As we continue to wait on the final ICD-10 implementation rule to be issued by the Department of Health & Human Services (HHS), it is important for HIM directors to stay the course and continue their ICD-10 preparations.
This delay provides them the opportunity to refocus their efforts and get it right, and one of the most important pieces of advice for a successful implementation is to make use of the entire timeline.
The implementation timeline is divided into four key phases:
Phase 1 – the planning phase, in which the full scope of the impact is determined
Phase 2 – the “doing” stage, in which all of the activities identified in the impact assessment are completed
Phase 3 – the “go live” phase
Phase 4 – the “post-implementation follow-up”
One of the key actions in phase 1 is the impact assessment. This involves identifying all impacts for every department of the organization. The steps are to analyze the impact on operational processes, documentation processes and work flow, and both internal and external reporting. An assessment of the detail in clinical documentation should be done to identify if it is adequate to support the new code sets.
Key components to the impact assessment are:
- HIM workflow assessment; operational process improvement
- Documentation gap analysis
- Hospital departments impact (i.e., human resources; admitting, utilization review)
- Complete a systems inventory of all databases, systems applications and interfaces currently using ICD codes.
- Prepare a multi-year ICD-10 implementation budget.
- Establish a detailed training plan.
Assessing the HIM Workflow Assessment
In managing an effective HIM department, there are five proposed actions necessary to achieve best performance: They are:
- Streamline processes, including improving process flow and aligning information with processes.
- Reduce wasted efforts, including elimination of non-value added steps and automating redundant tasks.
- Reduce variability, by standardizing work processes and deliverable and reducing risk through policies and procedures.
- Validate processes early, monitor and validate procedures to confirm application of policy and prevent re-work.
- Develop a Lean culture by enabling changes at all levels and measuring with metrics.
To identify these actions you need to evaluate all processes in the HIM department during the assessment.
- Look at your workflows in the clerical area (are the charts all being picked up). How long does it take to have a chart ready for the coders?
- What is your physician incomplete rate and how can you improve it?
- What are bottlenecks in your DNFB/AR management? Do you monitor daily?
- What is current coder productivity? What can be done to increase or enhance the productivity? Are there clerical duties the coders have always done that would be best suited in other departments? Are the coders entering charges and doing billing work vs. coding? What takes away from the coder productivity and quality?
- What is your transcription turnaround time?
- Perform a staffing assessment. Do you have enough staff to perform the tasks?
- Evaluate your policies and procedures. Are they up to date and reflect current practice?
For this process, look at utilizing LEAN methodology. Simply, that is the concept of looking to see if the right person is doing the right job at the right time. Also, you need to ask, “Do they have the tools to do that job?” Explore methods to reduce or eliminate any waste, delays, redundancy and rework. These methods can also assist to break down barriers between disconnected departmental “silos,” and allow the department to better work together for the benefit of patients, customer service and the bottom line.
Benchmark Your Success
A metric report done weekly is an outstanding tool for monitoring and benchmarking your successes. This is an excellent way to ensure the benefits resulting from your HIM assessment are still thriving when ICD-10 arrives. The elements to monitor on this report could be:
- Discharge not final billed (DNFB) in dollars: Break it down by patient types: inpatient, same-day surgery, emergency department and outpatient diagnostics. Report it every week so you can see trends and patterns.
- Number of accounts holding for billing: Do the same as the DNFB dollar report, but show number of cases.
- Coding Productivity: Best to start monitoring this now because it is predicted that 50 percent of productivity will be lost during the implementation phase of ICD-10. Then, after that, a reduction in 10 percent to 20 percent will be the norm. So if you know what your productivity is now, you can see what the impact will be come implementation time.
- Physician delinquency: What is your magic Joint Commission percentage?
- Transcription Productivity
- Transcription turnaround time by patient type
HIM directors need to know their departments’ strengths and weakness. The weak areas must be identified and an action plan put into place. Most importantly, best practices must be implemented immediately so the financial effect of ICD-10 will be reduced or minimal.
About the Author
Karol Richkus, RHIT, is director of HIM consulting for Precyse, a leader in Health Information Management (HIM) technology and services. Karol has more than 30 years of experience in the HIM profession with an emphasis in multi-hospital and acute care settings.
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