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Hospitals and health systems have been given the gift of time in the form of the ICD-10 delay. By using this time to take proactive steps to meet coding needs and prepare for the challenges of implementing a new coding system, they can mitigate the impact of the ongoing coder shortage and reduce the financial and productivity declines predicted immediately following the transition to ICD-10. Maximum compliance can only be obtained when staffers — coders, clinicians and others — fully understand ICD-10-CM and ICD-10-PCS concepts and have the ability to apply what they have learned.
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Options for Coder Shortage
Making the Most of the ICD-10 Delay: Implementing a Training Schedule That Works for You
Mitigation Strategies
A Multi-Faceted Approach
Tailored Solutions
Developing a Customized Plan
Continuous Quality Monitoring
Measuring Proficiency
The Gift of Time
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The Gift of Tim
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Welcome!Health information management (HIM) departments have faced an ever-worsening shortage of qualified coders for several years. Industry estimates point to a nationwide shortage as high as 30 percenti to 50 percentii. Exacerbating the situation is the mandated move to ICD-10, the complexity of which will further strain limited coding resources before, during and after the transition.
Indeed, the latest ICD-10 deferment is considered by many in the industry to be a double-edged sword
as it relates to the coder shortage. On the one hand, most new coders are trained exclusively on ICD-10 in preparation for the transition, leaving healthcare organizations scrambling even harder to fill ICD-9 coding needs. On the other, it has given healthcare organizations the gift of time to put into place strategies to mitigate the shortage of both ICD-9 and ICD-10 coders and to identify solutions to keep pace with current and future coding needs.
i Gurrieri JJ, Karban, KM. The good, bad, and reality of offshore coding: Some turn to distant shores to fill US coding demands. Journal of AHIMA 2013;84(9):44–48. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050329.hcsp?dDocName=bok1_050329.
ii Career step partners with California State University, Fresno to offer medical coding and billing ed. CareerStep blog. February 18, 2014, http://www.careerstep.com/blog/career-step-news/career-step-partners-with-california-state-university-fresno-to-offer-medic.
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itigation Strategies
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A Multi-
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Developing a Custom
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Measuring
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Mitigation Strategies
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itigation Strategies
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A Multi-
Faceted Approach
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Developing a Custom
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Continuous Quality M
onitoring5
Measuring
Proficiency6
The Gift of Tim
e7
A significant element of any mitigation strategy must be proper coder training, a lengthy time commitment that can quickly consume the extra year endowed by the delay. One industry insider estimates that it can take a full year to properly train an inpatient coder on ICD-10, six to nine months to train an outpatient coder and three to six months to train a clinic coder.iii
Time isn’t the only enemy of training. Coding volumes have gone up even as the number of available coders has gone down, making the time necessary to train new coders especially difficult for organizations to incorporate into daily workflows.iv The solution is to identify training programs that are flexible enough to accommodate the limited time available.
However, flexibility isn’t the only must-have when it comes to the best training programs. Other considerations include American Health Information Association (AHIMA) approved instructors and ongoing access to a library of practice records, codebooks, terminology manuals and reference sites to keep skills sharp. Pre- and post-training ICD-10 assessments should also be conducted to measure readiness and demonstrate proficiency.
Seek out live or remote clinical modification (CM) and procedural coding system (PCS) training courses featuring a schedule that includes interactive clinical case studies. Programs should also offer offline coding cases specific to inpatient or outpatient for CM and to each root operation of PCS.
Training programs should meet or exceed AHIMA training guidelines, which include 16 hours of ICD-10-CM and 24 hours of ICD-10-PCS remote or live classroom training, with an additional minimum of 10 hours of practice on each classification. Finally, the number of training hours should be complemented by ongoing opportunities to practice on patient records with chart types for each chapter of CM and each root operation of PCS.
iii Butler M. HIM frontlines: Preparing for a coder shortage—tips for hiring and training new coders. Journal of AHIMA. April 25, 2014. http://journal.ahima.org/2014/04/25/him-frontlines-preparing-for-a-coder-shortage-tips-for-hiring-and-training-new-coders/.
iv Heubusch, K. Coding’s biggest challenges today. Journal of AHIMA 2008;79(7):24–28. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_039062.hcsp?dDocName=bok1_039062.
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itigation Strategies
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A Multi-
Faceted Approach
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Developing a Custom
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Continuous Quality M
onitoring5
Measuring
Proficiency6
The Gift of Tim
e7
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A Multi-Faceted Approach
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itigation Strategies
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A Multi-
Faceted Approach
2Tailored Solutions
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Developing a Custom
ized Plan
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Continuous Quality M
onitoring5
Measuring
Proficiency6
The Gift of Tim
e7
Clearly, a cookie-cutter approach to training will not be eff ective. That is why AHIMA recommends a multi-faceted, customized program. This is true whether a facility is just beginning its ICD-10 training, is having to re-capture profi ciency lost during the gap between training and putting skills to use or is retraining outpatient coders, transcriptionists and new graduates whose education focused solely on ICD-10.
The most eff ective program will be one that combines some or all of the following:
• Retraining outpatient coders in ICD-9. Hiring quality inpatient coders is far more diffi cult than hiring their outpatient counterparts. Thus, hospitals are fi nding that retraining their outpatient coders is a highly benefi cial investment.
• Transitioning transcriptionists to ICD-9 coders. Because of their familiarity with the patient record and clinical terminology, transcriptionists can be readily cross-trained as coders.
• Retraining new graduates. Incorporating ICD-9 training programs into recruitment eff orts gives new graduates the short-term skills they need until they can use their ICD-10 knowledge in 2015 and makes them more experienced when ICD-10 is implemented.
