The following Latin proverb seems to be particularly relevant in light of ICD-10: “Times change, and we change with them.” By now, ICD-10 has spurred many changes in technology, templates, coding, documentation, and more. However, to be truly successful, organizations must look beyond their HIM internal processes and ask this question: Must the organization’s relationship with its outsource HIM vendor change in light of ICD-10 as well? In most cases, the answer is yes. Vendor relationships that don’t evolve commensurate with ICD-10 will operate at less-than-optimal efficiency, wreaking havoc for organizations during a time when they will be most vulnerable.
ICD-10 Questions To Consider
Consider the following questions when evaluating your vendor relationship in an ICD-10 environment:
- Did your vendor meet expectations in ICD-9?
Hopefully the answer is yes. However, do you have any reason to think the vendor might not meet expectations in ICD-10? For example, can the vendor provide sufficient staffing during times of increased denials and a rising DNFB? If not, this may require partnering with a new vendor.
- Can the organization benefit from a shared-risk arrangement?
In a shared-risk model, organizations share compliance and financial risk with their outsource vendor in order to achieve greater efficiency and shared savings. Timing a shared-risk model with the ICD-10 implementation has many advantages, including cost reduction and access to flexible HIM resources. Talk to your vendor about this type of arrangement and how it might benefit your hospital.
- What is a reasonable expectation for productivity in ICD-10?
Many vendors have agreed to meet whatever standards are set for coders internally. What can your vendor promise to deliver? What are you willing to accept? How might this change over time? What are your vendor’s plans to monitor productivity proactively?
- What should you expect in terms of accuracy and quality?
To what quality standard will your vendor be held accountable in ICD-10? Will it differ at all from ICD-9? Many vendors are striving for a 95% or greater accuracy rate even initially after go-live. Can your vendor meet this expectation? Why or why not?
- How will your vendor continue to adapt post-go-live?
What are your vendor’s plans for ongoing coder education post-go-live? How does this education compare with what will be provided to internal coding staff (assuming a portion of the coding is performed internally)? What’s your vendor’s plan for quality monitoring and quality reviews?
- What’s the plan for ongoing communication?
Consider scheduling weekly meetings with HIM and your outsource vendor to discuss challenges and barriers. Encourage your vendor to shed light on documentation problems. Likewise, organizations should to pass along information regarding denials.
- Can your vendor assist in other ways?
For example, can you expand the relationship to include denial management or auditing? Other vendors will assist with internal audits for the first 90 days post-go-live until organizations feel comfortable with their coding accuracy rates.
Looking Ahead With ICD-10
Use ICD-10 as an opportunity to strengthen the relationship with your coding outsource vendor, increase efficiencies, and form a strong foundation for communication going forward.
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