A view from the Center

Deloitte's Life Sciences & Health Care Blog

Preparing for life after ICD-10 implementation

We’ve entered the ICD-10 homestretch, the few short weeks before health care stakeholders finally see the implementation of a transformative change nearly twenty years in the making.

But go-live is just the beginning. Even with all the preparation, there are likely to be challenges organizations need to consider after the transition. Post-implementation, not only are the potential impacts that could disrupt the transition to ICD-10 important to consider, but they also provide multiple opportunities to assess and improve operations. Potential impacts include:

  • Operational disruptions: Implementation could trigger a decrease in coder productivity, backlogs in coding and billing, a fluctuation in performance metrics, and resource strain on clinical documentation programs.
  • Financial impact: Net revenue may decrease from cash flow interruptions and from increased denials and underpayments. Understanding the root cause of potential case mix and financial shifts will be critical.
  • Resource considerations: Change management processes, evolving training needs, employee retention, and resource reallocation may also present challenges.
  • Technological complexities and demands: Providers may experience data transmission issues causing a need for re-testing of critical functions and unscheduled vendor updates to ICD-10 software packages.

Addressing these impacts head-on will require organizations to understand the highest areas of risk to proactively allocate time and resources. And it’s not just providers – their payers, vendors, and trading partners all should be equally supportive in order to alleviate financial and operational disruption.

Here are some suggestions that may address post-go-live impacts:

Assess demands on resources: Assessing training gaps, employee morale, and effective allocation of the most impacted resources will support early identification of issues with your most valued asset – your team.

Prioritize DNFC (Discharge Not Final Coded): Post-ICD-10, coding expertise will likely be in short supply and potential negative impacts on coder productivity could create a perfect storm for increased DNFC. Identify strategies with positive productivity impact, low financial and quality risk, and minimized levels of effort to keep DNFC under control. Examples include overtime opportunities for high-performing coders, optimized work queues, and management dashboards that track DNFC as real-time as possible.

Monitor net revenue and cash trends: Model and focus on key financial metrics such as DRG shifts, CMI changes, claim rejections (i.e., edits), increases in time-to-pay by payers, payment variances (i.e., underpayments), increased denials, and impacts to A/R to track trends in reimbursement.

Assess documentation quality: Providers may still be wrestling with the new documentation specificity and granularity requirements, as well as using diagnostic terminology rather than clinical indicators. Formally reviewing documentation through a Clinical Documentation Excellence program is the most efficient and effective way to assess documentation quality, while also providing feedback loops to physicians through formal and informal educational channels.

Audit coding productivity and quality: Coders may still be trying to fully integrate new coding concepts into their work, especially with the procedure codes, which could impact both their productivity and their accuracy. Formally reviewing coder work through standardized key performance indicators around productivity and quality, and taking immediate corrective action by conducting additional training and stand-and-deliver educations sessions, as needed, could stem issues with productivity, quality, and accuracy.

Develop a formal post-ICD-10 education program: Physicians, coders, and clinical documentation specialists will be some of the most highly impacted stakeholders in this transition. Putting their pre-go-live training into practice may reveal gaps in their content knowledge and will require a robust, continuing education program designed to support their educational needs proactively, before quality issues arise.

Identify reporting and data integrity challenges: To achieve meaningful reporting and analysis using ICD coding (e.g., trend analysis, quality scoring, population management), data integrity across the transition is necessary. Modeling the state of the business and identifying how ICD-coded data is currently used in key reports and analyses that drive clinical, financial, and other decisions could reveal the options for handling the blended data during the conversion.

Assess your EHR template design: Updating the Electronic Health Record template to capture necessary information to support ICD-10 documentation requirements is an automated method that may positively impact quality and reimbursement.

Life after go-live

The challenges brought on by the transition to ICD-10 may seem daunting. But a carefully designed post-go-live strategy can mitigate some of the potential difficulties by effectively addressing not only the potential go-live challenges posed by ICD-10, but also how to adapt to the period of transition immediately afterward.


Author bio

Christine Armstrong, RHIA, MBA is a Principal at Deloitte Consulting LLP with over 25 years of health care experience. She has led numerous multi-system high profile engagements, including operations improvement, productivity, revenue cycle, supply chain, information technology implementation and redesign, charge capture, and CDM assessments. Christine has extensive international experience with operational improvement projects including ICD-10 coding quality improvement and training projects.