• Outsourcing. Finding quality coders can be a daunting task. Outsourcing is an appealing solution for the many facilities that don’t have ready access to a pool of qualifi ed coders.
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Tailored Solutions
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Measuring
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The Gift of Tim
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When targeted training, such as coding for a specifi c specialty, is most needed, self-paced online training that provides an interactive and customizable educational experience is the most viable option. These programs also help ensure healthcare organizations can access the training they need even as escalating demand makes it more diffi cult to purchase high-quality live programs led by qualifi ed instructors.
A prime example is Amphion U, an online, self-paced program designed to maximize ICD-10 comprehension and expand career options with a customizable curriculum of individual modules and complete training packages, including specialty-specifi c and PCS-root operations. Also provided are terminology manuals, codebooks and The Minnette Expert Coding Library™, a robust library of practice records coded by Amphion’s ICD-10 experts.
When it comes to self-paced training, little things can have signifi cant impact on achieving and retaining profi ciency. To that end, Amphion U’s robust e-learning modules include a unique “hover hint” feature that provides assistance with challenging exercises without revealing the answers. Coders can also submit questions to instructors via e-mail and receive responses within two business days of submission.
Because courses are self-paced, coders can pause and resume courses as often as necessary. They also have full access to Amphion’s library of practice records, codebooks, terminology manuals and reference sites, even after training has been completed. Additionally, Amphion U includes pre- and post-training ICD-10 assessments to measure readiness and demonstrate profi ciency.
Coders can earn up to 16 continuing education units (CEUs) for ICD-10-CM and 24 CEUs for ICD-10-PCS training. AHIMA CEUs can also be earned for completing the assessments and for practice coding through Amphion’s ICD-10 library.
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Developing a Customized Plan
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Training and educating coders and specialists is not one-size-fi ts-all, though. Customization is a necessity. That involves:
• Identifying facility needs• Training the trainers• Identifying and selecting a training coordinator• Identifying and selecting training materials
A good example of a well-designed training program is the AHIMA-approved approach taken by Amphion. Sessions are limited to 12 participants to accommodate the student/instructor interaction needed to address the increased clinical detail and specifi city of the new classifi cation system. Each program is designed to build the foundation for mastering ICD-10 and for ongoing retention of concepts and includes:
• Pre-ICD-10 training assessment• Web-based resources to address defi ciencies• ICD-10-CM and ICD-10-PM training• Post ICD-10 training assessment• The Minnette Expert Coding Library
A second set of assessments designed to show coders’ progress over the course of the training is also included. Further, assigning staff to each category over the course of three to four months will allow better retention of concepts over time. This schedule will also reduce downtime, as training days are staggered and coders will be available to work half-days during the course.
On-site education and meetings, webinars and handouts are designed to meet specifi c needs. Amphion’s training tracks closely to defi ned project plans that take into consideration an organization’s needs throughout the life of the transition, from kick-off to go-live.
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Continuous Quality Monitoring
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Complementing comprehensive training programs are regular quality reviews, which have long been important to coding accuracy. These reviews take on a new importance in light of looming federal mandates and as a means for maximizing the impact of ICD-10 on outcomes while mitigating fi nancial risk, particularly when implemented as part of a pre-transition dual-coding program.
Many hospitals and review vendors limit the focus of coding reviews to validating only those codes that determine diagnosis-related groups, or DRGs, prior to claims submission. However, this approach only tells half the story and therefore artifi cially limits the usefulness of quality coding review.
An education-based approach to continuous quality monitoring is one that reviews 100 percent of codes on each case reviewed and supports corrections with guidelines and references. This ensures accurate coding and billing while fi ne-tuning coder skills by ensuring each has a complete understanding of any errors they may make.
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Measuring Proficiency
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Coding quality monitoring should measure profi ciency and close gaps in coders’ ICD-10 knowledge, which subsequently impacts reimbursements and outcomes of RAC (recovery audit contractor) and other third-party audits. This allows organizations to target education and training eff orts to focus on shoring up specifi c areas of weakness. Over time, quality monitoring shifts from building profi ciency to maintaining it by making sure coders retain guidelines and coding accuracy.
When corrections or changes must be made, immediate, direct feedback should be communicated to the coder in a way that ensures a complete understanding of errors and recommended corrections, helping to close knowledge gaps. Whenever possible, this feedback should be supported by offi cial coding guidelines to continuously improve profi ciency and retention.
Ultimately, a continuous quality monitoring program helps healthcare organizations prepare for the complex ICD-10 coding environment. When approached from an educational perspective, it can also provide the knowledge and tools coders need to achieve profi ciency. It also helps them comply with increasingly strict regulations to prevent fraud and abuse that mandate regular internal audits.
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itigation Strategies
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The Gift of TimePHASE
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itigation Strategies
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Faceted Approach
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Developing a Custom
ized Plan
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onitoring5
Measuring
Proficiency6
The Gift of Tim
e7
Hospitals and health systems have been given the gift of time in the form of the ICD-10 delay. By using this time to take proactive steps to meet coding needs and prepare for the challenges of implementing a new coding system, they can mitigate the impact of the ongoing coder shortage and reduce the fi nancial and productivity declines predicted immediately following the transition to ICD-10.
Maximum compliance can only be obtained when staff ers — coders, clinicians and others — fully understand ICD-10-CM and ICD-10-PCS concepts and have the ability to apply what they have learned.
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Welcom
eM
itigation Strategies
1
A Multi-
Faceted Approach
2Tailored Solutions
3
Developing a Custom
ized Plan
4
Continuous Quality M
onitoring5
Measuring
Profi ciency6
The Gift of Tim
e7
