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Perform gap analysis to discover your agency’s ICD-10 knowledge deficits

Survey results show that agencies are falling behind on ICD-10 preparations, starting with a gap analysis.
With ICD-10 set to start in about one year, only 21% of the 240 respondents to HHL’s recent Home Health ICD-10 Readiness Survey say they already have performed a gap analysis.

Such a low percentage shows “our industry as a whole does not have an appreciation for how different ICD-10 is than ICD-9,” states Trish Twombly, senior director for DecisionHealth in Gaithersburg, Md.

A gap analysis determines “where you are, where you want to be and the steps to take to get there,” adds J’non Griffin, president of Home Health Solutions LLC in Carbon Hill, Ala.

Performed correctly, the analysis identifies what knowledge deficit clinicians and coders will have in an ICD-10 environment, Twombly says.

Every department should be analyzed for effective processes, Griffin believes. Involve your agency’s IT department to determine if the current software is ICD-10 ready.

Among the questions to ask about software, she suggests: If software vendors are not ready, when is the projected date for completion? Does the contract include an automatic upgrade to ICD-10? Also, are there dual coding capabilities?

Common mistakes agencies make when performing gap analyses include waiting too long to prepare and not following through with meetings at regular intervals, Griffin adds.

When ICD-10 was delayed to October 2015, many agencies pushed preparations plans down their priority lists, she says. Many agency task forces have not met since April.

About 38% of the survey’s respondents say ICD-10 won’t be a priority again until some time next year.

But it would be a big mistake to avoid conducting a gap analysis, adds Linda Scott, vice president of home health and personal care/private duty services for Professional Healthcare Resources in Annandale, Va.

The sooner agencies know the facts, the more comfortable and confident they’ll be that they can make the necessary improvements prior to ICD-10, she says.

Many agencies have yielded positive results from having conducted the analyses. Some spotted duplication in processes — and as a result improved efficiencies, Griffin says.

“This was mainly a switch in processes as a result of software changeover, but the analysis helped to identify things such as precoding in intake, the nurse coding and then the coder providing coding, then another person doing the OASIS review,” Griffin says.

A snapshot of ICD-10 preparedness

Nearly 41% of the readiness survey’s respondents believe ICD-10 will be delayed again. About five months ago, more than 62% of respondents to an ICD-10 delay survey said they believed the code set would be delayed again.

Asked about their top ICD-10 worry, about 44% of respondents say claims delays and denials; 28% say reduced coder productivity and 10% say reduced clinician productivity.

More than half of respondents have started training coders; 11% plan to begin training them this year and
one quarter plan to begin training next year.

How to examine coding, clincial deficits

• Appoint one or more people in your agency to become knowledgeable about what’s required for ICD-10. You can’t figure out gaps if you don’t understand what’s required, Twombly says.
  
• Determine your top 20 diagnoses. You want to make sure your clinicians and coders have an acceptable knowledge level of anatomy and physiology, for example, for cases with those 20 diagnoses, Twombly says.
  
• Create and conduct a knowledge deficit test.The test should examine your coders’ and clinicians’ knowledge when it comes to your agency’s most common diagnoses, Twombly recommends.

— Josh Poltilove (jpoltilove@decisionhealth.com)

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