(This sponsored blog was written by Tom Ormondroyd, vice president/general manager, Precyse Learning Solutions.)

Here is a continuation of some common ICD-10 myths, from my previous blog Dispelling Some Myths About ICD-10. These are common ICD-10 myths that continue to plague all of our efforts to obtain buy-in and motivate our impacted populations to want to learn more about and prepare for the transition. Some of these myths are just nuisances, while others are true showstoppers that undermine the efforts of our industry.

Myth 1: Physicians who choose their own codes will not have to worry about training as their EHR will do this for them.

Truth: Although EHRs are starting to do some great things in regards to prompts, problem lists, and other assistive tools for ICD-10, they do not take the place of required education for those physicians selecting their own codes. One of the biggest concerns with ICD-10 is driving accurate representation of the severity of our patients' illnesses and hence, the medical necessity of the procedures and tests we will perform. If a secondary condition is not on our problem list or we do not have quick access to more specific code choices, the physician may miss out on opportunities to capture this greater specificity and severity of illness leading to possible greater scrutiny. Documentation education is also key because if we do not have the documentation to support the code selected, then we open ourselves up to significant risk. EHRs are a vital aspect of our transition to ICD-10, but understanding of the core concepts of ICD-10 physician documentation and coding are required to be successful.

Myth 2: ICD-10-CM is a reimbursement system, not built for clinicians.

Truth: With all of the debate currently going on about ICD-10, one of the key aspects of ICD-10 that is often forgotten is the creation and development of ICD-10. The system itself started its origins at the WHO through the efforts of a team of physicians, clinicians, coders, and other healthcare professionals and then further modified by the United States again by a team of clinicians and other healthcare professionals. The system is far more rooted in current clinical thought and practice than the ICD-9 system, but it has not been able to shed its coding-only, reimbursement-only type moniker.

Take one example of how it is more clinically focused: hemorrhoids. Today, a physician lacks the ability to show the true severity of a patient's hemorrhoid. There are very few choices in ICD-9, and most end up being classified as simply external or internal. No matter how severe the case, we often need to choose from these limited choices. In ICD-10-CM, however, hemorrhoid codes are structured clinically, the opposite of the myth. With ICD-10-CM, we will be able to choose the grade/degree of the severity from first to fourth. As we all know, more severe cases of conditions take longer to diagnose and treat. Today in ICD-9, for this example, we have no way to show why we spent as many goods and services as we do, but ICD-10-CM offers the opportunity. Interestingly, ICD-10 does not do this with just more code choices (in fact, there are fewer ICD-10 codes for hemorrhoids), but instead, just better and more clinically relevant ones.

This is only one example, but one we must communicate to ensure the clinical nature of the system is understood.

About our partnership: HealthStream is proud to be partnered with Precyse Learning Solutions to ensure your staff and facility are prepared for the ICD-10 transition on day one. The Precyse ICD-10 Solution Suite is offered exclusively through HealthStream.

If you work in any healthcare environment, you know how inundated we have become with information around ICD-10 - most of it leaning toward the negative end of the spectrum. Yes, there is a lot to learn. Yes, there are time and financial burdens involved. Yes, it is one of the most significant changes ever for the healthcare industry. And Robert Tagalicod, director, Office of E-Health Standards and Services, reminds us why it is an important and positive change and why it should matter to us.
 

Why ICD-10 Matters

1. ICD-10 advances healthcare and the implementation of eHealth initiatives.

• ICD-10 is essential to healthcare reform and the CMS eHealth Initiative and is part of the overall goal - the triple aim to achieve better care, better access, and better health while lowering costs.
• eHealth programs such as ICD-10, administrative simplification, the Medicare and Medicaid EHR incentive programs, and quality reporting programs like the Physician Quality Reporting System are all aimed at accomplishing this goal. 
• Together, these eHealth programs will provide greater interoperability, easier data sharing, better quality measurement, improved clinical outcomes, and lower costs.

2. ICD-10 captures advances in medicine and medical technology.

• ICD-10 captures new procedures that lead to innovative healthcare and medical breakthroughs.

