Health Language Blog

How to Ensure Your ICD-10 Remediation Plan Is Working Beyond October

Posted on 05/04/15


As your healthcare organization prepares to implement ICD-10 codes you’ll need your clinical and IT departments to develop a remediation plan that not only meets the October 1, 2015 deadline, but ensures that your organization realizes the benefits of ICD-10 implementation far beyond the deadline date.

With limited time and resources, providers who have received training in the ICD-10-CM and PCS code sets know they’ll have to grapple with moving from about 16,000 to approximately 150,000 ICD-10 CM/PCS codes, but this is only part of the story.

The introduction of the expanded alphabet in the code sets has meant that field lengths and available characters are increasing. Additionally, there are substantial changes in the official Coding Guidelines. For example, ICD-9 encounter codes (V codes) for rehabilitation are no longer acceptable as a principal diagnosis and coders are required to assign the medical condition as the reason for the encounter when coding in ICD-10.

Several changes also impact payment information. For example, Anemia with neoplastic disease is sequenced differently in ICD-9 versus ICD-10. Anemia is sequenced first in ICD-9, but malignancy should be the principal diagnosis in ICD-10. Such a change can result in a different DRG weight.

Essentially, ICD-10 increases granularity, which in turn increases the coding options that may change the DRG weight. Several factors can cause a DRG shift including mistakes by coders and inadequate physician documentation. These errors can financially disrupt a providers business and may result in the provider’s team reopening conversations with payers about specific claims.

For these and other reasons, developing a plan to remediate your clinical and IT systems is critical to ICD-10 implementation. An ICD-10 remediation plan offers your healthcare organization an opportunity to improve coding accuracy, enhance clinical documentation and create a more effective financial impact management system across your organization.

A remediation plan also provides a pragmatic approach to ICD-10 conversion work that involves collaboration among team leaders in the financial, clinical and IT divisions of your organization.

As a partner to many healthcare organizations, we’ve noticed that many providers have fallen behind in their ICD-10 projects, especially small to mid-sized providers who lack resources and skilled coders to do the job. These organizations find that it’s too late to pursue a do-it-yourself approach and even purchase a claims analytics product to speed up their conversion timetable.

Other organizations have begun their conversion projects but find themselves burdened with few highly skilled coders, inadequate tools and limited time to complete code analysis, implementation and testing tasks in a timely manner.  

If you’re falling behind schedule, or need to pick up the pace of your project you should consider augmenting your team with services to assist you with ICD-10 conversion work.  In your quest to identify challenges and create a successful conversion plan, we can help jump-start your project by developing a system remediation plan that uses our list mapping and testing services tools.

To get started, here are several key issues you need to consider when working through your remediation plan of action:

You’ll need an ICD-10 systems remediation analysis. This involves assessing ICD-9 code usage across your organization and developing maps to remediate your organizations clinical and IT systems. To ensure a clinically complete translation, consider developing maps designed by applying business and clinical context using SmartGEMS, a proprietary content set that ensures your systems remediation efforts don’t get ‘lost in translation.”  

Implement ICD-10 Reporting Maps. Leveraging the GEMS reimbursement maps isn’t enough to tackle the challenge facing your reporting and analytics projects.  Implementing a 1:1 relationship that minimizing the use of unspecified codes is critical for your organization to realize the benefits of ICD-10 as well as ensure continuity beyond October 1st.

Simulate and Test Your Claims System. To ensure your clinical and IT systems are ready to accept ICD-10 codes, simulate ICD-10 claims before the transition date to support end-to-end system testing. Before testing, providers should identify potential high-risk codes and claims well in advance of the October deadline to mitigate financial risks. Remember that the best way to validate that your remediation analysis is complete is to test your claims system.

As you move past the October deadline, you’ll still need the right tools and services to realize your financial and clinical accuracy goals. To ensure your remediation plans are working beyond October, and to optimize your return on investment, you should consider a post go-live checkup to revisit your remediation plan to ensure your financial and clinical goals are being met.  A typical check-up includes:

Conducting an ICD-10 Financial Analysis. By analyzing DRG shifts based on your new ICD-10 claims, you’ll be able to assess the true financial impact using your ICD-10 code structure. The granularity of ICD-10 codes will enable you to assess the effectiveness of your CDI programs and spot outstanding financial risks with your payers. You’ll be able to base this analysis on either the MS-DRG and/or APR-DRG determination.

Use ICD-10 reporting Maps: As physicians, nurses and financial analysts in your organization adapt to the increased specificity in ICD-10, representing legacy ICD-9 alongside the new codes will be required to support continuity with your reports or quality measures. To accomplish this, leveraging one-to-one maps designed to translate ICD-10 back to ICD-9 will be critical for success.

As you work through your projects always keep in mind that by engaging the right vendor you can raise the quality of your clinical documentation projects, prioritizing coder and clinician training, focusing your dual coding and chart review activities and remediating medical policies and benefit tables for system updates and claim adjudication.

In short, engaging a professional services team with the ICD-10 expertise could be the key factor that helps you meet the October deadline while preparing your organization for ICD-10 success in the years ahead.

Webinar: ICD-10: Leveraging Claims Analytics to Mitigate Risks

Topics: ICD-10

About the Author

Brian Diaz is the Senior Director of Strategy, Health Language, part of Wolters Kluwer, Health. Brian has over 17+ years of leading product and marketing teams for SaaS-based healthcare companies focused on interoperability, data quality, and diagnostic imaging. Brian has a computer engineering degree with the University of Minnesota.