Training for ICD-10: A Complete Plan Extends Beyond Coders

Transcription

1 Training for ICD-10: A Complete Plan Extends Beyond Coders ICD-10 training discussions have primarily centered around medical coders. As providers experienced with MS-DRGs, however, effective clinical documentation and coding accuracy happens when coders work in concert with clinical teams Physicians and Clinical Documentation Specialists (CDS). This underscores the need for a complete training program that touches all key stakeholder groups. When the complete picture of training is examined, it s clear that signifi cant time and dollars must be allocated. The following table illustrates training needs based on a hospital of approximately 400 beds. (Note: training time and costs are an approximation and will vary based on method and format.) Role Qty. Est. Hours Rate Per Hour Est. Costs % of Total Data Coders $100 $500,000 30% Physicians 1,000 6 $100 $600,000 36% Nurses 1,500 3 $100 $450,000 27% Decision Makers 50 4 $200 $40,000 2% Analysts 20 3 $200 $12,000 1% Production Workers 50 2 $200 $20,000 1% Others 2,500 1 $20 $50,000 3% Total 5,220 $1,672, % This does not include overtime, backfi ll or redo costs. Coders carry the bulk of training time. But while physicians require only a few hours of training, the related costs of their training, in a 400 bed hospital, are higher than the cumulative costs for coders. Even more critical, Experis interactions with providers have shown that many physicians neither understand the full benefi t of ICD-10 for patient care nor understand their critical role in the new documentation system. Without physician cooperation and an understanding of ICD-10 requirements, the revenue cycle will not fl ow smoothly and the opportunities for patient care optimization will not be realized. To address all stakeholders, providers should create a training plan that includes four key elements: 1. Communication 2. Planning 3. Assessment 4. Education ManpowerGroup. All rights reserved.

2 1. Communication Introduce the new coding system and general terminology to the team and key stakeholders. Communication across the organization is essential to buy-in and to create a successful training process. Relaying the overall requirements of ICD-10 and the role of each group in implementing this mandate must begin early. Many physicians, for example, have been documenting the same way for decades and now must understand and embrace a new system. Including champions from each group in overall roll-out discussions can be tremendously important in advancing change management across the organization and enhancing receptivity to training, some of which will be disruptive to existing schedules. Having the endorsement of the Chief Medical Offi cer for the physician training program is critical. Gaining buy-in from departmental directors and infl uencers is also essential. Communication Use Audience ICD-10: What Every Healthcare Professional Should Know (Training handbooks) Experis White Papers Use to familiarize noncoding staff with ICD-10. Use for expert guidance on leadership and management on preparations for ICD-10. General staff awareness General staff awareness 2. Planning Create a training plan and procure buy-in. Build a training plan and allocate suffi cient time. Training timelines will depend on the current skill levels of your coders and clinical staff. Global guidelines are: Coding staff: 5 to 10 days based on current skill level and number of specialties involved Clinical staff: Up to 8 hours Administrative staff: Up to 8 hours on a need-to-know basis Build Training Options: Time and Level Ways in which training time can be accommodated must be considered. Options for evening and weekend training may be required, as well as training for different skill levels (e.g., beginning vs. more experienced coders). Consideration should also be given to the need for coverage while staff is at training. This may be particularly true for coders who will require many hours of training. Education of coding staff and clinical staff should commence as early as possible, certainly no later than January Physicians could experience an increase of 3 to 4 percent of time spent on documentation for ICD-10-CM code compliance, though this may ease with daily application ManpowerGroup. All rights reserved.

3 In addition to time, funds must be allocated to cover: One-time costs: training, system modifi cations/upgrades, outsourced implementation Recurring costs: employee salaries, benefi ts, etc. Train the Trainer Considerations Some organizations elect to implement a train-the-trainer model. This training can never start too early because the trainer(s) must be well-versed in the complexities of ICD-10 before the actual classes can begin. It is important to have a draft manual of ICD-10 to assist with this goal. The index is referenced in the same manner as ICD-9 but is expanded to accommodate the detail required by ICD-10 alphanumeric codes. Those who will be leading training should closely interact with the team(s) conducting general impact analyses in the organization. The move to ICD-10 will affect both the practice management system and the electronic health record. In addition to billing, consideration will need to be given to patient problem lists, appointment scheduling, local coverage determinations, drop menus or preventive intervention alerts. System interfaces, databases and standard reports will be impacted and any updates to these elements will need to be included in training. Plan Use Audience HIM Director s Guide to ICD-10 (Book) ICD-10 Trainer Newsletter ICD-10 Audio conferences and Webcasts CDI Specialist s Guide to ICD-10 (Book) Use to lead the organization s transition from ICD-9 to ICD-10. Use to stay on top of developments and tips for implementation and training. Use to give staff opportunities to obtain ICD-10-specifi c CE credits required maintaining their credentials. Topics include implementation and planning, vendor readiness, PCS surgery coding, and more. On-demand and live options offered. Use to familiarize CDI specialists with ICD-10 and changes in documentation requirements so they can begin preparing the organization and physicians. HIM/Coding Managers/Task force directors HIM/Coding Managers/Coders/ CDI/Case Managers Hospital and health system managers and coding staff CDI ManpowerGroup. All rights reserved.