3. ICD-10 improves data for quality reporting.

• Many quality measures rely on ICD diagnosis codes. ICD-10 provides better data for quality reporting and outcomes measurement.

4. ICD-10 improves public health research, reporting, and surveillance.

• ICD-10 is more effective at capturing public health diseases due to its greater specificity. Federal, state, and local officials, including researchers, will use ICD-10 diagnosis codes for public health research, reporting, and surveillance.

For more information on ICD-10 and training solutions available from HealthStream and Precyse, click here.

(This sponsored blog was written by Lee Ann Bryant, associate product manager, HealthStream.)

According to a recent survey conducted by the Workgroup for Electronic Data Interchange (WEDI), an industry leader on the use of healthcare IT to improve the exchange of healthcare information, healthcare facilities as a whole are not on track for a smooth transition to ICD-10 Oct. 1, 2014. Close to 1,000 industry participants were surveyed on readiness in February of this year, including 778 providers, 109 health plans, and 87 vendors.

Stanley Nachimson, director of the NCHICA/WEDI (North Carolina Health Information and Communications Alliance) stated "... it has become clear that many entities postponed their work until much later.  It remains to be seen how this postponement will affect the progress to compliance. Indications remain that significant numbers of industry participants have a considerable amount of work to do in a very short time."

Based on survey results, there was a shift in ICD-10 timelines across all facility types. Some contributing factors to this slow progress include the change in compliance dates, competing internal priorities, and other regulatory mandates.

Some key results from the survey include:

• Almost half of the health plans expect to begin external testing by the end of this year. In the 2012, survey all health plans had expected to begin in 2013.
• About half of the providers responded that they did not know when testing would occur and more than two-fifths of provider respondents indicated they did not know when they would complete their impact assessment and business changes.
• About two-thirds of vendors indicate they plan to begin customer review and beta testing by the end of this year. This is similar to the number who expected to begin by the end of 2012 in the prior survey.

"The survey results show that projected timeframes for testing have shifted, and many organizations will not begin this task until 2014," stated Jim Daley, WEDI chairman. "Because of the magnitude of ICD-10, it is critical that organizations complete their remediation efforts as quickly as possible in order to allow adequate time for testing." (For a full copy of WEDI's letter to CMS, click here.)

It is critical that providers get started with their training right away. CMS has provided numerous timelines and checklists based on facility type and size. To access the ICD-10 Implementation Timelines and Checklists, click here.

(This sponsored blog was written by Lee Ann Bryant, associate product manager, HealthStream.)

Many think ICD-10 is only a coding problem, but the true challenge of ICD-10 is the need for increasing specificity and granularity in documentation in order to receive optimal reimbursement, meet all reporting requirements, and most accurately reflect the level of care provided.

The term "clinical documentation improvement (CDI)" has been used in the healthcare information management industry for decades, yet never has it played a more crucial role than it does right now or that it will in years to come. The speed with which physicians adapt to reimbursement documentation requirements and guidelines has a direct impact on the rate of improvement of an organization's overall workflow quality and productivity and also its ability to enhance cash flow and receive appropriate revenues for work performed. The upcoming conversion to ICD-10 makes this even more important. Improving CDI workflow processes to advance documentation quality and accuracy is paramount as organizations prepare for the ICD-10 environment and the other challenges that lie ahead in the near future.

Documentation has always been necessary for the communication between the providers caring for a patient. But the need for increasing specificity has evolved along with industry trends.

Current Challenges and Trends

As the healthcare industry continues to evolve, there are global drivers and industry trends that are creating ongoing challenges:

• Increased government reform: With initiatives like the Accountable Care Act, Meaningful Use, Pay for Performance and National Agency Reporting, never before have healthcare providers been so exposed to the public on the quality of care they provide.
• Globalization: Travel and migration, prevention of epidemics, and medical tourism are creating new challenges to the healthcare industry.
• Aging population: People are living longer and, as a result, more complex healthcare is needed, coupled with shrinking reimbursement.
• Economic recession: The healthcare industry is being asked to provide better quality but with less resources; facilities have less money to spend on innovation, and providers continue to consolidate.
• Growth of data: The healthcare industry is rich in data but information poor. As medical knowledge grows, there is an increased need for comparative data; however EHRs are not built to analyze data.

