Becker's Hospital Review

Executive Briefing: ICD-10 55 "The physician needs to be trained on their specific cases," he says. "You pull a case and you say, 'Hey Dr. Green, let me show you some of the information necessary for ICD-10 coding. If it is missing, I will have to interrupt you to get it.' This is why training needs to be laser-focused." A managed care team with all of the proper ICD-10 financial analytic data about various DRGs and the provider's financial risk, will know what and how to deal with health insurers and possibly be able to work out neutrality clauses, he says. Training physicians on their specific case documentation is only part of the equation, however. Mr. Martin says providers should also implement technology that will prompt clinicians on what to record on their charts, "a tool that specifically says to a physician, 'Here's what you need to document when you're dealing with heart failure,'" for instance. The current grouper logic that assigns MS-DRGs presents a certain level of risk for hospitals and health systems preparing for ICD-10. Right now, most organizations are using version 30 of the MS-DRG Grouper to group claims in ICD-10, but Mr. Martin says version 31 should be out within the next month or two, version 32 will probably be in use when ICD-10 goes live. Hospital executives should consider tools and applications that will accomplish this and can be embedded in electronic medical records or installed on devices such as iPads, he says. Coder approach: Train and audit Although they aren't the main focus, long-term coder productivity issues are still a concern when it comes to financial risk, Mr. Martin says. "The risk could be in the coder's inability to forget the ICD-9 guidelines and use the ICD-10 guidelines. It is hard to forget 10, 20 or 30 years of coding expertise overnight. However this is exactly what we are asking the coders to do, he says. The number one action providers can take to address this issue is to pull charts, have their staff code them natively and have an outside company audit those charts. Ideally, the outside company should have certified ICD-10 trainers on staff who have coded at least 500 charts in the new coding system, he says. "That exercise allows you to see how long it's going to take coders to actually code charts," he says. "You're definitely alleviating risk." Pay attention to payers: Get the analytics from the coded cases to managed care teams Once coders have completed coding cases in accordance with ICD-10, providers should prioritize getting that information to their managed care teams, according to Mr. Martin. He says assessing cases for all payers — not just Medicare — is important for negotiating contracts. "If you don't give that managed care person any of this analytic data, then they're basically negotiating with a blindfold on," he says. The grouper factor: Wait and see and test "We're still dealing with a 'pilot grouper' that isn't going to be the production grouper for ICD-10," he says. Depending on adjustments to future versions and potential added calculations and weightings, providers who think they've adequately minimized their risk at this point could be in for an unpleasant surprise next year if they don't consider grouper changes. Subsequently, he says providers shouldn't do just one risk assessment but several, conducting new analyses as new versions come out. Providers who aren't dual-coding inside their patient accounting systems and are using another application such as Excel should strongly consider implementing a database system that can regroup quickly, he says. "If you put it into Excel, it's not going to be easy to put it back through the grouper," he says. In the end, though, there's only so much providers can do to avoid snafus. "The grouper is the grouper," Mr. Martin says. "We can't do anything about it except wait and see what the next version does." Conclusion Overall, Mr. Martin says the biggest financial risk for providers is doing nothing. At this point, providers should have started the process of pulling charts and should carry out a focused dual-coding effort, he says. By January or February, they should have a blueprint for physician training by individual physician or by specialty. "There's a huge risk in just sitting back and waiting and not doing any of these exercises," he says. n VitalWare leads the market in delivering healthcare intelligence for coding and documentation accuracy; the primary driver of our client's revenue. Through innovative, next-generation ICD-10, CDI and Revenue Cycle technologies and our extensive web service content offerings, VitalWare helps organizations navigate the myriad of regulatory changes taking place in today's healthcare environment.

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