ICD-10-Compatible vs. ICD-10-Ready: There Is a Difference
Guest commentary from Ken Lacy, chief information officer, Precyse Solutions
The ICD-10 compliance deadline is drawing closer; as of this month it's only three years away. As the health care industry scrambles to prepare for ICD-10, one thing is very clear: The process will be way too complex to manage without automation, namely Computer Assisted Coding (CAC). Already we've seen CAC tools being changed and developed in preparation, and the closer the deadline gets, the more valuable this software becomes. What can you do to ensure that your health care organization is ready for the most challenging transition in the history of coding? How will you upgrade? Which CAC solution should you choose? How will you go about training your staff on the new software? And have you thought about the new implications that ICD-10 has for RAC audits?
Just about every health information management (HIM) company out there says they have a CAC solution for the transition to ICD-10, and every day it seems a new CAC software is being released that promises improved coder productivity, more streamlined processes, shortened turnarounds and reduced costs. Let the buyer beware -- there is a big difference between CAC applications that are ICD-10-compatible and CAC applications that are ICD-10-ready, and it can mean the difference between simply dealing with the obstacles posed by the ICD-10 transition and having the power to virtually overcome them.
Most of the solutions out there are just ICD-10-compatible, meaning the vendor has taken an existing CAC product that was built for ICD-9 and updated or re-engineered it to be ICD-10 compatible. While these CAC solutions can work with ICD-10, they were not built for it, so they will inevitably go through some growing pains and have some kinks to iron out. It's kind of like wearing a suit that was custom-made for someone else. It may fit, but it's not going to fit as well as it fits the person it was made for.
On the other hand, a CAC solution that is ICD-10-ready is one that has been built from the ground up to work with ICD-10, as opposed to merely being updated or re-engineered to meet ICD-10 requirements. Such a solution never even heard of ICD-9. To stretch my metaphor a bit further, the ICD-10-ready solution is the custom-made suit, and ICD-10 is the person it was made for. These are the most advanced CAC platforms available, and they can break through the clutter of outdated processes to streamline and modernize the information management workflow. One of the major benefits of ICD-10-ready systems involves meeting the challenge of integrating electronic health records (EHRs) into the coding process. The CAC engine inherent in a system built specifically for ICD-10 can provide a bridge between EHR documentation, the transcription system and the health care provider's financial systems.
ICD-10-ready CAC solutions can also make a difference in Recovery Audit Contractor (RAC) audits. For the most part, ICD-10-ready means RAC-ready too. That's because the areas of risk associated with RAC audits will become more complicated once ICD-10 is in place. Furthermore, RACs themselves are implementing the latest CAC solutions to identify those not in compliance with ICD-10. ICD-10-ready solutions have NLP (natural language processing) and speech understanding technology driving the automated code assignment. The type of CAC software that will help you proactively attack RAC is the kind that incorporates automation for coding workflow and process.
Additionally, CAC solutions that provide the ability to set up coding work pools specific to RAC-target case types coupled with an automated pre-bill quality assurance (QA) rules and routing process is a tremendous benefit. These pre-bill QA rules can be based on a number of variables; from a RAC perspective, a rule can be established for each targeted case. And since ICD-10-ready systems help meet the challenge of integrating EHR records into the coding process, it follows that organizations that adopt ICD-10-ready solutions will have the power to get through RAC audits more smoothly and to improve the accuracy of claims management.
A great example of how an ICD-10-ready CAC solution can revolutionize coding workflow is the Baptist Health System (BHS) in Birmingham, Ala. Before implementing an ICD-10-ready solution a few years ago, the BHS team was frustrated by a number of issues, including recruiting and retaining quality coders, optimizing the coders' proficiency, capturing revenue that human error may have missed, retaining a coding audit trail and meeting changing compliance rules and regulations.
Since implementing an ICD-10-ready solution, BHS has been able to increase productivity, accuracy and quality, while significantly reducing costs and providing valuable management reporting tools. BHS has experienced a 20 percent increase in coding efficiency; a 5 percent increase in DRG-based revenue through more accurate coding and improved Case Mix Index (CMI); a 10 percent reduction in voluntary auditing; coder productivity improvement; reduced audit costs; and a revenue increase of 0.25 percent, due to better information and more accurate coding.
The bottom line is this: There is an absolute difference between CAC solutions that are ICD-compatible and those that are ICD-10-ready. Hospitals and health systems that choose ICD-10-ready solutions will be better prepared to optimize coding operations, accelerate ICD-10 transition and manage RAC and other governmental auditing bodies. When assessing which solutions will best help manage the transition to ICD-10 and proactively attack RAC audits, providers mustn't be distracted by the urgency and complexity of the evaluation and decision-making process. Don't scramble. Carefully shape your vendor technology evaluation criteria, create an evaluation matrix so you are confidently comparing apples to apples, and be sure the solution you are selecting addresses your facility's specific priorities and circumstances. After all, scrambling to the ICD-10 deadline without careful assessment and selection of the right tools for your organization could leave you struggling to keep your ill-fitted pants amid a compliance quagmire.
Mr. Lacy is chief information officer at Precyse Solutions, where he is responsible for setting the technology direction for the company's product offerings and internal systems, overseeing the development, implementation, and customer support teams. He has led the development of PrecyseCode, an advanced health information management platform. Mr. Lacy has over 15 years of experience in the health care information services industry. He holds a B.S. degree in electrical engineering and an M.S. degree in Business and Health Care Administration from Georgia Institute of Technology.