As a result of these trends, the challenge is to reduce costs while enhancing the quality of care. Specific challenges include:

• Quality: Provide consistent and accurate documentation that provides the specificity necessary for ICD-10and reduces exposures for fraud and abuse.
• Financial: Reduce labor costs, denials, and DNFB while optimizing reimbursements.
• Strategic: Create clinical data integration to support IT, HIM, and financial goals.
• Human resources: Resource management monitoring, outsourcing, and role consolidation all create unique challenges, in addition to the need to educate employees not only on ICD-10 but on other initiatives like MU, value-based purchasing, etc.

A white paper is available that includes:

• the evolution of CDI
• current healthcare challenges and trends
• the need for increased specificity and granularity in documentation
• the main groups affected by ICD-10: physicians/providers, CDI specialists and coders
• key processes related to CDI
• the role technology will play in supporting a successful CDI program of the future.

(This sponsored blog was written by Lee Ann Bryant, associate product manager, HealthStream.)

With small and medium practices in mind, CMS has put together the following checklist of ICD-10 tasks, including estimated timeframes for each task. Depending on your organization, many of these tasks can be performed on a compressed timeline or performed at the same time as other tasks. This checklist is designed to provide a viable path forward for organizations just beginning to prepare for ICD-10. CMS encourages those who are ahead of this schedule to continue their progress forward.

To prepare for testing, make sure you have completed the following activities. If you have already completed these tasks, review the information to make sure you did not overlook an important step.

• Review ICD-10 resources from CMS, trade associations, payers, and vendors
• Inform your staff/colleagues of upcoming changes (one month)
• Create an ICD-10 project team (one to two days)
• Identify how ICD-10 will affect your practice (one to two months)
• How will ICD-10 affect your people and processes? To find out, ask all staff members how/where they use/see ICD-9
• Include ICD-10 as you plan for projects like meaningful use of electronic health records
• Develop and complete an ICD-10 project plan for your practice (one to two weeks)
• Identify each task, including deadline and who is responsible
• Develop plan for communicating with staff and business partners about ICD-10
• Estimate and secure budget. Potential costs include updates to practice management systems, new coding guides and superbills, staff training (two months)
• Ask your payers and vendors-software/systems, clearinghouses, billing services-about ICD-10 readiness (two months)
• Review trading partner agreements
• Ask about systems changes, a timeline, costs, and testing plans
• Ask when they will start testing, how long they will need, and how you and other clients will be involved
• Select/retain vendor(s)
• Review changes in documentation requirements and educate staff by looking at frequently used ICD-9 codes and new ICD-10 codes (ongoing)

For the full ICD-10 Implementation Guide for Small and Medium Practices, click here.

If you would like more information on how HealthStream and Precyse can help your organization prepare for ICD-10, click here.

By Stephen McClure, marketing manager-content, HealthStream

As the healthcare industry draws closer to the go-live date, ICD-10 remains a polarizing topic among healthcare professionals. While some healthcare organizations are actively preparing for a strategic rollout, others are, more or less, bracing for impact.

In April 2012, CMS extended the ICD-10 implementation deadline to Oct. 1, 2014, at the request of some physicians, hospitals, and other industry stakeholders. Since then, the American Medical Association (AMA), in partnership with other groups, has urged CMS to eliminate ICD- 10 implementation altogether due to the significant administrative and financial burden it imposes on physicians. There is no sign this will happen, however, or indication of any further postponement.

In fact, the acting CMS Administrator, Marilyn Tavenner, recently stated, "Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10. Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments."

ICD-10 Complements Our More Advanced Healthcare System

There are many differing opinions concerning the transition to ICD-10. But, in reality, ICD-10 is necessary to all levels of a technologically progressive healthcare system. Given the magnitude of change happening in the U.S. healthcare delivery system, ICD-10 is a natural and necessary advancement that will address the critical gaps and operating flaws inherent in ICD-9, which was developed more than 30 years ago. Since then, healthcare science and technology have greatly advanced, making ICD-9 inadequate to deal with the advances in healthcare. Moreover, the content of the ICD-9 Clinical Modification (CM) was not designed to be used as a data system for disease management, nor was it intended to support reimbursement of medical services.

