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ICD-10: Minimizing the Financial Hit

Rene Letourneau, for HealthLeaders Media, December 13, 2013
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South Nassau is taking what Rosenhagen calls an "80/20 approach to training."

"We are focusing on the top 20 or so diseases that account for the top 80% of our cases. We are focusing on the diagnoses and procedures where accurate ICD-10 coding will be impacted."

The organization expects to spend roughly $1 million to implement ICD-10. Of that, it has invested about $40,000 in an online training course for coders and $12,000 to certify six internal ICD-10 trainers to provide classroom education.

The online training includes rigorous anatomy and physiology education because of the increased level of specificity required for correct and complete coding, Rosenhagen says.

"It's a very formal course where they go through body system by body system and have to pass a quiz on each section before they can move onto the next," he says. "Everyone who is going to code for us in 10 is going to have to go through this process to reinforce the foundation they will need. You need a reference set for the medical terminology so you can take the coding to the highest level possible."

"We want to make sure our coding staff is thoroughly trained to do the task because we are so dependent on having well-defined clinical information for our future analytics and reimbursement," he adds.

South Nassau will also begin dual coding in ICD-9 and ICD-10 in January. Despite the long lead time and detailed training, Rosenhagen knows the move to ICD-10 will affect staff efficiency.

"There will be a slowdown in productivity. What we are hoping is, if we do an adequate job of training and have the right computer resources, it will make the slowdown as short as possible," he says, noting that the EMR "has been built with information that coders can use for making coding decisions."

With decreased productivity and the natural attrition that is expected as some ICD-9 coders opt out of learning ICD-10, there will likely be a need to hire new FTEs, Rosenhagen says. To attract enough skilled coders in its competitive marketplace where many health systems are trying to hire from the same limited labor pool, South Nassau is rethinking its human resources strategy and becoming more flexible with regard to employee work sites, viewing remote coding as a viable option.

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