Risk management for ICD-10: 3 areas worth provider focus

With the deadline to transition to ICD-10 rapidly approaching, providers must continue efforts to ensure the code set switch goes smoothly. 

Enterprise risk management will be an important focus for organizations in the coming months, according to Fred DiLuzio, ICD-10 Program Manager for Orange County, California-based Hoag Memorial Hospital Presbyterian, and Michael Roach, who has led program management offices at Hoag.

The healthcare professionals, in a HIMSS News post, outline areas of risk management providers should focus on for ICD-10, which include:

  • Sustainability: Providers should make sure stakeholders remain vigilant about the transition and sustain the level of attention ICD-10 is currently receiving as the deadline grows near. It's easy for attention to be pulled somewhere else, but organization employees should remember what could happen if they're not ready for the new code set come October. Ways to sustain current activity could include incentives such as bonuses or opportunity for "other prized assignments," they say.
  • Engagement: Alongside sustainability is engagement, DiLuzio and Roach say. Providers need to ensure everyone remains engaged in the effort through enhanced communication. Leaders need to regularly be in contact with everyone who is involved in the transition--separately from project meetings or reviews--and make sure they are staying focused.
  • Practice: Making sure any issues or revenue impacts are realized or addressed before October is also important. Providers can create mock scenarios that bring up issues like increased A/R delays or high rate of claims denials, DiLuzio and Roach say. "These exercises will help establish practiced responses to anticipated issues so the organization can knowingly and quickly react as needed," they write. In addition, practice drills should be led by business leaders, which will further prepare them to assume control of the ICD-10 program down the line.  

Despite years of delays, it's looking more like Oct. 1 will be the official date of implementation.

However, professionals in the industry and government officials are still working on ways to ease the transition, which include a proposal by the Centers for Medicare & Medicaid Services in conjunction with American Medical Association that would loosen penalties for imperfect claims submissions by certain physicians within the first year.

In addition, a new House bill, introduced by Reps. Marsha Blackburn (R-Tenn.) and Tom Price (R-Ga.), would require a transition period for ICD-10 by mandating dual coding in ICD-9 and ICD-10 for six months.

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