"When we started to develop the ICD-10 project, we didn't look at it as a revenue-cycle project," Collins explains. "We looked at how it would affect providers and the way they document things and how it would change the work flow, then we looked at how it would impact the revenue cycle. That's the reason why Jan and Dr. Thompson joined the team—they own the practice side."
Getting early physician engagement in the process is essential, the Mayo team says, not only to guide the documentation process, but also to ensure all systems are included.
"If you operate in a black box, you don't know what work is being done and who is doing it and you'll miss something. Physician leadership needs to be a part of this from the beginning. Our team developed an intricate spreadsheet that lists the readiness of systems, what needs to happen next, who's in charge, which systems are vendor areas, and which are homegrown. The physician leadership can look at this sheet and see that the systems are cataloged correctly and where these systems are in the transition process," says Thompson.
Though the trio makes up the core of the ICD-10 transition team, membership fluctuates as colleagues from various departments are called on for guidance. For instance, Graner explains during work flow process mapping that the team called on front office personnel to review the patient access process and explain the daily work flow. And, Collins notes, with such an expansive system to track, having that input is essential to get at the core of what is being done and what equipment and systems are being used. Moreover by process mapping departments with technologies that will be affected by ICD-10, such as the front office, the transition team can assess the potential impact on the revenue cycle if updated technology and training aren't completed in a timely fashion.
Similar to the transition at Mayo Clinic, at the 435-licensed bed South Nassau Communities Hospital, Mark Bogen, senior vice president and CFO for the Oceanside, N.Y.–based organization, says process mapping the revenue cycle for ICD-10 took input from across the organization. Like Mayo, SNCH began its process map journey not by looking at the revenue cycle but by looking at how ICD-10 would affect staff and the need for training. Bogen, along with Richard Rosenhagen, the assistant vice president of EMR, HIM, and the clinical documentation improvement program, and Colleen Garvey, the director of HIM and chair of the ICD-10 steering committee, assembled an organizationwide team to look at the impact of the transition.
"Training was our big concern," says Rosenhagen. "We wanted to know how many people would need training, how to roll that training out, and whether we should do it ourselves or bring in a vendor whose primary purpose was training."