ICD-10 Assessments today need a faster start because there is less time to spare to get ready for the October 1, 2014 2015 deadline.

What you don’t know can hurt your reimbursement if you are a provider, and put you at risk of fines if you are a payor.   For most health care providers, we see many missed opportunities to prepare for ICD-10 by improving the clinical workflow and problem lists.  In fact, many electronic medical records systems encourage less specific documentation – that sends you in the wrong direction.

Therefore, we find it insufficient to hire an “ICD-10 project manager” to identify these issues.  A PMP-credentialed project manager is a good idea, but they do not have the clinical, coding, and IT knowledge or the ability to engage with physicians or assess healthcare IT system readiness.  A combined, multi-disciplinary approach with cross-functional involvement is important to successfully transition.  And YES – it is worth the money.

In addition to our ICD-10 Assessment program, we recommend starting with senior leadership training including C-Level executives, and physician training, combined with analytics that rapidly assess the highest risk areas of the organization, clinical documentation, and physician – coder interaction. Determining where the ICD-10 reimbursement risks are may depend mostly on whether your current documentation supports the extra specificity required. Knowing who to train (and we are not just talking about ICD-10 coders) is extremely important and missed by most organizations.

For health plans, ensuring that your medical policy and coverage determinations have rules to support ICD-10 is key.  For both payors and providers, we recommend ICD-10 financial risk assessments.

So today, ICD-10 assessments must prioritize the most important components first.  Coder training is obvious but there are several other areas of ICD-10 that aren’t necessarily IT related that should be examined.

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