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Successful ICD-10 Implementation Starts with a Process


Rome wasn't built in a day. It took a carefully planned long-term process. A compliance expert says the same holds true for ICD-10. Though October is the deadline, the work of ICD-10 needs to happen before and after that date.

Rome wasn’t built in a day. Neither was the Statue of Liberty. Their completion was the result of a carefully planned and executed process—what Dictionary.com defines as “a systematic series of actions directed to a specific end.”

Nicholas Merkin, CEO of Compliagent, a Los Angeles-based firm providing compliance counseling to medical organizations, says that the approach to maximizing the benefits of ICD-10 documentation should be no different.

“We really encourage people to think of ICD-10 integration as a dynamic process,” he explains. “You have this deadline of October 1, and the problem with a deadline is it becomes a static event. But it’s not really a moment in time.

Thinking about process

Merkin says that in health care there are many deadlines where people see being compliant by a certain date as simply checking off a box once they’ve achieved that goal and thinking there’s nothing more to be done. But that’s not the case where ICD-10 documentation is concerned.

“To make an analogy to health care, I need to be healthy by October 1. But being healthy, in terms of individual health, is a process as well,” Merkin says. “There are short-term plans and long-term plans. The short-term plan may be, ‘I’m going to eat a salad for lunch today instead of a cheeseburger.’ But there shouldn’t be a date whereby I’m now healthy and I no longer need to consider my health. There’s a process that’s going to continue. And that process starts well before the deadline.”

The most important thing to be done quickly, Merkin says, is the creation of a plan of action with a realistic timeframe. That includes determining what your staff training needs are; identifying your current systems that are still on ICD-9 codes; working with your practice management system vendors; confirming which systems you currently have in place are going to be able to meet the standards; discussing the implementation plans with your billing services, your payers and clearinghouses; and scheduling testing of your systems.

“You’re sort of doing a fire drill,” Merkin says. “This is especially relevant to making thoughtful budgeting decisions regarding what the implementation costs are, and considering how ICD-10 can impact the fees that are generated by your practice after transition.”

Benefits Outweigh the Costs

Social Exchange Theory states that human relationships are formed by the use of a subjective cost-benefit analysis. But the theory is also frequently used in the business world to imply a 2-sided, mutually contingent and rewarding process involving transactions or exchange. That, says Merkin, is an important consideration when weighing the costs versus the overall benefits of ICD-10 integration.

For example, he explains that many providers are rightfully concerned about the costs associated with ICD-10 integration. As such, it’s important to budget for those costs so that the practice is not negatively impacted, from a cash flow perspective, 3 or 6 months down the road.

“You have to look at your practice as a business, as a growing concern,” Merkin suggests. “Look at the business of your practice as you would look at preventive medicine. With any kind of potential health risk, you want to take a long-term view. Don’t wait until the heart attack to have it treated in the emergency room.”

Merkin acknowledges the controversy and cynicism over whether medical practices will recoup the expenses associated with getting ICD-10 up and running. He agrees there’s a cost for training, a cost associated with—at least initially—productivity lost, and a cost associated with increased time spent on billing. But over time, he feels the benefits will more than outweigh the costs.

“It may take some time to bear fruit, but if done right, you’ll see more accurate payments; eventually see fewer rejected claims; and perhaps most importantly, patient benefits like improved quality of care,” Merkin says. “In England they’ve been doing [ICD-10] since the mid’90s, so there is a track record.”

Important Considerations

As far as pitfalls go, Merkin says it’s important for medical practices not to take a generic approach to implementation. He says there’s a lot of very well intended advice floating around about ICD-10, but it’s not being written for one specific practice.

“What we’re suffering from at this point is an information overload,” Merkin says. “It really behooves physicians to talk with their peers, to look at their professional and trade organizations. Don’t try to apply every single tip to your practice, because some of them won’t fit. Sit down with colleagues because they’re going to have the best recommendations that will be tailored for you.”

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