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EDITOR’S NOTE: This is the second in a two-part series addressing ICD-10 training and education matters for providers.

Part I of this series focused on the impact and importance of formal project planning, instructional design methodologies and learning styles in an ICD-10 training and education plan. In this installment we will focus on staffing, budgets and the importance of careful vendor selection when planning for ICD-10 education in a variety of settings.

Time and again the industry has suggested supplementing staff for ICD-10 implementation. This will be important after the go-live date, but also may be of value as training activity accelerates. Supplementing staff may help with productivity while training is ongoing during the next two years. It also may afford organizations an enhanced ability to absorb attrition and to reduce stress-related, avoidable mistakes before and after implementation.

Much has been said in the industry regarding documentation improvement. We know that it will be a vital concept in ICD-10 and of critical importance in any training and education plan. Implementing a clinical documentation improvement (CDI) plan will require strategic thinking. There is value in both the ICD-9 world and the ICD-10 world for starting a CDI program sooner rather than later. And such a program is also fairly easy to justify to a CFO when there is potential for revenue benefit by starting early.

In order to highlight areas to target, consider conducting a documentation gap analysis. This is a fancy project management term that in essence means a process through which an organization determines where documentation is not meeting specificity. Documentation gap analysis can be done easily by providers, facilities and even payers who may be creating CDI training for their own provider networks. By targeting the most frequently utilized or highest revenue-generating codes and DRGs, and analyzing the documentation in ICD-9 and ICD-10, organizations can begin work on this core revenue-generating area and  hopefully will see benefits. Perform routine documentation audits to ensure physicians’ collaboration. While this can be a time-consuming internal task, it is equally (if not more) expensive to bring in a consultant. CDI programs also can engage nursing and other non-provider staff to help with documentation. While not appropriate for coding, non-provider documentation can help coders and auditors form more sophisticated physician queries.

Payers face unique training challenges, and I have yet to see any training or education organization manage to address payer needs regarding ICD-10 training. Vendor training options are limited in the payer world. This is largely due to the level of customization required for payers and vendors when formulating an ICD-10 education program – in essence, what might work for a large national payer may not work for a small state Medicaid agency.

Many payers have been forced to “cherry-pick” offerings currently available in the industry as well as design their own offerings for proprietary systems or compliance applications. Unlike on the provider side of healthcare, payers have dozens and dozens of systems that might require training, and many varied applications of the ICD-10 code set. Some of those systems include, for example, actuarial and underwriting, medical economics, claims departments, call centers, claims adjudication systems, fraud, waste and abuse – the list goes on. It is exceedingly rare for payers to code medical records; rather, payers may use or apply coding concepts across a wide range of departments and business areas. This creates a perfect storm of ICD-10 training challenges in the payer setting.

In October 2011, a Healthcare Information and Management Society (HIMSS) virtual briefing indicated that roughly 50 hours of training would be needed per coder at an estimated cost of $100 an hour. That means $5,000, per coder, per organization. That is a lot of money, and the more coders an organization has to train, the more fiscally daunting the challenge. Training trainers is a great cost-savings mechanism that can be employed by fiscally challenged organizations. The difficulty lies in selecting the right individual to act as an organizational trainer, but the right person will be able to accomplish great things in any position. Ideally, trainers will be the organization’s most seasoned coders (this is not a job for a recent graduate of coding school). Any candidate should be comfortable with public speaking and change, highly organized, detail-oriented and possess a willingness to branch out from day-to-day chart coding. Once an organization has identified a candidate, that is the time to immerse them fully in all manners of ICD-10 training, anatomy, pathophysiology and code set-specific training – and industry organizations like the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) have excellent programs in place to train trainers.

A word of caution – being as the industry fully expects a shortage of skilled ICD-10 coders in 2014, organizations should be certain to protect themselves throughout the ICD-10 implementation process. Consider creating or modifying HR education policies or creating retention agreements to retain trained ICD-10 coders. For example, an organization that pays $5,000 to train an employee may consider requiring a one-year service commitment in return. Or perhaps offer an incentive or retention agreement to keep skilled ICD-10 professionals beyond the Oct. 1, 2014 proposed implementation date. Organizational size and budget will be an issue here, but the point is to have some mechanism in place in advance of the go-live date to prevent attrition issues with recently trained employees.

We know that the proposed delay offers the gift of additional time in implementing ICD-10. Training and education programs surely will benefit from this time. It also will allow organizations to think more strategically about how they implement training. With careful consideration, starting early so as to spread out costs across multiple budget years and employing cost-saving concepts like training trainers along the way, ICD-10 education and training plans can be successful.

The key is to begin planning early and not to underestimate the size and scope of the organizational ICD-10 education needs.

About the Author

Annie Boynton has worked in the health information management field for more than 10 years in provider, payer and educational capacities. Currently she is the director of 5010/ICD-10 communication, adoption and training at UnitedHealth Group. Annie is a member of the American Academy of Professional Coders National Advisory Board, representing the Northeast region, and was a developing member of the AAPC’s ICD-10 Implementation Training Curriculum.

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