5 Key Resourcing Factors to Consider with ICD-10

Published on November 11, 2014

With the ICD-10 implementation deadline less than a year away, this is a perfect time for a tune-up of your resourcing strategy. Coding demands due to strategic needs, performance goals, DNFB management, and ICD-10 compliance requirements needs to be matched against your current coding capabilities, capacity, turnover, and workflows. This process should take account of five key factors:

1. Location: The balance between onsite and remote coders is critical to maximizing productivity and maintaining quality. The coders’ environment should be comfortable to prevent fatigue and distractions (with dual monitors, wrist cushions, and adjustable work chairs). Frequent communication and feedback – for both onsite and remote coders – is essential to ensure an engaged, well-functioning staff. Global labor may be appropriate and cost-effective for simpler, outpatient worktypes, allowing current staff to focus on more complex tasks. Elements to consider before outsourcing include the need for follow-the-sun labor, a secure method for uploading and delivery of records, appropriate certification, and a guaranteed service level agreement.

2. Response: ICD-10 and ongoing payment reforms will only increase pressures for faster turnaround times and demands to keep DNFB and AR down. Here,an analysis of trends, seasonality and other factors that impact workflow can be helpful. A checklist of factors that can impact resources – such as vacations, attrition, retirements, and training – can help identify targets for action to optimize productivity.

3. Scalability: Once the resources have been analyzed to respond to organizational needs, active and ongoing capacity planning can ensure scalability. Most organizations use an overflow coding outsourcing group, but this process can be slow to respond. One option to consider is to outsource a specific body of work to a vendor. These committed resources can be more cost-effective than the constant change involved in unknown overflows. It can be easier to manage internal resources to meet needs while benefiting from guaranteed TAT and high quality from a committed arrangement.

Overall, when considering deployment options, balance – between requirements and capacity, capabilities and needs, and internal initiatives and future demands – is vital.

4. Organizational Expertise: There is much to be said for keeping complicated work in-house for the organization’s best and brightest. The need for planning remains, however, to ensure an understanding of where – and why – staff are most productive. Intangibles come into play here, including familiarity with individual physicians’ work practices, insights into hospital processes, and the ability to leverage existing relationships for CDI. It may be useful to move CDI efforts upstream so the downstream impact is minimal, working concurrently with the CDI team where possible.

5. Clinical Experience: Use of a matrix can be helpful in fully understanding and visualizing the clinical expertise of coders, which now goes way beyond inpatient vs. outpatient. Outpatient coding has become complex, with Observation, Same-Day Surgery, Diagnostic, Procedural and Specialty worktypes. These demand high levels of expertise and training. Added to this is the fact that coders may be more comfortable with some types of charts than others. This analysis of staff expertise can pay dividends in preparing for future needs.

Overall, when considering deployment options, balance – between requirements and capacity, capabilities and needs, and internal initiatives and future demands – is vital. A thorough understanding of how factors such as location, scalability, and expertise impact coders’ productivity and performance enables resources to be tuned accordingly. While ICD-10 caused many to hit the brakes in their preparations, now is the time to ease back into gear and accelerate the resource planning process.