or remote coding
- System upgrades will be critical to the success of ICD-10 implementation (these may be included in your IT department budget)
- Technical resources, including books and other periodicals
Step four includes getting executive support. Stewart states this step is critical and allows you to “move the strategic bulldozer.”
“You need a senior champion who will be on your side, helping you to get what you need,” she said. Use your timeline and budget to demonstrate both needs and progress.
Step five involves collaboration with the CDI staff and the medical staff. This should be a continuation from what is currently done using ICD-9-CM. If it’s not already being done, the transition to ICD-10 is an opportune time to begin a regular dialog with the medical staff. The one year delay provides additional opportunities to work with physicians on specific documentation requirements related to both ICD-10-CM and ICD-10-PCS.
Step six includes defining the need for back-up coding resources (during training and transition). Consider internal PRN pools, external agency/contract coverage. If you use an external agency, verify their qualifications and capacity.
Step seven includes both education and training. Develop role-based training, as much as feasible to ensure the plan includes what the coder needs to know on a daily basis. Sample role-based training categories include Physician Practice/Professional Fee Coders; Hospital Outpatient Coders; CDI specialists; and Hospital Inpatient Coders. Consider different learning styles and settings, and pick what will work best for your environment whether that be online self-directed learning, lunch and learn sessions, staggered eight-hour days, or “boot camp” approaches.
Finally, step eight calls for monitoring the education and training for staff moving towards implementation and post-implementation. Ongoing education and training will continue following ICD-10 implementation as opportunities for improvement are identified for each individual. The final goal is getting back to the original level of productivity.
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