ICD-9 is an antiquated classification that has a puzzling mixture of code descriptions-some very specific, and others that are so broad they fail to even identify the site of the disorder. Today, we have a system that does not always fully capture the severity of our patients' illnesses, which prevents physicians from receiving full credit for the care performed in quality reporting.

Focusing on ICD-10's Benefits is Important

To be sure, implementing ICD-10 is a major undertaking for all healthcare professionals who are faced with many other challenges, including meeting the requirements of Meaningful Use legislation. ICD-10 compels greater specificity in documentation practices; it also involves a new coding classification system and an increase from 17,000 to more than 140,000 codes.

It is estimated that ICD-10 implementation costs will range between $83,000 and $2.7 million, depending on the healthcare organization or physician practice size, according to the AMA. The Advisory Board Company calculates that the three-year incremental impact of ICD-10 could range from $2.5 to $7.1 million for a typical 250-bed hospital, with coder productivity decreasing by close to 20 percent and physician productivity taking a 10 percent to 20 percent hit due to significant increases in queries.

A white paper is available that includes:

• clinical roots: how physicians shaped ICD-10
• why physicians should care about ICD-10
• how ICD-10 data will benefit physicians
• what's the physician return on investment for ICD-10?
• case study: applying ICD-10 to crohn's disease
• a guide to taking control of ICD-10
• a list of major ICD-10 documentation changes.

Download the White Paper Here.

By Lee Ann Bryant, associate product manager, HealthStream

Click here to see how HealthStream and Precyse can help you mitigate these risks by having you and your staff ready to succeed from day one.

By Lee Ann Bryant, associate product manager, HealthStream

Although nearly all healthcare providers are aware of the Oct. 1, 2014, deadline, studies show that most are unprepared for this transition. Recognizing that these changes require widespread education and planning initiatives beyond just the coding population, Centers for Medicare and Medicaid Services (CMS) provided a timeline for preparation between now and the "go-live" date of Oct. 1, 2014.

Transition and Testing

March 2013 to September 2014

• March 1, 2013 - Dec. 31, 2013: Conduct high-level training on ICD-10 for clinicians and coders to prepare for testing ... e.g., clinical documentation, software updates (ongoing)
• April 1, 2013: Start testing ICD-10 codes and systems with your practice's coding, billing, and clinical staff (nine months)
• Use ICD-10 codes for diagnoses your practice sees most often
• Test data and reports for accuracy
• Monitor vendor and payer preparedness, identify and address gaps (ongoing)
• Oct. 1, 2013: Begin testing claims and other transactions using ICD-10 codes with business trading partners such as payers, clearinghouses, and billing services (10 months minimum)
• Jan. 1, 2014 - April 1, 2014: Review coder and clinician preparation; begin detailed ICD-10 coding training (six to nine months)
• Work with vendors to complete transition to production-ready ICD-10 systems

Oct. 1, 2014

• Complete ICD-10 transition for full compliance
• ICD-9 codes continue to be used for services provided before Oct. 1, 2014
• ICD-10 codes required for services provided on or after Oct. 1, 2014
• Monitor systems and correct errors if needed

While this timeline is a good high-level guide for what your organization should be focusing on now, it does not provide guidance on the day-to-day task of educating all necessary staff for this transition. With more than 50 affected populations in a healthcare facility, the ICD-10 transition is a great one and shouldn't be taken lightly. ICD-10 is coming - are you ready?

For more information on how to get your organization and staff on track and ready to succeed from day one, click here.

By Lee Ann Bryant, associate product manager, HealthStream.

The decision has been made to move forward with your ICD-10 education and training, but the transition process is just beginning. Some lingering questions might be ...

"Where will we look for our education?"

"How will we manage all of these changes while ensuring our employees are getting the education required?"

"What resources are out there than can help us on this journey?"

While improving documentation is at the forefront, it is a mere fraction of what facilities must factor into this evolution. Adapting to and managing change, providing training and ongoing testing, and revenue planning - these are all aspects that must be considered and will be impacted by the transition to ICD-10. Aside from the actual education, there is so much to learn!

