ICD-10 Provider Initiatives.. Things to consider

As most of us know by now, ICD-10 is a massive effort impacting huge aspects of healthcare and healthcare IT. It requires application upgrades, data normalization, CDIS (Clinical Documentation Improvement Services), conversion of reports, forms, documents and procedures. The scope is from patient intake (clinical) to clean bill (patient billing) and includes Denial Management, Reimbursement Risks, ACO (Accountable Care Organization), alignment with meaningful use and other governance reporting with simplification and automation of the clinical documentation, coding, patient billing and reporting processes. My latest initiative, with a large IDN with multiple abstracting instances, regions and a very disparate environments with multiple HIS instances (McKesson, Cerner, Siemens, Meditech and Epic), so please keep in mind to adjust this to fit your organization. Some activities are weighted due to the regionalized and disparate nature of the organization.

The ICD-10 Program I have developed and manage is ahead of schedule compared to other providers so I have had numerous questions about various activities so I wanted to share some important things to consider and plan for;

Build a strong Program Management Office; As the Program Director for the ICD-10 PMO (program management office), to accomplish the development and management of the program required flexibility and an ability to wear multiple hats. Relationship building was a key in building a strong foundation for the program. We developed a core team of project managers with varying skills and abilities to assist with developing the tools and templates needed to support our project management and operational processes.

Standardization and developing a toolkit of templates, how to’s, simplified process and procedures, defined ‘rules of engagement’ for clear, simple, repeatable processes and activities are part of the approach to achieve the program goals.

The ‘ICD I0 Program Approach’ was developed to guide us during the overall life of the program and a way to segment the work type based on impacted systems and users. This enabled us to create a guide and toolsets to provide a roadmap to improved revenue cycle performance and ICD compliance.

  1. Application upgrades for all systems with procedure and coding impacts, to ICD-10 compliant version.
  2. Assessments of all ICD impacted systems, workflows, regulatory requirements, coding processes and revenue cycle/supply chain touch points and clinical documentation audits
  3. 3M 360 Encompass CAC & CDIS implementations and integration
  4. ICD functionality integration and automation initiatives
  5. Data normalization–  36 hospitals across 7 regions with varying abstracting instances
  6. Complete report/form standardization and ICD remediation
  7. Coding simplification and automation initiative
  8. Comprehensive testing strategy – System to integration to full life cycle testing required so plan for and build a realistic testing approach that will enable full life-cycle testing
  9. Full life-cycle integrated ICD testing –  From patient intake to a clean bill/denial management


Here is a summary of high level activities for a successful ‘ICD-10 Program;’

  • ICD-10 Conversion & optimization strategy development
    • ICD-10 Assessments
      • Applications
      • Workflow
      • CDIS/coding
      • DRG/MS-DRG integration
      • CAC & CDIS (CDE)
  • ICD-10 operations impacts
    • Coding improvement
      • Physician/coder training
      • Coding optimization
      • Reports/forms conversions
      • Governance impacts
        • Compliance reporting
        • Regulatory auditing
        • Meaningful Use compliance
    • Application/IT impacts
      • Applications upgrades (294)
      • ICD functionality integration initiatives (63)
      • Data modeling/normalization (61 systems)
      • ICD functionality development and initiation
  • Program/portfolio development & management
    • Charter development
    • Budget development and tracking
    • PMO Program process definition & development
      • Technical groups
      • Infrastructure groups
      • Interface teams
      • Database teams
      • Relationship Management
      • Revenue cycle development & optimization (for ICD)
      • Patient Access & HIM
      • Clinical (intake) optimization
      • Formulary/MS-DRG improvements/integration
    • Strategic planning/integration planning
    • Business/clinical  life cycle modeling & management
    • Risk & quality improvement management
    • Communication process development
    • Relationship Management
    • Requirements definition
  • IT project governance/oversight
    • Application update oversight
    • Application upgrade management
    • New HIS implementations
    • Solution development (new system selection, definition, implementation and integrations)
    • Contract ModelingAre you ready?
  • Clinical/Patient Access/ HIM operations
    • Clinical Documentation Improvement
    • Risk reimbursement
    • Case mix management
    • Coding standardization
    • Standardized and developed improved coding model. Migrated to an Enterprise wide coding model.
    • Third party payer relations and testing

The goals of the ‘Program’ should be related to desired performance. I’m careful to correct insinuations of this being a conversion. To convert to ICD-10 does not provide the integration with revenue cycle, determining  risk reimbursements, contract modeling, accounting  for ACO models, nor coding simplification, all of which is essential to overall improvement and success. Complete coding life-cycle testing is essential to identify any issues between system functionality, workflow, human touch points, reporting, third-party (payer and clearinghouse) and governance models.

Keep in mind, this initiative requires that you delve into and validate the majority of your processes, systems and forms, from patient intake through patient billing/denial management. Why wouldn’t you optimize and improve efficiencies and quality assurance?

Please feel free to contact me with any questions or thoughts. I like to provide my knowledge to help others and always value additional input and perspectives. There is never just one path to success, so please share any insight.

Adept Healthcare specializes in strategic healthcare initiatives, including ICD-10. If your organization needs assistance with ICD-10, CAC and CDIS implementations or coding standardizations, we have knowledgeable and available project leaders and analysts who can help. Please don’t hesitate to reach out to me at EMcGuire@Adept-Healthcare.com



Filed under Clinical, HIS, ICD-10, Implementations, Meaningful Use, Organizational Performance, Project Management, Revenue Cycle

5 responses to “ICD-10 Provider Initiatives.. Things to consider

  1. Great post Eric…

    Thanks for sharing…

  2. Very informative article Eric. I will keep this for reference because I think this change is the “next big thing.” I stumbled over this point though: “3.3M 360 Encompass CAC & CDIS implementations and integration” –I don’t know what those things are.

    • Thank you! I would agree it is a ‘big’ thing among several ‘big’ things. The real key is how providers are integrating these various initiatives to deliver more capabilities.

      3M has a product called ‘Encompass 360’ it consists of two modules, CDIS – Clinical Documentation Improvement Services and CAC – Computer Assisted Coding CAC basically takes your patient intake documents (encounters, physician notes, order-able results, ADT, etc..) and scans and through intuitive algorithms (and CDIS integration), provides procedure code suggestions and automation capabilities. CDIS works with the patient intake process to assist with ‘Best Practices’ with clinical documentation requirements, specifically for coding.

      I hope that helps!!

  3. Jason Gottlieb

    Eric – always good to see other’s strategy and approach as it helps to validate the things you are doing in your own institution. We are, guessing from your article, at very similar stages of transition. Curious as to your timeline around implementation of dual coding and how you’re engaging HR to ensure risk is mitigated around staffing/skillset shortages, job code re-evaluation (especially with the implementation of CAC). Not sure where you are with CAC implementation but a caveat with that technology in that it is only as good as the clinical data infrastructure in yoru organization. This includes both EMR and quality of documentation.

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