Hospitals and health systems have been given the gift of time in the form of the ICD-10 delay. By using this time to take proactive steps to meet coding needs and prepare for the challenges of implementing a new coding system, they can mitigate the impact of the ongoing coder shortage and reduce the financial and productivity declines predicted immediately following the transition to ICD-10. Maximum compliance can only be obtained when staffers — coders, clinicians and others — fully understand ICD-10-CM and ICD-10-PCS concepts and have the ability to apply what they have learned.

1. Making the Most of the ICD-10 Delay:
Implementing a Training Schedule
That Works for You
Mitigation Strategies
A Multi-Faceted Approach
Tailored Solutions
Developing a Customized Plan
Continuous Quality Monitoring
Measuring Proficiency
The Gift of Time
1
2
3
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5
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7
Options for Coder Shortage
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Proficiency
Measuring
7 of Time
The Gift

2. Welcome!
Health information management (HIM) departments
have faced an ever-worsening shortage of qualified
coders for several years. Industry estimates point to
a nationwide shortage as high as 30 percenti to
50 percentii. Exacerbating the situation is the mandated
move to ICD-10, the complexity of which will further
strain limited coding resources before, during and
after the transition.
Indeed, the latest ICD-10 deferment is considered by
many in the industry to be a double-edged sword
as it relates to the coder shortage. On the one hand,
most new coders are trained exclusively on ICD-10
in preparation for the transition, leaving healthcare
organizations scrambling even harder to fill ICD-9
coding needs. On the other, it has given healthcare
organizations the gift of time to put into place strategies
to mitigate the shortage of both ICD-9 and ICD-10
coders and to identify solutions to keep pace with
current and future coding needs.
i Gurrieri JJ, Karban, KM. The good, bad, and reality of offshore coding: Some turn to distant shores to fill US coding demands. Journal of AHIMA
2013;84(9):44–48. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050329.hcsp?dDocName=bok1_050329.
ii Career step partners with California State University, Fresno to offer medical coding and billing ed. CareerStep blog. February 18, 2014,
http://www.careerstep.com/blog/career-step-news/career-step-partners-with-california-state-university-fresno-to-offer-medic.
2
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Proficiency
Measuring
7 of Time
The Gift

3. 1
Mitigation
Strategies
PHASE
3
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

4. A significant element of any mitigation strategy must be proper
coder training, a lengthy time commitment that can quickly consume the
extra year endowed by the delay. One industry insider estimates that it
can take a full year to properly train an inpatient coder on ICD-10, six to
nine months to train an outpatient coder and three to six months to
train a clinic coder.iii
Time isn’t the only enemy of training. Coding volumes have gone up
even as the number of available coders has gone down, making the
time necessary to train new coders especially difficult for organizations
to incorporate into daily workflows.iv The solution is to identify
training programs that are flexible enough to accommodate
the limited time available.
However, flexibility isn’t the only must-have when it comes to the best
training programs. Other considerations include American Health
Information Association (AHIMA) approved instructors and ongoing
access to a library of practice records, codebooks, terminology
manuals and reference sites to keep skills sharp. Pre- and post-training
ICD-10 assessments should also be conducted to measure readiness
and demonstrate proficiency.
Seek out live or remote clinical modification (CM) and procedural
coding system (PCS) training courses featuring a schedule that includes
interactive clinical case studies. Programs should also offer offline
coding cases specific to inpatient or outpatient for CM and to each root
operation of PCS.
Training programs should meet or exceed AHIMA training guidelines,
which include 16 hours of ICD-10-CM and 24 hours of ICD-10-PCS remote
or live classroom training, with an additional minimum of 10 hours of
practice on each classification. Finally, the number of training hours
should be complemented by ongoing opportunities to practice on
patient records with chart types for each chapter of CM and each root
operation of PCS.
iii Butler M. HIM frontlines: Preparing for a coder shortage—tips for hiring and training new coders. Journal of AHIMA. April 25, 2014.
http://journal.ahima.org/2014/04/25/him-frontlines-preparing-for-a-coder-shortage-tips-for-hiring-and-training-new-coders/.
iv Heubusch, K. Coding’s biggest challenges today. Journal of AHIMA 2008;79(7):24–28.
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_039062.hcsp?dDocName=bok1_039062.
4
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Proficiency
Measuring
7 of Time
The Gift