With our growing Resource Library, see how HealthStream and Precyse are quickly becoming your thought leaders when it comes to managing such a transition - from beginning to end. Here you will have access to webinars, white papers, articles, course demos and pricing requests and more:

Click here to check out HealthStream's ICD-10 Resource Library, and see how it can help you with the ICD-10 journey today!

By Lee Ann Bryant, associate product manager, HealthStream

The impending shift to ICD-10 comes with many challenges as well as opportunities. The old adage "don't believe everything you hear" certainly stands true as we rapidly approach what has come to be seen as a healthcare phenomenon. While a successful transition does require a tremendous amount of education and training, our focus should remain on the benefits to both the employee as well as the organization.

In a recent article, Thomas Ormondroyd of Precyse Learning Solutions has debunked some of the most prevalent "myths" associated with ICD-10 that ultimately have led to a lack of enthusiasm around its implementation.

Myth #1: The increase in documentation required by ICD-10 will involve a huge amount of added content to the medical record.

Reality: In most cases, ICD-10 will require just a few more words per condition documented.

The good news is that physicians already know this information as part of the clinical story based on their encounters with the patient or the encounters reported to them by ancillary departments - all they need to do is make sure that they actually document this information. And physicians may already be aware of the new terminology required due to changes in clinical practice. A good example of this is asthma. Physicians already should be using clinical criteria to establish the stage of the asthma; ICD-10 now allows documenting and coding of these stages.

Myth #2: All codes in ICD-10-CM will be complex, seven-character codes.

Reality: There are three-character codes in ICD-10-CM, and the most common code length is four characters; therefore, in many cases, the ICD-10-CM code actually will be shorter than its ICD-9-CM counterpart.

Click here to continue reading this article: "Dispelling Some Myths About ICD-10."

The transition from ICD-9 (the International Classification of Diseases, ninth revision) to ICD-10 codes is quickly approaching. Originally, the U.S. healthcare industry was required by the Department of Health and Human Services (HHS) to switch to ICD-10 codes by Oct. 1, 2013; however, there now has been a final adjustment by the Centers for Medicaid & Medicare Services (CMS) to extend the ICD-10 implementation deadline to Oct. 1, 2014. The extension was a reaction to intense pressure from the American Medical Association (AMA), hospitals, and others who reported that they need more time to implement the extensive changes.

Why ICD-10? Better Healthcare Outcomes and Patient Safety

The overhaul is long overdue in light of the vast changes in the U.S. healthcare system since ICD-9 was first released more than three decades ago. During that time, there has been a dramatic rise in chronic conditions, compounded by an aging baby boomer population. Moreover, the last decade has witnessed a national movement to improve quality outcomes and patient safety. Now, government and private payers are demanding to know more about patient care and outcomes information as they roll out aggressive pay-for-performance (P4P) programs, many of which are already tied to reimbursement rates and bonuses. ICD-10 will provide updated medical terminology and a new level of detail about diseases and clinical procedures in today's climate of intense healthcare reform.

ICD-10 is Just One Among Competing Priorities for Hospitals

As deadlines loom, many hospital leaders admit their organizations aren't prepared for the ICD-10 transition. In fact, only 26 percent of organizations were part-way through ICD-10 preparation, according to a July 2011 survey of healthcare leaders. Lack of readiness could lead to significant challenges, considering that ICD-10 is on par with the magnitude of HIPAA and Y2K. It's not a surprise that hospitals are lagging behind given their push to comply with other multimillion-dollar government initiatives, including the roll out of EHR projects that meet "Meaningful Use" criteria and qualify for financial incentives under the American Recovery and Reinvestment Act of 2009.

Our white paper, "The Race is on for ICD-10 Implementation," written by HealthStream's Christian Oliver, associate vice president for catalog and courseware, details:

• how ICD-10 compliance can support innovation
• the risks of noncompliance
• ICD-10's impact on hospitals
• how focusing on education can put hospitals in the ICD-10 driver's seat
• how to build an ICD-10 training program
• the impact of ICD-10 on physicians.