ICD-10 is No Game, Except in This Simulation

The transition to ICD-10-CM/PCS has been described as healthcare’s Y2K due to the depth and breadth of the impact this HIPAA standard will have on almost every component of the healthcare industry—from coding diagnoses to new software deployment to payment changes.

While most industry stakeholders understand the scale of the change, it can be hard to understand and appreciate how all the ICD-10 elements are linked together.

Facilitating and participating in a “gaming simulation” could help to identify and drive home the key lessons about the ICD-10 transition, according to Christine Turner-Rezai, MBA, CPC, CHCO, senior compliance officer at University of Utah.

“It is crucial for all organizations to identify and prioritize their critical business imperatives related to ICD-10, so that their implementation process can stay on track,” Turner-Rezai said. “If not, organization implementation may get delayed or derailed due to competing business imperatives.”

Leveraging an ICD-10-CM/PCS gaming simulation that AHIMA conducted during its 2011 Annual Convention, Turner-Rezai and Spartanburg Regional Healthcare System’s Ginger Boyle will present “ICD-10 Gaming and Simulation: It’s Your Move…” at the 2012 ICD-10 Summit April 16. The presentation focuses on the value of conducting a model and simulation exercise within one’s organization as a method to determine critical decisions, identify and prioritize tasks, and decide who should engage in the ICD-10 transition process.

While model and simulation exercises have traditionally been thought of as something relegated to the military realm, where exercises are used to determine possible combat scenarios and assess potential vulnerabilities, these methods have evolved to support a wide range of industries including healthcare.

Participants at the ICD-10 Gaming and Simulation session during the 2011 AHIMA National Convention identified key tasks in the ICD-10 transition process.

Gaming Definitions

A model is a simplified representation of a system at some particular point in time, used to promote understanding of the real system. A simulation is the manipulation of a model in such a way that it operates on time or space to compress it, thus enabling one to perceive the interactions that would not otherwise be apparent because of their separation in time or space. When employed together these techniques aid in developing a level of understanding of both the interaction of a system’s parts, as well as of the system as a whole.

ICD-10 Simulation Peaks into Future

Both Turner-Rezai and Boyle participated in the ICD-10 transition simulation exercise at last year’s convention. The exercise was conducted by Allison Viola, MBA, RHIA, director of federal relations at AHIMA, in collaboration with Malcolm Hastings, director of global strategy at 3M Health Information Services (HIS). The exercise brought together professionals representing multiple fields affected by the transition, from coders, providers and billers to contractors and compliance officers. (A list of the task force members who participated in the exercise is listed below.)

Having representatives from such diverse healthcare areas allowed the group to gain an in-depth understanding of the full ramifications of their ICD-10 imperatives and decisions.

“Gathering so many stakeholders together shows the insight…of AHIMA,” said Boyle, MD, CCS, CCS-P, a member of the clinical faculty and a coding educator at the Spartanburg Family Medicine Residency Program, based in Spartanburg, SC. “The wisdom and experience gained from this group can then be shared with others to facilitate the transition to ICD-10.”

The participants chose to play out the scenario of an acute care hospital and the filing of a claim for a coronary artery bypass graft. They believed the denial or challenge of such a claim would create significant cash flow issues for the organization.

“The gaming exercise enabled the team to systematically identify critical business imperatives related to the ICD-10 transition and their corresponding action steps,” Turner-Rezai said. “Once identified, we were able to prioritize the action step based on mitigating areas of risk to an organization.”

ICD-10 transition areas the team identified as significant include the generation of clean claims, the ability to meet compliance requirements, the effective support for clinical decision making, and support for population health.

“This exercise helped me get perspectives of other key players in the system,” Boyle said. Participants also identified several external and internal environmental drivers that would typically affect provider entities during the ICD-10 transition, such as other organization initiatives, continued organizational growth, and pressure to maintain up-to-date software.

The simulation exercise brought together professionals from multiple fields affected by the ICD-10 transition, from coders, providers and billers, to contractors and compliance officers.

Key Takeaways

The utilization of similar gaming exercises when planning large-scale initiatives or projects could be highly beneficial to organizations, Turner-Rezai said. Through the course of the gaming and simulation exercise, the group identified several critical concepts for consideration in the planning and implementation process for the ICD-10 transition, from training and documentation improvement to regional and local variations, and the potential impact on reporting measures.

Additional information on this exercise is available in the April 2012 print edition of the  Journal of AHIMA here.

2011 AHIMA National Convention ICD-10 Gaming and Simulation Exercise Participants

Ginger Boyle, MD, CCS, CCS-P
Dwan Thomas Flowers, MBA, RHIA, CCS
Gail Garrett, RHIT
Eileen Guenther, RHIT
Mary Beth Haugen, MS, RHIA
Amy L. Hayes, CMBS, CCS-P, CHA, MBA
Linda Ray, RN
Chantel M. Susztar, RHIT, CCS, CCS-P
Christine Turner-Rezai, MBA, CPC, CHCO
Tracie Vaughn, RHIA

2011 AHIMA National Convention Exercise AHIMA Staff

Jill S. Clark, MBA, RHIA
Kathryn DeVault, RHIA, CCS, CCS-P
Diana Warner, MS, RHIA, CHPS, FAHIMA
Lou Ann Wiedemann, MS, RHIA, FAHIMA, CPEHR
Allison Viola, MBA, RHIA

2011 AHIMA National Convention Exercise 3M Staff

Malcolm Hastings
Todd Wallenfelt

1 Comment

  1. Hi…I’m curious as to what you mean by your steaemtnt that “missed opportunities with MS-DRG’s resulting from inadequate clinical documentation and/or inaccurate ICD-9-CM coding will CONTINUE & ACTUALLY INCREASE under ICD-10-CM/PCS?”What are these missed opportunities?

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