5. 2
A Multi-Faceted
Approach
PHASE
5
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

6. Clearly, a cookie-cutter approach to training will not be eff ective. That is why
AHIMA recommends a multi-faceted, customized program. This is true whether a facility
is just beginning its ICD-10 training, is having to re-capture profi ciency lost during
the gap between training and putting skills to use or is retraining outpatient coders,
transcriptionists and new graduates whose education focused solely on ICD-10.
The most eff ective program will be one that combines some or all of the following:
• Retraining outpatient coders in ICD-9. Hiring quality inpatient coders is far more
diffi cult than hiring their outpatient counterparts. Thus, hospitals are fi nding that
retraining their outpatient coders is a highly benefi cial investment.
• Transitioning transcriptionists to ICD-9 coders. Because of their familiarity with the
patient record and clinical terminology, transcriptionists can be readily cross-trained
as coders.
• Retraining new graduates. Incorporating ICD-9 training programs into recruitment
eff orts gives new graduates the short-term skills they need until they can use their ICD-10
knowledge in 2015 and makes them more experienced when ICD-10 is implemented.
• Outsourcing. Finding quality coders can be a daunting task. Outsourcing is an
appealing solution for the many facilities that don’t have ready access to a pool of
qualifi ed coders.
6
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Profi ciency
Measuring
7 of Time
The Gift

7. 3
Tailored
Solutions
PHASE
7
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

8. When targeted training, such as coding for a specifi c specialty, is most needed, self-paced
online training that provides an interactive and customizable educational experience is the
most viable option. These programs also help ensure healthcare organizations can access
the training they need even as escalating demand makes it more diffi cult to purchase
high-quality live programs led by qualifi ed instructors.
A prime example is Amphion U, an online, self-paced program designed to maximize
ICD-10 comprehension and expand career options with a customizable curriculum
of individual modules and complete training packages, including specialty-specifi c
and PCS-root operations. Also provided are terminology manuals, codebooks and
The Minnette Expert Coding Library™, a robust library of practice records coded by
Amphion’s ICD-10 experts.
When it comes to self-paced training, little things can have signifi cant impact on achieving
and retaining profi ciency. To that end, Amphion U’s robust e-learning modules include a
unique “hover hint” feature that provides assistance with challenging exercises without
revealing the answers. Coders can also submit questions to instructors via e-mail and
receive responses within two business days of submission.
Because courses are self-paced, coders can pause and resume courses as often as
necessary. They also have full access to Amphion’s library of practice records, codebooks,
terminology manuals and reference sites, even after training has been completed.
Additionally, Amphion U includes pre- and post-training ICD-10 assessments to measure
readiness and demonstrate profi ciency.
Coders can earn up to 16 continuing education units (CEUs) for ICD-10-CM and 24 CEUs for
ICD-10-PCS training. AHIMA CEUs can also be earned for completing the assessments and
for practice coding through Amphion’s ICD-10 library.
8
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Profi ciency
Measuring
7 of Time
The Gift

9. 4
Developing a
Customized Plan
PHASE
9
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