4 3. Assessment Determine specifi c training needs and target audiences for more intensive ICD-10 coding training. Evaluate coders anatomy and physiology knowledge and identify areas for additional training. Identify new documentation requirements and physician readiness. Understand the Most Frequently Submitted Diagnosis Codes Documentation will make or break accuracy in coding patient conditions. Concentrate on the most frequently submitted diagnosis codes by specialty. A comprehensive review of documentation is essential to planning the targeted training programs relevant to each specialty area. This should be a priority. Assess Coder Knowledge The clinical terms used in ICD-10 code descriptors require a greater understanding of medical terms and anatomy and may require even advanced coders to refresh their knowledge base in these areas. Reconciling clinical terminology with coding and classifi cation terminology will take signifi cant effort for many coders. Reassess your coding professionals clinical knowledge to identify key gaps in the areas of: Intermediate Medical Terminology Intermediate Anatomy & Physiology (includes all body systems) Intermediate Pathophysiology (includes all body systems) Intermediate Pharmacology Assess Use Audience ICD-10 Coding Assessment (5 pack) Also sold as part of the ICD-10 Toolkit (Available November 2011) ICD-10 Assessment for Anatomy and Physiology (5 pack) Also sold as part of the ICD-10 Toolkit Use to assess and plan for staff training needs on ICD-10 coding. Use to identify and address gaps in foundational anatomy and physiology knowledge. HIM/Coders/CDI HIM/Coders/CDI 4. Education Provide coders with training to introduce the ICD-10 code structure and terminology. Strengthen coders terminology, anatomy and physiology knowledge. Launch intensive training of coding staff. Educate physicians on specifi c documentation requirements. Provide continuing practice activities for coding staff and offer AHIMA or AAPC certifi ed coders ICD-10 activities ManpowerGroup. All rights reserved.

5 Provide CE credit opportunities to help them maintain their certifi cation. Prepare AAPC certifi ed coders for the profi ciency exam (offered starting in October 2012). ICD-10 Coder Training ICD-10 coders require training in order to analyze the detailed documentation necessary to assign codes accurately for ICD-10. Super-bills will need an upgrade to ICD-10 codes and this may be diffi cult because many additional digits cannot be assigned until the patient is actually seen. An example is the 7th character requirement for an initial or subsequent encounter. ICD-10 Physician Training This should include both peer-to-peer general high-level overview of the impact of ICD-10 on physicians, and detailed physician education by specialty. Specialty curricula development will take time, especially given the number of specialties that exist today. Training physicians can and should start as soon as possible. Improved physician documentation can be of benefi t while still under ICD-9. Mock ICD-10 coding can start after training is complete to assess documentation improvements and give individualized feedback. Behaviors generally change slowly so start the change early. CDS/CIS Awareness Training Awareness training for Clinical Documentation Specialist/Clinical Information Specialist and Data Coders should provide a detailed understanding of the impact of ICD-10 on clinical documentation improvement. Train Use Audience Certified Coder Boot Camp: ICD-10 Physician ICD-10 Training Coder s Guide to ICD- 10 (Book) ICD-10 Flashcards (Flashcards-5 pack) Use in 2012 to provide in-depth training to coders on the ICD-10 coding system. Live 5-day (starts January 2012), online 4-weeks (online starts March 2012). Both live and online classes include instructor question and answer sessions. Begin preparing physicians in 2012 with more intensive onsite customized education for medical staff/physicians. Prepare physicians for documentation needs. The toolkit includes 5 copies; also sold individually. Available November The toolkit includes 5 copies; also sold individually in packs of 5 copies. Available November Use to provide practice on code set and root operations. (Audience is Coders/CDI). Coding/HIM/CDI/ Case Management Physicians, Physician Advisors Coders Coders ManpowerGroup. All rights reserved.

6 Suggested Topics/Resources (continued): ICD-10 Mail for Coders (CD with sleeve, available November 2011) Train Use Audience ICD-10 Mail for Physicians (CD with sleeve, available November 2011) ICD-10-CM and ICD-10-PCS the Complete Official Draft Code Sets, 2011 ICD-10 Basics Boot Camp Live and Online Just Coding Anatomy and Physiology elearning Library Use these trainer tools in CD, PowerPoint presentation on CD to educate staff with checklists, quizzes and exercises, plus messages for follow up refreshers. Use this PowerPoint presentation on CD to educate your medical staff along with messages for staff. Apply the latest update to the code set for use in all your training programs. Use to familiarize coding, CDI and task force staff with ICD-10 and ease apprehension about the transition. Day One covers CM for OP/Professional services, Days One and Two cover your medical staff. Use to give staff opportunities to obtain ICD-10-specifi c CE credits required for maintenance of credentials. Also includes clinical condition encyclopedia with ICD- 9 vs ICD-10 coding and documentation comparisons for all conditions. Use to increase staff understanding of anatomy and physiology necessary for increased specifi city of codes in ICD-10. Coders Physicians, Physician advisors Coders/HIM Coding/HIM/CDI/ Physician Advisors/ Revenue Cycle/ Case Management Coders/HIM Coders/HIM For more information, contact healthcare@experis.com. Experis TM is the global leader in professional resourcing and project-based solutions. Our healthcare focus leverages the expertise of the entire Experis organization, bringing solutions to the payer, provider and pharmaceutical sectors. Experis is a dedicated business unit of ManpowerGroup TM ManpowerGroup. All rights reserved.