Wednesday, August 31, 2011

Herding Nerds: 5 project management tips for ICD-10 implementation

I recently spoke with Carl Natale the Editor of ICD10Watch, a web site dedicated to ICD-10 compliance topics, about some of my experiences and ideas regarding ICD-10 Assessment and Remediation projects.  Carl was nice enough to write up some of our conversation and share it with his readers and those interested in ICD-10. 

He also came up with a pretty funny take on the title of a project manager I used to work with as a consultant back in the Healthcare Capital of the United States - Nashville, TN => "Nerd Herder"

Here's a link to the article: Herding Nerds: 5 project management tips for ICD-10 implementation

Previously I made a blog post that contained a list of ICD-10 topics that may be of interest to those working on ICD-10 projects.  You can find that list here and if any of you have particular topics that you'd like to me expound upon, please feel free to add a comment or send me an email request. You can also follow me on Twitter where I frequently share ICD-10, healthcare IT and related business topics.

Monday, August 22, 2011

Classic & Contemporary Lessons Learned - For Your ICD-10 Project (Part 3)

Here’s Part 3 of my on-going, multipart series on Classic & Contemporary Lessons Learned.

See Part 1 here and see Part 2 here.

1.       Spend time to think through resource requirements and their on-boarding process. Try not to bring resources on too early – or too late. Make sure you have the right resources in targeted roles and that their roles and responsibilities are defined, assigned and able to be measured BEFORE they start.

{All people are NOT interchangeable!  And all people generally want to do a good job!}

2.       Recognize and plan for the challenge of simultaneously maintaining legacy platforms and non-ICD-10 projects while advancing your ICD-10 efforts.

{In my opinion, this will be one of the most challenging aspects for ICD-10 compliance projects.}

3.       Identify simple ways to leverage virtual conferencing, instant messaging, content tagging and social media distribution channels into a content management system. Require and support project stakeholders to persist and leverage knowledge as it is acquired and clarified.

{Build your corporate knowledgebase and intellectual capital!}

4.       Keep direct and indirect stakeholders up to date on what’s going on.  Post major milestones, activities, issues and risks for all stakeholders to be kept up to date on a regular basis. Consider how to highlight successes and request ideas to mitigate issues and risks.

{Err on the side of over-communication so as to avoid confusion and the “but no one told me” toward the end of your project.}

5.       Create a means to report status to executives and other leads with as little overhead expended by those originating the information as possible.  Start out with a “less is more’ approach – Capture status as events occur - you can always add to your reports later based on feedback from consumers.

{Capture status as events occur - status reporting as merely an administrative task is worthless}

Simple ideas, eh?  Check back for Part 4 of this multipart series.

Monday, August 15, 2011

Classic & Contemporary Lessons Learned - For Your ICD-10 Project (Part 2)

Here’s Part 2 on a multipart post on Classic and Contemporary Lessons Learned that apply to all projects in general and ICD-10 projects in particular.  See Part 1 here.

1.  Create small groups (tribes) for each major horizontal and vertical functional area. Charge them with being the “go-to” resources throughout various stages of the project, support their work and recognize/reward them appropriately.  Switch people into and out of these groups to even the load and grow your intellectual capital.

{Every team has certain official and unofficial “go-to” people; everyone will benefit more from these valuable resources if they are supported and recognized,}

2.  Educate business staff and technical resources as to how ICD-10 differs from ICD-9. Make sure they understand that ICD-10 compliance is way more than just a Y2K-like field expansion effort. See items #3 & 4.

{This is particularly important when using internal resources who may not be expert with ICD-10 and related areas}

3.  Make sure project resources are aware of how ICD codes impact Diagnosis Related Groups (DRG’s,) Major Diagnostic Categories (MDC’s,) Hierarchical Condition Categories (HCC’s,) Episode Treatment Groups (ETG’s,) case rates, etc. Educate them on the basic concepts of these related topics and how they will be impacted by ICD-10.

{ICD-10 impacts a lot of other data points and business concepts – having a basic understanding of these data points and business concepts will ensure a more comprehensive assessment takes place.}

4.  Provide some examples as to how ICD-10 impact business processes and software applications. Share some ideas and approaches regarding various methods for bringing applications and processes into compliance. 

{See my post on Approaches to ICD-10 Compliance  here}

5. Create some process and reference materials to support the on-boarding process. Create an on-boarding guide and require all team members to add to and edit the guide.

{This will accelerate bringing on new team members and help to provide consistency across varying skill sets and levels.}

More simple ideas, eh?  Check back for Part 3 of this multipart series on Classic & Contemporary Lessons Learned - For Your ICD-10 Project.

Thursday, August 11, 2011

Classic & Contemporary Lessons Learned - For Your ICD-10 Project (Part 1)

Anyone who’s been involved with large business and information technology projects for a handful of years – or, in my case, more than two handfuls and two ‘feetfuls’ of years, knows that applying lessons learned from earlier projects increases the likelihood of success in subsequent projects.

