ICD-10: A Checklist for Implementation Readiness

Coding experts from the American Health Information Management Association and the Workgroup for Electronic Data Interchange count down the steps healthcare organizations should be taking in the final weeks before implementation.

October 1st, the day ICD-10 codes must be implemented, is just weeks away. As summer wanes, anyone hoping for another reprieve from the Centers for Medicare & Medicaid Services is almost certainly about to be disappointed.

There's no time to waste. Follow the guidelines below for the best chance of a smooth implementation.

T Minus 5 Weeks

"By now, the IT department should have identified every system that used ICD-9 [-CM] codes and validated that [the systems] are ready," says Melanie Endicott, senior director of HIM practice excellence at AHIMA.

She also recommends reviewing contracts with third-party payers at this time. "Most private insurance companies have their own version of diagnosis-related groups."

"Make sure they have materials ready that they will need to consult on game day, says Devin Jopp, president and CEO of the Workgroup for Electronic Data Interchange (WEDI), a non-profit health IT organization. "[Insurers] should have received training by now and should know the top 10 diagnosis codes [they will use]."

"Now is the time to make sure system upgrades have gone through," says Lynne Thomas Gordon, CEO of the American Health Information Management Association (AHIMA). It's also a good time for the finance team to test claim submissions with carriers and check that the facility has "saved up some cash just in case."

Human resources should also consider bringing on a few temporary coders to help keep the coding team on track and avoid productivity loss, Endicott says.

Case managers and finance should be ensuring preauthorizations for procedures that will be performed on or after October 1 are completed in ICD-10.

Some team members will already be very comfortable with ICD-10, while others may be struggling, Gordon says. Implement an ICD-10 help desk staffed by power users at ease around the topic. For best results, members should come from diverse areas around the hospital, including finance, billing and IT.

Stop Complaining About ICD-10 and Start Training

Gordon suggests asking each member of this special team to go through a typical day and discuss findings with coworkers holding similar roles.

"Have them imagine their day in detail. They arrive, hang up their coat, get their cup of coffee, sit at their desk. Then what do they do? There will be some last-minute realizations—'oh, I forgot about that report!'" says Gordon.

She also suggests creating an organizational newsletter, either electronic or hard copy, to keep everyone abreast of ICD-10 related changes.

T Minus 4 Weeks

Both the leadership and finance teams should use this opportunity to make sure metrics and dashboards are in place and ready to roll out, says Jopp. "Define the key metrics executives need to be aware of. How often are they reported? What kind of thresholds are there, and what internal plan do they have to put in place to make sure they react when numbers hit certain marks?"

The accounts receivable team should focus on getting as much off their plates as possible, says Endicott. "They need to get as much as they can out the door so they'll be ready to go on October 1."

Both Jopp and Endicott say this is a great time to start running mock cases to ensure the team's ICD-10 fluency, that third parties are correctly looped in, and that everything is all systems go.

Four ICD-10 Fears, Decoded

Endicott recommends using this time to do focused education classes with anyone in the hospital who should have an understanding of ICD-10, but seems to be behind.

A vacation blackout period should be instituted, says Gordon. "At this point, it's all hands on deck. Everyone needs to be in the hospital." Check-ins with department leadership should be performed daily.

T Minus 2 Weeks

By mid-September, "you're probably still putting out last-minute fires, but most of your dry runs should be done by now," says Gordon.

"This is the final push up to implementation," says Jopp. Timelines and process should be laid out by now, backups tested, and additional backups of data and systems created.

The finance team should have gained familiarity with what dashboard measures mean by now, says Jopp, and the escalation process for different emergency scenarios the dashboards were designed to alert teams to finalized.

"This is about when coders should be feeling really confident," says Gordon. "They should know dual coding inside and out and have had intense training by now… I'm hoping they will see the light at the end of the tunnel."

"Make sure your PR department is ready," says Gordon. The local media may contact hospitals looking for sensationalistic Y2K-style stories, and you should make sure they don't get them from your organization. It is prudent to ensure frontline workers know to refer media queries to the communications department.

T Minus 10 Days
Now is the time for the helpdesk team to get ready for Day One. Endicott suggests creating a phone extension where they can be reached from the end of September through the middle of October.

"There needs to be people on that team who have deep knowledge of ICD-10 and can either personally assist callers or figure out who to send questions to," says Endicott. These people will spend significant time on ICD-10-related issues over the next few weeks, so make sure their managers are aware of this.

Log issues as they are brought to the help desk. Look for trends, find solutions to common problems, and make sure issues are closed out in a timely fashion.

"I like to think everyone will have done or will do risk mitigation plans on the financial side by this point," says Jopp, who suggests having plans in place to protect revenue should there be any business systems interruptions due to ICD-10.

Take this opportunity to determine points of contact at insurance companies and electronic health record vendors. "Assume something will go wrong, somewhere," says Gordon.

T Minus 5 Days

"Organizations should have their cutover system and plan ready in addition to a disaster recovery plan," says Jopp. There should be a contingency plan in place in case the organization needs to go to paper temporarily, and processes in place for worst-case scenarios.

Teams should ensure they have a baseline for all critical success factors, says Gordon, and go-to people should be identified.

"Go over your go-live plan again," suggests Endicott. "Make sure the plans are all set."

Send out a homestretch email highlighting ICD-10-related accomplishments over the past weeks and calling out major players who have dedicated a lot of time or energy to these projects.

Clinicians and coders should also be mindful of the fact that many patients currently in the hospital will be discharged after ICD-10 goes live, and should code and document with that in mind, Endicott says.

T Minus Zero
On the night before implementation, Jopp suggests running test cases before turning on ICD-10. "Take a last look at the results and see what's happening in the controlled environment," he says. He suggests that finance take final snapshots of what life was like under ICD-9-CM before switching over to ICD-10.

"Everyone should be ready at this point," says Gordon. "Go home and get a good night's rest."

October 1

"It's hard to be the prognosticator, but I believe most larger entities will be fine," says Jopp, who doesn't think most nightmare scenarios regarding reimbursements will come to fruition.

"It will be a little chaotic for a few days," says Endicott. She suggests ensuring coders and physicians have a clear, open line of communication during this time in order to avoid a bottleneck in reimbursements due to coding errors.

Prepare last year's benchmark report—if any numbers in the days and weeks after October 1 seem wildly different, investigate to make sure it's not an ICD-10 change-related error. "It's one thing if it bounces back, but it's another if you're just not making the money you thought you would make," says Jopp.

Two Weeks Post-Implementation

"It will mean a lot to your people to be thanked for all of their hard work, the extra hours, not taking vacation and so on," says Endicott.

Gordon suggests handwritten thank you notes for a personal touch, and she and Endicott both think a hospital-wide barbeque, a spaghetti dinner, or gift certificates to local restaurants are all great ways to show appreciation.

"Cash bonuses are always nice," says Jopp. "But remember, it really isn't over. What happens two years from now, when we start learning about specificity? That's when things will really get interesting."

HealthLeaders Media Webcast: How Health Systems Prep for ICD-10—Physician Alignment, Support and Technology, will be broadcast on Tuesday, October 20, 2015, from 1:00 to 2:00 p.m. ET. Hear from the University of Mississippi Medical Center's chief health information officer as he describes how to overcome the obstacles of implementing ICD-10.