ICD-10-CM/PCS
Tango2 is ready to help your organization through one of the most significant changes confronting healthcare delivery organizations in decades. ICD-10-CM/PCS represents one of the most significant and far reaching changes to occur in healthcare in the last few decades. It is much more than just a new set of diagnosis and inpatient procedure codes; it represents significant changes for clinicians, HIM staff, coders, and billing personnel, among others. The ripple effect on an organization’s revenue and cash flow could range from mild to debilitating.
ICD-10CM/PCS codes may be universal but the effects on your processes and A/R are not. Our experience in both operations and IT provides our associates with the ability to recognize your organization’s unique strengths and opportunities. Unique challenges equate to unique solutions and Tango2 consultants are ready to develop solutions through our partnership with you that will lead to success.
Tango2 approaches ICD-10-CM/PCS in 4 distinct phases. Each phase builds on the prior one(s) and is designed to move the organization closer to a seamless incorporation of ICD-10 codes into daily routines and to maximum operational control.
Phase I – ICD-CM/PCS Readiness Assessment & Gap Analysis
The first phase of the process is conducting an assessment of the organization’s readiness for the transition to ICD-10. Key components of the assessment:
- Documentation of Interviews with staff in key areas done to identify current state, ICD code activity, and potential enhancement opportunity. Areas to be interviewed include:
- patient access
- scheduling
- pre-authorizations/certifications
- registration
- billing office operations, including customer service and collection/follow-up
- finance, with emphasis on denial management
- clinical workflows & activities
- HIM operations
- Staff training plans for ICD-10
- Physician clinics and practices
- Payer contracting
- Data reporting (creation/generation/support)
- information systems
- marketing
- hospital foundation activities/fundraising
- Tertiary care activities (SNF, Rehab, Hospice, etc…)
- Determination of your organization’s current state of readiness based on actual practices
- Review of policies and procedures to identify obscure ICD activity
- Review and validation of key indicators and metrics
- Assessment of your software vendor’s state of readiness
- Assessment of your payer’s state of readiness
- Identification and analysis of organizational initiatives and their impact on the ICD-10 initiative
- Identification & documentation of issues, their impact, effort required to remediate and identification of functional areas affected
- At the conclusion of the assessment, your organization will receive:
- Detailed formal report documenting the assessment, findings, gaps, recommendations of identified issues, actions to take during the next phase of the initiative
- Summarized presentation focusing key aspects from, the detailed report for presentation to executive leadership and key stakeholders
- Recommended timeline, approach and initial project plan for implementing ICD-10
- Supporting documentation, including all tools used during the assessment
Phase II – ICD-10CM/PCS Preparations
The preparation phase is the organization’s opportunity to address issues identified during the readiness assessment. Because each organization’s needs are different, the activities in this phase vary widely.
- Tango2’s skilled and experienced consultants can assist your organization with your preparations. Examples of our impact during this phase include:
- Working with your staff to develop action plans for identified issues/risks
- Monitoring HIM efforts to ensure successful changeover
- Continued monitoring and update of vendor and payer readiness
- Assisting IT with software vendor and payer coordination of changeover
- Development of an overall approach for the implementation phase that reflects your organization’s unique situation
- Working with staff on the development of unit and end-to-end test scripts
- Monitoring clinical preparedness for use of ICD-10
- Assisting with payer contract terms best able to prevent disruption of reimbursement attributable to coding assignment debate
- Working with you to develop and monitor ICD-10 training for staff
- Continuing to develop the implementation project plan
- Development and execution of a communication plan to maximize awareness of ICD-10 and preparations for it
Phase III – ICD-10CM/PCS Implementation
The implementation phase involves training the right staff at the right level based on role and job responsibilities, testing software applications and monitoring the readiness of the organization to make the transition to ICD-10.
- Tango2 is prepared to work with your organization throughout this phase to deliver:
- The overall execution and management of implementation
- Issue management and resolution
- Application and data integration expertise
- Identify, manage, and develop plans to resolve
- Support your organization through the initial 30 days of the transition
- Synergy with your staff to monitor daily operations and take actions to resolve problems quickly
Phase IV – ICD-10CM/PCS Optimization
The impacts of ICD-10 on your organization will only begin to surface after the initial go-live period.
- Tango2 has the expertise and experience to help your organization mitigate/minimize these effects by:
- Working with the financial management team to monitor and analyze A/R aging, shifts in DRG assignments, reimbursement rates, and denial trends, among others
- Monitoring billing office workloads/backlogs and assisting with the development of remediation steps
- Working with HIM management to monitor and address work backlogs, review clinical documentation to determine completeness
- Working with clinicians to strengthen clinical documentation with sufficient information to facilitate the coding and billing of all services provided to each patient
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