LESLIE: The urgency to complete planning activities and begin implementation of ICD-10 transition plans continues to intensify. As healthcare provider organizations finish their gap assessments and budgets, they are assessing the need for parallel processing, such as processing discharges and encounters in ICD-9 and ICD-10 to determine changes needed for accuracy and efficiency in documentation, clinical documentation improvement, and coding and revenue cycle workflow. Organizations are seeking to better understand the strategic benefits and associated costs of parallel processing.

PATTY: I think the strategic questions that planners need to answer about parallel processing are: Why is it necessary? For how long? Should 100 percent of discharges/encounters be included, or just a sample? What technology is needed to support it? How many coders and PFS staff will be necessary for the parallel processing period? How much will it cost?

LESLIE: Yes, and those are not easy questions to answer. Let's talk with Lisa Fink, MBA, RHIA, CPHQ, senior HIM consultant at Care Communications Inc. as she is in the trenches helping provider organizations work through this and other ICD-10 transition issues.

PATTY: Great! Lisa, please join our conversation and share with our readers what you have been learning about parallel processing in ICD-10 plans over the past year.

LISA: While all organizations will have reasons to include some level of parallel processing in their go live preparations and training plan, each one needs to determine their specific needs-by department and function-so they can determine the workflow impacts and additional staff required to support the effort. Parallel processing can include several departments and functions such as coding patient access, scheduling, PFS, registries, outcomes reporting, etc.

PATTY: What are some reasons to consider parallel processing?

LISA: Working with the new ICD-10 code set before Oct.1, 2013, is expected to reduce risks associated with the transition such as coding and billing backlogs, errors in coding, incomplete documentation, and outcomes reporting inconsistencies, all of which would have serious financial implications. Provider organizations are trying to avoid a slowdown in cash flow, a surge in Discharged Not Final Billed (DNFB), bad debt, and an unwarranted change in their Case Mix Index (CMI).

LESLIE: What do the ICD-10 transition teams hope to accomplish during the parallel processing?

LISA: One key objective will be ensuring that interfaces are working perfectly. We have all lived through upgrades and systems implementations and know that we usually encounter interface issues that do not always appear until the systems have been tested on possible case scenarios that exemplify day to day workflow across the organization. No one wants glitches showing up after Oct.1, 2013, because they will take time to correct, causing the backlogs that we are trying to avoid. A comprehensive organization-wide test plan will be essential to test interfaces and overall functionality.

PATTY: The parallel processing period also should provide ample opportunity for physicians, coders, clinical documentation specialists, and other key staff to hone their new ICD-10 documentation and coding skills, building speed and accuracy in real time.

LISA: For physicians in particular, learning new documentation behaviors should begin immediately, because the changes in some body systems are substantial. This will give them time to gain speed and for managers to determine exactly what productivity to expect on the go live date. Incomplete documentation poses serious risks affecting the ability to properly code and bill.

LESLIE: What about individuals who use coded data, such as the revenue cycle professionals?

LISA: The finance department will need to trend the impacts of the change from ICD-9 to ICD-10 on future reimbursement risks. The parallel processing period will provide them an opportunity to assess any impact on CMI and to work with payors as needed on contract revisions prior to the mandated go live. PFS staff will be able to identify glitches in billing workflow.

PATTY: The parallel processing period also will provide an opportunity to create and test outcome reporting and decision support tools.

LESLIE: So what about the really big question: For how long should organizations do parallel processing?

LISA: It is an individual decision for each organization depending on the concerns of each department involved and the resources available. We are seeing people plan anywhere from three months to one year prior to the go live date.

PATTY: I understand that some people are counting on the GEMS analyzers to do the translation from ICD-9 to ICD-10 as well as ICD-10 back to ICD-9. That sounds risky to me.

LISA: Yes, it poses a risk to the quality of information the users need, because GEMS mapping is not one-to-one for all diagnoses and procedures. The mapping software can be useful on those codes that are one-to-one, but for the one-to-many, human intervention will be needed. To have the best data quality for payments, reporting, decisions support, etc., you need to generate the most accurate codes possible. That is accomplished by using the code set that the system or database has been designed to use. That is why it is so important for payors to be ready to accept ICD-10 codes on Oct. 1, 2013, and for other users of diagnostic and procedure data to be ready as well.

LESLIE: Thank you, Lisa, for clarifying the parallel processing issue for us. It will require careful analysis and judgment calls by ICD-10 teams in every organization, but you have provided the rationale needed to help individuals as they think through this aspect of the transition.  

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president, Care Communications Inc., Chicago. You can follow Leslie on Twitter: @FoxatCARE. Leslie and Patty invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.