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Last Modified: 10/13/2011
Location: FL, PR, USVI
Business: Part A, Part B
ICD-10 (International classification of diseases, 10th edition) 15 steps of implementation
Are you preparing for the transition to international classification of diseases, 10th edition (ICD-10)? If you are and are not sure where to begin we’ve created this document to help you get started on the transition. We feel the steps will help you put a process into place to begin transitioning to ICD-10. Please feel free to use these steps as you begin your journey to ICD-10.
Note: This outline is based on input from the American Academy of Professional Coders (AAPC) and the Centers for Medicare & Medicaid Services (CMS).
1. Organize implementation effort
• Identify staff person (coder, biller, manager) to oversee effort
• Will prepare information to share with providers and staff
• Will identify work and scope for implementation
• Make it a team effort involving all medical practice staff
• Determine all areas that impact practice and identify each one that will be affected
• Practice management system
• Superbills
• Electronic medical record (EMR)
• Clinical areas
• Schedule regular meetings to share information with physicians and discuss progress/barriers of implementation
2. Establish communication plan
• Point person will communicate to all staff regarding status of implementation
• Email
• Meetings
• Memos, newsletters
• Develop regular meeting schedule
• Monthly until six months prior to implementation
• Bi-weekly thereafter
• Develop materials to disseminate to providers and staff
• Clearly indicate information regarding dates and training
• Gives awareness to all that “Somebody’s working on ICD-10”
3. Conduct impact analysis
• How will ICD-10 affect your practice?
• Consider this prior to development of budget
• Determine costs involved as well as work processes affected
• Complete in-depth look at resources required for implementation
• What systems will be affected?
• Practice management
• Coding look-up programs
• EMR
• Hardware space
• Contact system vendors to verify status of implementation
• Health insurance portability and accountability act (HIPAA) 5010
• ICD-10
• Complete high level review of regulatory requirements, timeline and resources needed over next several years
• Identify changes to current reports/trending involving ICD-10
• Identify any new products needed because of ICD-10
• Identify additional quality efforts needed to ensure proper coding specificity
• Review health plan impacts
• Coverage determinations
• Medical review policies
• Actuarial projections
• Fraud and abuse monitoring
• Quality measurements
4. Organize cross-functional efforts
• Identify staff to represent cross-functional areas
• Establish lines of communication for cross-functional team
• Who has decision-making authority?
• Schedule for ongoing updates on work status
• Schedule meetings and reports
• Inform senior management of progress or problems
• Establish executive steering committee
• Workgroups for technical and/or department-specific efforts
• Perform a Gap analysis program (GAP) analysis
• Review existing operations and consider areas of improvement
• Establish coordination with 5010 project team
5. Develop your budget
• Software costs
• Software license costs
• Hardware procurement
• Development costs
• Implementation/Deployment costs
• Possible EMR upgrade or implementation
• Staff training costs: coding staff, clinical staff, financial staff, billing staff, administrative staff, physicians
6. Internal system design and development
Note: If all development is addressed by vendors, you may skip this step
• Establish organizational implementation structure
• Determine project requirements
• Finish design work
• Complete reengineering analysis
• Implement programming
• Install and test
• Review and perform beta testing
• Validate/verify
• Ensure ongoing support
7. Develop training plan
• Identify staff training needs and resources
• External training
• Training materials
• What type of training mechanism will be used?
• Webcast
• Distance learning
• Workshops/conferences
• Textbooks
• Establish training schedule
• Who will be trained and when
• Temporary staff needed?
• Develop communication plan re status of staff training
8. Contact system vendors
• Determine if vendor will support changes in systems, and timeline for implementation of changes
• Inquire regarding testing time (when will testing start, for how long, and what will be needed e.g., sample claims)
• Identify system upgrade costs
• Scanning
• Billing
• Financial analysis
• Electronic medical record
9. Implementation planning
• Establish how the project will be implemented by the organization
• Implementation stages -- what gets implemented and by whom
• Planning
• Analysis
• Implementation
• Education
• Testing
• Production
• Identify benefits of implementation
• Develop post-implementation problem resolution process to address issues identified
10. Training
• May involve separate levels
• Level I training
• ICD-10 conventions
• Training on ICD-10-CM guidelines
• General code set training
• Regulatory issues and guidance
• Level II training
• Specialty specific training
• Review of guidelines specific to specialty
• Specialty specific codes
• Determine options for training (e.g., webcast, face-to-face, teleconference)
11. Business process analysis
• Identify all systems that currently use ICD-9-CM: determine if need to be upgraded to ICD-10-CM
• Clinical (lab and radiology)
• Administrative (practice management and registration)
• Billing (systems and superbills)
• Other (quality and public health)
• Determine impact to various types of reports
• Internal
• State
• Federal
• Consider impact on payer/health plan contracts
• Verify if reimbursement tied to specific diagnosis for some contracts
• Determine potential changes to existing contracts with payers
• Modify agreements as needed
• Communicate contract changes to staff
12. Develop policy changes
• Make changes to policies and processes
• Based on issues identified in previous steps (GAP analysis, review of system impacts)
• Notify staff of changes made
• Apply this step after insurance carrier develops payment policy changes
• Providers should identify most common diagnosis codes and local coverage determinations (LCDs) used
• Determine the ICD-10 equivalents
• Review LCDs (once updated)
13. Measure outcomes
• Measure coder productivity with ICD-10-CM
• Evaluate medical documentation to ensure ICD-10-CM coding can be completed
• Complete internal testing of staff on ICD-10-CM proficiency
• Arrange provider education and training if deficiencies identified
14. Deployment of code (Vendors to customers)
• Vendor delivers software update with ICD-10-CM and ICD-9-CM mapping to install on practice systems
• Test to ensure ready on “Go live” date
• Integrate and customize software within practice/production systems
• Assess individual systems (end-to-end) with clearinghouses, payers, electronic claims transmission
15. Implementation compliance
• October 1, 2013, is “Go live” date
• Implementation plan -- ongoing for 12 months after this
• Resolution of claim errors and denials
• Review of insurance carrier (e.g., First Coast Services Options (FCSO)) payment policies
• Re-assessment of medical record documentation
• Measurement of training and productivity outcomes
• Retraining as needed
Sources: The Centers for Medicare & Medicaid Services --
http://www.cms.gov/ICD10/04_CMSImplementationPlanning.asp#TopOfPage
http://www.cms.gov/ICD10/04_CMSImplementationPlanning.asp#TopOfPage
American Academy of Professional Coders --
http://www.aapc.com/ICD-10/
http://www.aapc.com/ICD-10/
Disclaimer
This material is proprietary information of First Coast Service Options Inc. This material may not be duplicated, in whole or in part, for profit-making purposes. FCSO and its staff make no representation, warranty or guarantee this compilation of Medicare information is not error-free, nor that use of this information will prevent differences of opinion or disputes with Medicare.
Source: FCSO Education Action Team
