With that goal in mind, the steering committee included financial and patient service groups, members of the revenue cycle, billing, HIM, clinical documentation improvement program and information services, human resources, and the medical staff. Ultimately, the team's mapping process took the committee into the revenue cycle.
"You have to identify all systems that use coding for statistical purposes and any data analysis behind the scenes. We need to know if anyone is using coding in the background because that needs to be ready, too," explains Garvey. For instance, the operating room booking may be collecting ICD-9 codes when booking surgical procedures. Organizations should recognize all potential diagnoses collection areas, she says.
As SNCH created its map by analyzing work flow, Garvey says committee members would look at the developing list of systems and continually add to it. "Once we had all the systems listed, then we identified all the South Nassau staff that touches coding and billing and created a master file of who does what, so now we can determine how to train everyone."
Rich Rogers, senior vice president of support services and CIO at Health First in Brevard County, Fla., agrees that it takes an organizationwide team approach to tackle such a transition. Like SNCH and Mayo, Health First, a four-hospital system, first looked at this transition not in terms of the larger revenue-cycle impact but in terms of documentation gaps.
Rogers, who was given ownership of the project, created a 15-member executive steering team of revenue cycle, HIM, clinical documentation, and patient business services to scrutinize the work-flow processes influencing documentation. As the organization had done a general revenue-cycle map recently, it was a matter of refining that process map to look at ICD-10. It took just three months to complete, and the analysis concentrated on how the 70 systems across the four hospitals that feed in to the revenue cycle would be affected.
"We did a vendor readiness analysis to decide which systems to upgrade, at which time, and how many resources to allocate," Rogers explains. "So once we pulled together our team we had IT send formal letters to our vendors so we could understand and document the vendor's strategies. We created a list so we'd know internally what system was tracking to which area."