Category: Value Creation
January 20 2016
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Florida Hospital Tampa, a member of Adventist Health System (AHS), found it best to go back to basics during its preparation for ICD-10. As part of ICD-10 training, AHS provided refresher courses in anatomy and physiology to help its coding staff improve efficiency prior to the code set transition.

As of November 2015, AHS hospitals have improved discharged not final coded time to 2.4 days, the discharged not final billed time to 4.3 days and its accounts receivable process to 55.8 days.

Kim Vogan-Barelos, director of coding for the Florida Hospital campuses in West Florida, discussed her team’s preparation and how online courses and training from AHS and Cerner made for a smooth ICD-10 transition. Through this training, Florida Hospital Tampa now has 80 percent of their coding staff back to the productivity level they achieved while using ICD-9.

What did you do to prepare for the transition?

AHS coders completed 206 hours of coding training. Web training courses started in 2010, including an extensive anatomy and physiology class, which served as a review for coders who completed these classes in the past. Knowledge of anatomy and physiology became increasingly important for medical billing and coding specialists, as ICD-10 code sets are much more anatomically specific.

In addition to online courses, coders completed three days of intense education via video conference. They reviewed the ICD-10-CM and ICD-10-PCS books, coding guidelines, and practiced with coding example cases. While the classes were helpful in gaining the foundation of ICD-10, the coders truly benefitted from the ability to dual code accounts up to a year prior to the transition. We began dual coding a small number of records daily and increased this amount over time. AHS implemented a coder retention program across all facilities in an effort to retain proficient coders who completed the ICD-10 training.

Our implementation teams also participated in the Cerner Illumination Sessions, unique web-based presentations offered by Cerner. These sessions provided us with guidance on the testing process. Cerner also shared results and lessons learned from other client test sessions. It was helpful to understand what other organizations experienced during testing. We were also provided a list of system upgrades required for the new coding set.

AHS conducted multiple ICD-10 Gap Analysis reviews to assess potential physician documentation gaps. To stress the importance of complete documentation, specialty-specific physician training was provided in the form of videos, presentations, and lunch and learns. AHS did not experience significant staff challenges or changes in the coding workforce, which also helped us achieve success.

How have you measured success? What challenges did you run across?

AHS leadership anticipated a 40 percent decrease in coding productivity for the first 90 days following the transition. Physician documentation improvement, dual coding and coder training were included in a plan established to gain back 20 percent of the expected productivity lost.

Florida Hospital Tampa’s coding leadership is tracking the team’s productivity, ensuring we are increasing our numbers over time and meeting weekly and monthly goals. This team is working with the patient financial services team to track the payment of claims coded in ICD-10, as well as any denials received. Coding accuracy audits are conducted by an outside vendor to determine the precision of ICD-10 and ICD-10-PCS code sets.

How are claims generally moving between clearinghouses and payers?

AHS facilities’ claims are being processed by our clearinghouses and payers without any delays related to ICD-10. A diagnosis that meets medical necessity is required for outpatient testing. Our facilities coding team experienced issues with processing medical necessity due to discrepancies between the local and national coverage determination mapping of ICD-9-CM to ICD-10 codes. The Medicare Administrative Contractors and the Centers for Medicare and Medicaid Services are working to fix the errors reported by AHS and other health care providers.

Do you anticipate claims denial spikes moving into 2016? How do you prepare for and address these denials?

From a denials perspective, it’s still too early to tell. The AHS corporate financial team continues to review our data to determine if we will have denial spikes in 2016. The Florida Hospital Tampa coding leadership closely monitors the results of our coding accuracy and physician documentation audits. Our plan is to quickly address audit results to minimize potential denials.

What were some lessons learned from your experience?

Preparation is key! We are fortunate to work for AHS, an organization that strives for excellence and worked hard to ensure its employees were prepared for the transition. The education we received and the ability to dual code in the months leading up to ICD-10 were key to our success.