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Educate yourself, staff, and physicians
Because the prior authorization process occurs well in advance of a service, your Patient access staff will need to be prepared for ICD-10 well before the Oct. 1, 2013, implementation date, warns Rennae J. Glidden, RHIT, director of data services at HealthEast Care System Midway Campus in St. Paul, MN. Use these strategies:
To educate yourself:
Glidden says that you should be participating in ICD-10 training, including audioseminars and inservices offered within your facility. "Partner with your health information management coding personnel as you go live on ICD-10," she says.
To prepare for ICD-10, Kedigh has participated in several webinars from the Healthcare Financial Management Association (HFMA). (To learn about upcoming events, go to www.hfma.org. Select "Education & Events" from the top bar. Select "Online Learning" from the left bar and then "See a listing of current webinars offerings.")
To educate staff:
Your patient access personnel will need much more in-depth knowledge of coding than they have with ICD-9, according to Glidden. "This is because of the complexity and specificity of ICD-10," she says.
Patient access departments will be faced with using a "robust coding system," says Glidden. "This is likely to test their knowledge of medical terminology, anatomy, and physiology," she says.
First, identify all staff who work with diagnosis codes, and determine their required level of knowledge, advises Jeffrey Smith, RN, MBA, CPC, a New York City-based manager at Accenture Insight Driven Health, a management and technology consulting company. "Education is the biggest challenge," he says. "Staff will need to know the code structure will change. It's going to look a lot different."
If staff members are contacting providers or discussing any kind of diagnosis information with payers, those individuals will need more training, says Smith. "This needs to be done two or three months prior to the implementation," he adds.
To educate provider offices:
In addition to your own staff, physician office staff will need education because ICD-10 affects the scheduling process, says Kedigh.
This process will be a challenge for coders and patient access staff alike, says Glidden. "Terminology in ICD-10-PCS often does not match what physicians are typically saying," she explains.
Susan Hoyle, CCS, coding manager at Mission Hospitals in Asheville, NC, says, "Since ICD-10 codes are more specific, we'll need to ensure the physician offices provide as much detail as possible. We are planning to do a lot of physician education during the year prior to implementation."
A physician advisor is assisting with physician education regarding documentation, says Hoyle, and he will continue to take a lead role in ICD-10 preparation.
In 2012, the department's encoder and clinical documentation improvement tools will provide information to coding staff, says Hoyle. This information will explain the documentation that will be needed for the added specificity for the ICD-10 codes, while staff members still are using the ICD-9 codes, she says. "We are also beginning to look at the opportunities we may have to use prompts or drop down boxes for our physicians, as we build our electronic progress notes" in the electronic health record," says Hoyle.