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Planning Coder Staffing Changes for ICD-10

With the ICD-10 deadline looming, budget now for coder and physician education, loss of productivity and extra staffing.

Hospitals can't afford to pull coders out of production for ICD-10 training and hands-on practice without some type of backup coding support. Daily coding production must be maintained. Claims must continue to be submitted and hospital revenue must keep flowing. Herein lies the coder staffing conundrum-thoroughly prepare internal staff for ICD-10 while meeting day-to-day coding workload demands.

During recent months, we've received a flurry of requests from hospitals that have only used outsourced coding service companies "as-needed." It appears that in 2014, HIM Directors are rethinking their outsourced coding partnerships and searching to establish permanent, long-term partnerships with coding firms. In addition to coverage for in-house/staff coders during ICD-10 training and dual coding ramp-up, hospitals want more consistent, ongoing relationships before, during and after the transition to ICD-10. Here are four best-practice strategies that have emerged.

Strategy #1: Bring in backups now
Even though many HIM Directors might not need backup coders until Summer 2014, some are contracting now for services. Start slowly and ramp up the amount of work delegated to outsourced coding teams throughout the year. For example, you might begin with several cases per week or all cases not completed by Friday.
Contracting with an outside firm now helps guarantee coding coverage throughout the transition while also ensuring day-to-day coding production remains 100 percent current. In addition, reserving backup coding resources sooner rather than later achieves the following three best-practice objectives:

- Provides adequate ramp-up time to establish system access, learn hospital-specific software applications, understand physician documentation nuances, and master facility coding guidelines.
- Integrates outsourced coders into the in-house coding team for stronger relationships and knowledge sharing throughout the conversion to ICD-10.
- Builds experience for the outsourced coding team to improve coding accuracy and productivity prior to the October 1 deadline.

The key is to keep coding productivity current so in-house teams can focus on ICD-10 training and dual coding initiatives prior to ICD-10's impact.

Strategy #2: Prepare for impact
Many different scenarios and predictions are circulating around ICD-10 impact on coder productivity. We can make educated guesses in response to our questions, or infer answers from the experiences of countries that have already made the switch. Canada, for example, never regained its full, pre-ICD-10 productivity. However, until we go through the transition ourselves, we won't know exactly how much-or for how long-productivity will be negatively impacted.

Questions we do not yet know the answers to include: What will be the new productivity standard? If losing productivity, even after transition, what does that do to a hospital's FTE count?

We suggest you plan for a 50 to 60 percent loss in productivity and hope for 25 percent. In other words: Plan for the worst, hope for the best. Budget for additional education time, spikes in denied claims, additional physician documentation queries, and more coding management concerns. And beware, any of these may lead to overtime.

It's also important to look at physician documentation in order to reduce time- and revenue-consuming audits post-ICD-10. Physician training is a critical part of ICD-10. Clinical documentation specialists should be in place, working with physicians to minimize issues and help get charts coded as quickly as possible.

Strategy #3: Keep the good ones
Hospitals should maintain their current coding teams through retention plans-incentives that encourages them to stay. These may include bonuses that increase the longer the coder is with the hospital. Remote coding is no longer an option; it is a necessity. And as demand increases, we're seeing salaries go up for coders.

Proactively addressing coder retention concerns with your human resources and recruiting departments helps to get everyone on board. Bring these other departments into the conversation now so you're all part of the transition together.

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And beyond in-house teams, your best outsourced coding partners should be secured and relationships tightened. They too will experience coder shortages and heightened demand. Enlist several companies to serve your facility in 2014 and maintain strong communications with them all.

Strategy #4: Fine-tune budgets
It is important to fine-tune your budget for additional time, overtime, auditing services, education, training, and coding coverage, which may include the need to contract with outside services. Most hospitals are planning for extra staff coverage for six to nine months post-October 1. Additionally, dual coding and end-to-end testing efforts conducted now will help paint a clearer picture of coder productivity and staffing needs later in 2014. Expect your coder staffing budget for the next 24 months to be a work in progress, continually changing based on new information gleaned and lessons learned.

Proper planning
ICD-10 is the Y2K of healthcare. It may or may not be as bad as some predict. We just don't know. What we do know is that proper planning is essential. Preparing now helps ensure trained coders are in place and claims data is clean-smoothing the financial transition to our new coding system.

Kayce Dover, MSHI, RHIA, is President and CEO, HIM Connections.

• You can't wait until August or September, 2014,to bring in your backup coding team. Do it now.
• Get an outsourced partner on board now and use them on a small scale (even 10 to 15 charts per week) just to get started. Or send the outsourcing company everything not completed by Friday afternoon.
• Coding vendors need a volume commitment to help with staffing plans, but it's okay to start small and ramp up for the Oct. 1 deadline.
• Set up the technology components and get the learning curve started between your coders and the outsourced team.
• Depending on your coding partnership and facility volumes, having more than one vendor may be needed.
• If you're going to ramp up with in-house staff, start hiring now.
• Consider a permanent placement firm to assist with recruitment efforts.
• Create new graduate positions, titles, salaries and comp plans. This does require ICD-10 trainers on staff to help mentor these new coders now. Some sites may not be able to do this.
• Remote coding options are a must; onsite coders are a lot harder to find and keep.
• If brining your remote team onsite during the first few weeks of the transition, budget for this now (hotel rooms, travel, meals, space within the department, additional workstations, etc.).

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