"The devil is in the details and you have to map it to ensure you have the right processes in place and to be sure you'll be documenting and capturing all the information that's needed. I have difficulty suggesting that there will be a minimal impact to millions of dollars because there's so much risk in the process. … The underlying need from this documentation is to enhance the processes in place to be sure that money doesn't dribble out," says Bogen.
The subtle revenue leak from an underdocumented record in ICD-9 could swiftly turn into a revenue gush after ICD-10, and that's exactly what concerns organizations such as the Mayo Clinic. Its process map focused on clinical documentation gaps and found it could be improved for the ICD-10 transition.
Mayo adjusted its ongoing training to target how the physicians document. The organization uses the physician's existing documentation under ICD-9 and provides comparative feedback on how to adjust the documentation to meet the ICD-10 guidelines.
"It's important to get the training going well in advance," Thompson explains. "Giving them the feedback for the future so they can start adding the documentation now helps make it so ICD-10 doesn't affect billing and it gets the physicians up to speed before it starts affecting revenue."
To know how extensive the training will need to be however, hospitals and health systems have to first know how deeply the documentation challenges run. Health First's process map showed that charge capture was inconsistent in the organization, affecting the case mix being reported. In preparation for the upcoming transition, Rogers says the organization made an investment in computer-assisted coding software. "We think it will offset some of the losses we anticipate will occur from increased denials and documentation deficiencies," he says.
As with Health First and the Mayo Clinic, SNCH found that its map put a spotlight on existing documentation challenges that needed correcting. "From my vantage point … ICD-10 continues to heighten our concerns about areas we've been having issues with for ICD-9, particularly documentation. Our biggest concern now is that this transition will exacerbate it," says Bogen.
Although some organizations may choose begin the ICD-10 impact analysis by only doing a documentation gap analysis, Collins says, the revenue-cycle process map has been an integral part of the Mayo Clinic's approach. "The visual provided by the process map gives us the help we need to really see the steps to take, and with the ICD-10 project you can't miss a step or two because it's just too critical to the organization to get it right."
This article appears in the May 2012 issue of HealthLeaders magazine.