ICD-10 Goes live October 1st 2015

Finally! After all these years, one announced delay by CMS and hundreds of thousands of hours of work effort, we are on the doorstep of ICD-10! I had the privilege of working on this project from planning to execution at my healthcare provider and it was something like the equivalent of the Y2K project. We reviewed the application inventory, reached out to the vendors to understand their plans, worked with our EMR vendor to understand the way in which we needed to see which records in the system that we need to update and then reviewed those to understand what the work effort would be. We identified our team members, put together a project charter, a master test plan for our pre-test, unit test integrated testing rounds 1,2, 3 with the payers and finally User Acceptance Testing with the providers. We built our project management protocol and work breakdown structure and kicked off the project.

With all of the testing that has hopefully happened within healthcare provider and payer organizations this year, ICD-10 codes should be good to go when you go to the doctor and they then file a claim to get your ambulatory visit or inpatient treatment paid for by insurance, but nevertheless, you may want to wait a while if your visit isn’t of an urgent nature; just in case the physician has forgotten how to use that new tool in the EMR system that helps them with putting in the right specificity for the diagnosis that they used to remember the old ICD-9 code for the last 40 or so years.

Hopefully by now, healthcare provider organizations have kept about 6 months of reserves on hand or have worked with their financial institution to have those funds available to them in case they are required due to claim backlogs. Time will tell through financial reports whether their is truly concern about whether ICD-10 codes are revenue neutral for the organization or not.

Commanding your ICD-10 Go Live! Are you in command yet?

ICD-10 is about two weeks away and your in the last stages (or not) of putting together your command center and go live to support your healthcare organization’s transition to the world of ICD-10 specificity. The ICD-10 Command Center should ideally be staffed with Subject Matter Experts (SME’s) in Information Technology as well as Administrative/Operational and Clinical representatives who record all identified issues and will manage the support processes during the go-live transition.

The Command Center will ensure that the appropriate communication of the go-live progress occurs among the end users and leadership of the healthcare organization prior to, during and after October 1st, 2015. For your command center, you need to think about having:

  1. A Dedicated room or location(s) that you will have to co-locate your SMEs
  2. Cell Phones for the “At the Elbow Support” team members who will be supporting the physicians
  3. Laptops for the staff to work on issue resolution
  4. White Board/Flip Chart to record issues and resolutions or Incident Reporting Tools/Technologies
  5. A dedicated phone number(s)/”hot line” for the ICD-10 Command Center that you broadcast to the organization in the run up to the go live and continuously remind through daily status communication
  6. Beverages and food for the command center team that will be at that site during the day (and possibly nights for areas such as ED)

Your physicians will be impacted in the following ways after they complete their ICD-10 physician education by this month:

  1. As a result of the need to complete education and need for increased specificity of their documentation
  2. Their future orders for procedures that occur after October 1st, 2015 must contain ICD-10 diagnosis codes.
    3.Clinical Documentation Improvement queries will create an additional workload on physicians starting in October and
    5.Physicians will begin to select ICD-10 codes October 1st through some sort of job aid that most EMR vendors have included in their software to help mitigate the impact of ICD-10 specificity.

Each organization has different ways in which they are dealing with ICD-10’s regulatory go live on October 1st.

Patients too will be impacted by ICD-10 go live.

There might be possible delays in being seen by their doctors, backlogs by physicians that have not planned ahead, delays by their healthcare payers (insurance companies) in making payments to the provider (hospitals) may cause patient frustration and delay in payments. While we all plan for the worst, but hope for the best, here’s wishing for the best outcome possible for ICD-10 starting October 2015.

ICD-10. One Month to go!

After all these years, we are closer to the finish line than we have ever been. By now, you should have:

Identified all project scope components for your ICD-9 to ICD-10 conversion. Collaborated with your Interface and Reporting teams and conducted regular status updates to assess Reports and Extracts that required ICD-10 remediation. Identified all project activities including development of your project schedule, tracked your project issues (which I am sure would have been many) and tracked your project scope, schedule, resources and budget of all resources and tasks associated with the project.  You would’ve ideally worked with your Physician Champion or CMIO, operational managers and Education,  Communications and Marketing teams to identify training required for Clinical, Operational and IT Staff for ICD-10. Completed your End to End Integrated Testing of your EMR with any 3rd Party bolt-On applications and solved issues that you came up with as well as your organization has been dual coding for a while or have a solution (such as outsourcing your coders) to prepare your organization for the upcoming transition.

Are you ready for Command Center? Some organizations I know have been practicing on ICD-10 diagnosis terminology and are not going to have a long drawn out Command Center. Others, who have not been so lucky, will have a command center that will mimic their EMR vendor’s timeline. For those that thought that there would be another extension…well..good luck! See you on the flip side!