10. Training and educating coders and specialists is not one-size-fi ts-all, though.
Customization is a necessity. That involves:
• Identifying facility needs
• Training the trainers
• Identifying and selecting a training coordinator
• Identifying and selecting training materials
A good example of a well-designed training program is the AHIMA-approved approach
taken by Amphion. Sessions are limited to 12 participants to accommodate the student/
instructor interaction needed to address the increased clinical detail and specifi city of the
new classifi cation system. Each program is designed to build the foundation for mastering
ICD-10 and for ongoing retention of concepts and includes:
• Pre-ICD-10 training assessment
• Web-based resources to address defi ciencies
• ICD-10-CM and ICD-10-PM training
• Post ICD-10 training assessment
• The Minnette Expert Coding Library
A second set of assessments designed to show coders’ progress over the course of the
training is also included. Further, assigning staff to each category over the course of three
to four months will allow better retention of concepts over time. This schedule will also
reduce downtime, as training days are staggered and coders will be available to work
half-days during the course.
On-site education and meetings, webinars and handouts are designed to meet
specifi c needs. Amphion’s training tracks closely to defi ned project plans that take into
consideration an organization’s needs throughout the life of the transition, from kick-off
to go-live.
10
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Profi ciency
Measuring
7 of Time
The Gift

11. 5
Continuous Quality
Monitoring
PHASE
11
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

12. Complementing comprehensive training programs are regular quality
reviews, which have long been important to coding accuracy. These reviews take on a
new importance in light of looming federal mandates and as a means for maximizing
the impact of ICD-10 on outcomes while mitigating fi nancial risk, particularly when
implemented as part of a pre-transition dual-coding program.
Many hospitals and review vendors limit the focus of coding reviews to validating only
those codes that determine diagnosis-related groups, or DRGs, prior to claims submission.
However, this approach only tells half the story and therefore artifi cially limits the
usefulness of quality coding review.
An education-based approach to continuous quality monitoring is one that reviews
100 percent of codes on each case reviewed and supports corrections with guidelines
and references. This ensures accurate coding and billing while fi ne-tuning coder skills
by ensuring each has a complete understanding of any errors they may make.
12
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Profi ciency
Measuring
7 of Time
The Gift

13. 6
Measuring
Proficiency
PHASE
13
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

14. Coding quality monitoring should measure profi ciency and close gaps in coders’
ICD-10 knowledge, which subsequently impacts reimbursements and outcomes of RAC
(recovery audit contractor) and other third-party audits. This allows organizations to target
education and training eff orts to focus on shoring up specifi c areas of weakness. Over time,
quality monitoring shifts from building profi ciency to maintaining it by making sure coders
retain guidelines and coding accuracy.
When corrections or changes must be made, immediate, direct feedback should be
communicated to the coder in a way that ensures a complete understanding of errors
and recommended corrections, helping to close knowledge gaps. Whenever possible,
this feedback should be supported by offi cial coding guidelines to continuously improve
profi ciency and retention.
Ultimately, a continuous quality monitoring program helps healthcare organizations
prepare for the complex ICD-10 coding environment. When approached from an
educational perspective, it can also provide the knowledge and tools coders need to
achieve profi ciency. It also helps them comply with increasingly strict regulations to
prevent fraud and abuse that mandate regular internal audits.
14
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Profi ciency
Measuring
7 of Time
The Gift

15. 7
The Gift of Time
PHASE
15
Welcome
Mitigation
1 Strategies
A Multi-
Faceted
Approach
2
Tailored
3 Solutions
Developing a
Customized
Plan
4
Continuous
Quality
Monitoring
5
Measuring
6 Proficiency
The Gift
7 of Time

16. Hospitals and health systems have been given the gift of time in the form of the
ICD-10 delay. By using this time to take proactive steps to meet coding needs and prepare
for the challenges of implementing a new coding system, they can mitigate the impact of
the ongoing coder shortage and reduce the fi nancial and productivity declines predicted
immediately following the transition to ICD-10.
Maximum compliance can only be obtained when staff ers — coders, clinicians and others
— fully understand ICD-10-CM and ICD-10-PCS concepts and have the ability to apply
what they have learned.
16
Welcome
1 Strategies
Mitigation
2
A Multi-
Faceted
Approach
3 Solutions
Tailored
4
Developing a
Customized
Plan
5
Continuous
Quality
Monitoring
6 Profi ciency
Measuring
7 of Time
The Gift