4. During the initial implementation, expect productivity impacts on the functional areas that routinely use ICD-9 codes. Productivity loss in anticipated, said Stark, with the greatest impacts most likely to occur within health information management/coding, case management, claims processing, and decision support. “Also, there may be an increased number of claims denials due to poor understanding of new code sets and coding requirements,” he said. “Providers must prepare for this productivity reduction to prevent negative impacts to reimbursement and cash flow.” Stark added that a set of questions could be helpful in preparing for potential productivity losses. The questions include: 

• What managed care contracts will need to be renegotiated?
• How will the organization monitor contract compliance and track reimbursement for accuracy? 
• What will be the impact to accounts receivable and cash flow?  
• What will be the impact to financial reserves and working capital?  
• How will dual payment processing under ICD-9 and ICD-10 impact financial reporting?  
• What financial resources, in terms of capital and operational dollars, are required to implement ICD-10?

Training programs on new and/or revised clinical documentation requirements and coding nomenclature should be developed for coders, medical staff, nurses, and allied health providers, said Stark. “Early training will lessen productivity impacts associated with the learning code,” he said. “Training may need to include anatomy and physiology courses, detailed clinical documentation requirements, practice coding experience with real-time feedback, and general awareness sessions for staff currently using ICD-9 data.”

[See also: CMS promise on ICD-10 stirs the pot.]

5. Transition planning is important; providers should be prepared to run dual systems. “Not all payers are expected to accept ICD-10 codes as of Oct. 1, 2013; this will require hospitals to work from both an automated and manual process to facilitate reimbursement as well as process both I-9 and I-10 codes/claims,” said Stark. He recommends working with a firm that has expertise in this area to help assist in preparing to meet these requirements. “It will be very important that they have spend a good deal of time working through their code mapping procedures, GEMS, backward/forward mapping, etc. so they will have a solid system in place prior to the go-live date.”