Access Management Quarterly

Access technology will need revamping

Now is the time to get involved

Systems will need to be remediated if they will be used to check medical necessity for ICD-10 standards when they are implemented in October 2013, says Jeffrey Smith, RN, MBA, CPC, a New York City-based manager at Accenture Insight Driven Health, a management and technology consulting company.

Patient accounting and registration systems will need to be upgraded to accept the increased field length of diagnosis codes, he explains.

Third party web-based systems for obtaining pre-authorizations and certifications will need to be updated to meet ICD-10 standards, along with ancillary systems used by lab and radiology, adds Smith.

Smith gives these recommendations to prepare:

• Inventory all third party systems used in the scheduling/registration and authorization process.

"Sometimes systems aren't all fully integrated," notes Smith. "It is a question of where you are doing registration and scheduling. Some systems might fall outside patient access, like lab or radiology."

Even if staff members are not capturing the diagnosis code, says Smith, the systems still might need to be remediated if they are working in areas where scheduling is done. "If they are doing any checking for medical necessity, that clearly needs to be identified," he says.

• Determine timetables for upgrading systems.

"If you have a third party system that is utilizing diagnosis code information that is being captured at the time of registration, you need to know when that vendor is going to have that system ready for ICD-10," says Smith.

While this task probably will be handled by members of the IT staff, they might not be aware of all the systems patient access is using to process diagnosis code information, Smith adds.

• Examine all patient access workflows to determine whether ICD-9-CM diagnosis codes are utilized and processed.

"You will probably need to flow out in detail all the workflows that involve the handling of the diagnosis codes," Smith says.

Identify when data is coming in from third parties, such as any paper requisitions from community physicians, says Smith. "If you are processing any diagnosis codes from these, there would potentially be an issue with ICD-10," he says. "If you are receiving an inaccurate and incomplete diagnosis and you are trying to determine medical necessity, follow up with those particular provider offices."

Consider web-based applications used in your department, because payers might have certain systems where diagnosis codes are entered, says Smith.

Systems upgraded

Vanderbilt University Hospital in Nashville, TN, is creating a web-based tool for staff to use as a quick reference, with a list of the top 50 conditions and 25 procedures.

"It also has a listing of payers which will require ICD-10 codes," says Marsha Kedigh, RN, MSM, director of admitting, ED registration, discharge station, and insurance management.

The department is upgrading its registration system to expand the fields to accept the longer code and increased volume of codes and upgrading internal insurance web sites used by staff to assist with coding, says Kedigh.

The emergency department's electronic whiteboard houses the ICD-9 codes and also will need upgrading, adds Kedigh, as the ED physician attaches the appropriate code to the patient via the whiteboard based on diagnosis.

At Mission Hospitals in Asheville, NC, staff will use an encoder to provide the ICD-10 codes, based on the verbiage provided by physicians. Susan Hoyle, CCS, coding manager, says, "Patient access will utilize a medical necessity checker to verify that codes meet criteria for coverage for Medicare."