It’s Your Move
Gaming and simulation exercises can help organizations determine the tasks they must accomplish in implementing ICD-
10 and who they must engage. They help prioritize tasks and
narrow the focus on vital actions that must be taken first.
Based on modeling and simulation, gaming and simulation
exercises have evolved from their military roots to support a
wide range of industries such as the sciences and healthcare.
A model is a simplified representation of a system at a particular point in time to promote understanding of the real system.
A simulation is the manipulation of a model in such a way that
it operates on time or space to compress it, thus enabling one
to perceive the interactions that would not otherwise be apparent because of their separation in time or space. Modeling and
simulation is a discipline for developing a level of understanding of the interaction of the parts of a system and of the system
as a whole. 1
Identifying and Sorting the Imperatives
Shown in the figures here are sample results from a gaming and
simulation exercise held during the AHIMA 2011 annual convention. The exercise was intended both to gain a better understanding of an organization’s business imperatives in transitioning to ICD- 10 and to demonstrate the critical nature of
working in concert with other key stakeholders. Two facilitators
and several AHIMA members represented the coding, compliance, physician, revenue cycle and billing, systems, operations,
clinical documentation improvement, and ICD- 10 expert disciplines.
For a setting and scenario, participants selected an acute care
hospital and the filing of a claim for a coronary artery bypass
graft. The team believed the denial or challenge to such a claim
would create significant cash flow issues for the organization.
To set the stage, participants identified external and internal
environmental drivers acting on organizations, such as pressures from other initiatives and stress from growth in areas
where coding takes place without coding professionals.
To further drive the discussion participants then identified key
business imperatives in achieving the ICD- 10 transition, such
as meeting regulatory requirements, generating clean claims,
supporting clinical decision making, and generating accurate
internal and external quality and safety reports.
The group scored the imperatives comparatively on the level
of impact each activity would have. The key action steps fell into
one of three major category areas: process and workflow improvement, technology (systems and automation), and education and training (see “Key Action Prioritization”).
The list was further broken out into a rake chart that displayed
the imperatives in descending order within each of the major
activity categories, as shown below. ¢
1. Bellinger, Gene. “Modeling & Simulation.” www.systems-thinking.org/modsim/modsim.htm.
Allison Viola ( firstname.lastname@example.org) is director of federal relations at
ICD- 10 Rake Chart
THE PRIORITIZATION LIST was further broken out into a rake chart that listed the business imperatives in descending order
within each of the major activity categories.
Process and Workflow
(Systems and Automation)
x Not addressed
x Streamline physician documentation
x Streamline clinical data reporting
x Streamline (pre-)registration workflow
x Streamline coding workflow (IP, OP)
x Streamline clinical documentation
x Streamline billing workflow
x Streamline claims adjudication and
x Install clinical documentation tools
x Ensure vendors are ready
x Upgrade or replace internal IT
x Integrate systems (interoperability)
x Deliver rules, alerts, editing capability
x Test systems
x Assess payer and associate status
x Rewrite reports
x Obtain longitudinal patient data
x Conduct broad
x Conduct ICD- 10
x Conduct ICD- 10
training for HIM