So…assessing your healthcare business processes and software applications and bringing them into compliance with the October 2013 ICD-10 mandate will be a complex and huge undertaking.  Here’s Part 1 of a multipart post on Classic and Contemporary Lessons Learned that I believe apply to all projects in general and ICD-10 projects in particular.

1.   Make sure upper management informs and supports department managers and business SME’s in regards to the importance of working with systems analysts, architects and other project staff doing the grunt work assessment and solution design.

      {Many times a 5-10 minute response from someone who knows will save an inquiring mind hours of time!}

2.   Clearly define primary contacts for core business areas and topics.  Note secondary backups and the process for escalating issues both internally and externally.  Do your best to allow project resources to know they will not be reproached for escalating what they consider valid issues.

{It’s human nature to want to do a good job.  Also human nature to want to avoid blowing up dust unless one believes they’ll move some dirt!}

3.   Develop an organization chart and SME contact list.  Add information as to preferred contact methods and working hours.  Keep it up to date and consider allowing everyone to take responsibility for enriching and maintaining it.

{We all have a life and preferred method of interaction – honor these preferences!}

4.   Create an acronym list and a glossary of consistent terminology and definitions.  Post it for all to reference and maintain.

{People like us speak a strange language.  Don’t make others guess what something means!}

5.   Carefully decide who should be in meetings: make sure that only the correct resources are invited based on the subject matter, meeting purpose and attendee value.

{Who among us likes to attend meetings that waste our time and place us father behind?}

Simple ideas, eh?  They seem obvious; and yet are often not recognized and followed. 

Check back for Part 2 of this multipart series on Classic Lessons Learned for Your ICD-10 Project.

Friday, August 5, 2011

Approaches to ICD-10 Compliance: Beyond Eenie Meenie Miney & Moe

Payers and providers have quite a number of applications and business processes they’ll need to bring into compliance by October 1, 2013. It’s popular to hear and read that applications and business processes will be assessed and “remediated’ while, in fact, applications and processes will be brought into “compliance.”


In some cases, vendors will handle the chore of ICD-10 compliance. In other cases, payers and providers will address compliance in-house or with assistance from 3rd parties.  In all cases, one of four general approaches will be used to bring an application or business process into compliance with the ICD-10 mandate:



This is where logic utilizes ICD-9 only. Any ICD-10 code introduced into the logic is backward mapped to an ICD-9 code.  This is typically the least expensive option for the short run and will be most used with systems that will be retiring.  The downside is this option requires use of a backward crosswalk.




This is where logic utilizes ICD-10 only. Any ICD-9 code will be forward mapped to ICD-10. A benefit of this approach is that it reaches the end state with the least effort and lower system maintenance cost than dual processing.  The downside is remediation requires a forward crosswalk to process run off claims received after the October 2013 cutover date.


Dual Process


This is where logic is modified to handle both ICD-9 or ICD-10 codes depending on the compliance date and type of claim. The benefit of this approach is that a crosswalk is not needed and it is the least risky option from a service disruption perspective. This option is likely the best approach for strategic business processes and applications.


Manual Process


This is where business is processed manually; to the point of forcing transactions through the process.  This might be a valid approach for low volume, retiring systems.

A major part of your ICD-10 assessment process should include determining the current lifecycle of your business processes and applications along with their strategic value to your organization. You may be better off retiring, replacing or manually processing some of your business instead of spending a lot of money on full-blown, automated, nearly risk-free compliance.

Good Luck!

Monday, August 1, 2011

Establishing a Framework for Assessing & Managing ICD-10's Financial Impact

Whether you’re a healthcare provider, some sort of payer or an intermediary eagerly serving healthcare payers and providers, the concept of financial neutrality should mean this to you:

After remediation of your systems, business processes and policies are completed, there won't be any meaningfully negative impact to your payer, provider and/or intermediate business partner's financial, clinical and operational outcomes.

While there are some subtle and not so subtle differences inhow payers, providers and other healthcare constituents will have to tweak and tune their systems, business processes and outcomes, the basic approach to establishing a framework for assessing and managing ICD-10 reimbursement impact and remediation mechanisms is quite similar and includes iterating the following:

Analyzing Your Data History

1. Identify your most common codes (create a frequency distribution)
2. Determine which of the common codes map through a GEM

Mapping Your I-9 Codes to I-10 Codes

1. Create your high-level or enterprise-wide code mapping
2. Create function-specific (or purpose-built) maps
3. Identify fallout codes and opportunities for resolving fallouts

Define and Test Your Modeling Scenarios

1. Identify negative and positive impacts to your enterprise and functional scenarios
2. Leverage forward-mapping across your enterprise and purpose built scenarios
3. Test and measure your results.
-         Compare your results to established and evolving industry “norms”
-         Tweak and adjust your scenarios with input from your SME’s before it’s too late.

Lather, rinse and repeat until squeaky clean!  Just don’t wince and retreat!