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BOWMAN, CLELAND, AND STAGGS
certifıed to help assist their practices in being ready for the
conversion.
Providing coders the opportunity to become ICD-10 certifıed
is a good idea to promote the sharing of knowledge
among coders and throughout the practice as a whole. Coders
should also be an essential part of establishing a closedloop
process for reducing the use of unspecifıed codes and
increasing the specifıcity of documentation and coding.
Teams need to focus on reducing the use of unspecifıed codes
now to decrease the risk for increased denials with ICD-10
because of lack of documentation specifıcity. Increased specifıcity
means documenting more details on location, laterality,
severity, sequelae, duration, stage, cell type, etc. If
documented in a structured manner, some EHRs can use
documentation to assist providers in selecting a diagnosis.
For example, some EHRs will reduce the list of diagnoses or
problem codes to ease selection based on laterality, stage, etc.,
and also alert the clinician when there is not enough documentation
to support a specifıc code.
Many practices are applying the concept of dual coding to
help staff learn by practicing documenting and coding in
ICD-10. A dual-coding regimen leading up to the conversion
can also help practices prepare for the productivity effects of
coding in ICD-10 compared with ICD-9 by measuring sideby-side
productivity. Dual coding can also help identify areas
for clinical documentation improvement.
PAYER ENGAGEMENT AND MONITORING READINESS
Teaming with payers is essential, but it is also a challenge.
Many payers are only testing with select providers or recommending
that providers only test with clearinghouses and
vendors. Ideally, providers would be able to perform end-toend
testing with all of their high-volume payers and receive a
full round-trip test and testing results from the payers. This
provides the best representation of the actual process and
eventual results of converting to ICD-10 on October 1, 2015.
Take advantage of any opportunities to test with Medicare,
whether it be acknowledgment or end-to-end testing. For
end-to-end testing with Medicare, MACs target select clearinghouses
and providers, therefore practices should register
to have a chance of being selected.
Payer readiness is uncontrollable from a provider perspective.
Project teams should work diligently to gauge the readiness
of their high-volume payers. Identify any risk that can
potentially be mitigated by asking payers how they plan to
handle activation tasks and stabilization support after converting
to ICD-10. For example, know when payers have updated
their medical policies and how they plan to handle
authorization before and after the conversion.
DENIAL MANAGEMENT FOCUS ON METRICS,
WORKFLOW, AND PERFORMANCE
Proactive monitoring and elimination of denials is typically
part of the daily fabric of a practice’s business offıce. With
ICD-10, practices need to actively work today to reduce the
potential of new future denials by increasing the specifıcity of
documentation. Care team education and awareness on required
documentation and tracking unspecifıed code utilization
to target areas for improvement are two attributes of a
closed-loop approach to improve documentation.
Comprehensive and timely metrics are essential for practices
to track denial trends leading up to and after the conversion
to ICD-10. Tracking performance after conversion
will let practices know when steady-state has been achieved
or target areas to address to get back to steady-state. Refıne
denial and rejection metrics to target denial reasons that are
driven by diagnoses and coding. This is a good way to target
areas for improvement that would otherwise be exacerbated
with the introduction of ICD-10.
ICD-10 workflow remediation is the perfect opportunity to
look at your denial management workflow from start to fınish.
Reduction of current and potential future denials can be
accomplished through collaboration across teams, targeting
areas for improvement based on denial trends, education,
and new policies and procedures to invoke and maintain
change. This is a good opportunity to apply Lean Six Sigma
principles with the team for long-term improvement.
NAVIGATING CHANGE THROUGHOUT ICD-10
CONVERSION
Change is inevitable during long-term programs like ICD-10
remediation and especially now with an extended timeline.
Have mitigation plans in place to help prepare for and adjust
to change. There are obvious substantial changes, like the delay
of ICD-10, but again with the duration of this type of remediation,
always prepare for other events such as staff
turnover, new substantial projects, application migrations
for meaningful use, etc.
Any controllable changes defınitely need to be addressed
before the 90 days leading up to the ICD-10 conversion date.
Ideally, this 90-day period would be a freeze period with no
change to prepare for activation of ICD-10.
Beyond the inherent benefıts of converting to ICD-10, seize
this opportunity to achieve as much long-term value as
possible from remediating practice processes, improving
performance, and creating a team-based approach to improvement.
Always take advantage of large systemic changes
like ICD-10 to take a renewed look at how the practice team
collectively provides patients access to care.
DETERIORATING QUALITY OF HEALTH CARE DATA
The quality of health care data progressively deteriorates as
long as the United States continues to rely on the outdated
and imprecise ICD-9-CM code set. By continuing to use the
outdated ICD-9-CM code set, the United States has limited
ability to extract information that will optimize public health
surveillance, exchange meaningful health care data for individual
and population health improvement, and move to a
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2015 ASCO EDUCATIONAL BOOK | asco.org/edbook