Hometown Health Spring ConferenceDr. Denise W. Hines, PMP, FHIMSS

GA HIMSS Chapter PresidentGA-HITREC-Director of Education &

Outreach

Overview

• HIMSS/GA HIMSS

• ICD-10

• GA-HITREC Education Opportunities

• Meaningful Use Stage 2 & Stage 3

• Questions

HIMSS

• Health Information Management & Systems Society

• Over 44,000 members nationally

• Dedicated to the use of health information technology to improve healthcare

• Founded in GA at GA Tech

GA HIMSSMission and Vision Collaborate

AdvocateEducate

Signature EventsHIMSS National Events (Advocacy & National Conference-GA Chapter Events)Georgia Healthcare Trade Faire & Regional ConferenceLunch & LearnsMeet the Board EventsGolf TournamentCPHIMS Review & ExamNursing Informatics ConferenceStudent Scholarships & Involvement

www.himss.org www.gahimss.org

ICD-9 to ICD-10

• ICD-9 is 30 years old, outdated and obsolete, inconsistent with current medical practice

• Covered entities must move from using ICD-9 to ICD-10 to submit claims on and after the compliance date

• For hospital inpatient only, does not affect CPT codes (outpatient)

• Different structures:– ICD-9 is mostly numeric with 3 to 5 digits. – ICD-10 is alphanumeric with 3 to 7 characters. Contains

“one to many” matches • ICD-10 must be done to issue claims and to get paid• Original date for compliance was Oct. 1, 2013 to Oct. 1, 2014

Benefits of ICD-10

•More accurate payment for procedures•Fewer improper and rejected claims •Better understanding of health conditions •Better monitoring and reporting of disease from a public health perspective

Examples of Changes

ICD-9

• Diabetes Mellitus– 59 Codes

• Injuries

• Fracture of the femur, shaft, closed– 1 code

• Pathologic Fracture– 8 codes

ICD-10

• Diabetes Mellitus– 200 Codes

• Injuries– 7th character extension

• Fracture of the femur, shaft, closed-24 codes

Pathologic Fracture– 150+codes

ICD-10 Readiness and Costs

• HHS cites a CMS survey finding that one quarter of providers do not believe they will be ready by October 1, 2013, and a recent WEDI readiness survey in which nearly 50 percent of the 2,140 providers responding did not know when they would complete their impact assessment.

• HHS projects that ICD-10 will cost commercial and government health organizations between $650 million and $1.3 billion.

Costs to Delay Compliance to 2014

• Savings would come from the avoidance of costs that would occur as a consequence of significant numbers of providers being unprepared for the transition to ICD-10.

• HHS determined a cost avoidance of between $3.6 billion and $8 billion – but acknowledged that “a 1-year delay of the ICD-10 compliance date would add 10 to 30 percent to the total cost that these entities have already spent or budgeted for the transition.”

• HHS demonstrated that a 1-year delay in the compliance date of ICD-10 would cost the entire health care industry approximately $1 billion to $6.5 billion.

Reactions to the Delay (10/1/13 to 10/1/14)

• American Medical Association-Applauded the delay

• College of Health Information Management Executives-(CHIME)-Appreciates the extra breathing room but doesn’t want to lose focus.

• Medical Group Management Association (MGMA)-wants ICD-10 certification of practice management system vendors.

• American Hospital Association-"welcome news, particularly for smaller hospitals.”

• American Health Information Management Association (AHIMA)-preferred no extension and supports the shortest extension period; continued delay is in no one’s best interest .

ICD-10 Project Management Steps

• Designate a Project Manager & Team• Review the impact to the organization• Develop Work Plans

– Health Information Management – Clinical Departments– Information Technology/Systems– Revenue Cycle/Finance– Application Assessment & Readiness

• Physician and Staff Training

Project Management Tips

• Gain buy-In from Administration/Executive Team• Identify a physician champion• Use a Steering Committee• Provide On-going education about the importance of

the project and the status• Offer a variety of training methods and tools:

– One-on-one– Off-site training sessions– Rounding – Departmental/Medical Staff Meeting

Summary/Take-Away Points

•Transitioning from ICD-9 to ICD-10 will be challenging –Requires more complete and accurate documentation by physicians–Thorough knowledge of anatomy and physiology by nurses, clinical staff, and coders

•Benefits include more complete patient information (severity of illness, medical necessity) and improved reimbursement•Don’t be afraid to ask for help! •Prepare for ICD-11

Stages of Meaningful Use

Meaningful Use Stage 1 Effective until 2014 – Providers can receive 3 payments under Stage 1

• 2011, 2012, 2013 ($18K, $12K, $8K)

Meaningful Use Stage 2 NPRM released– Delayed to allow vendors time to implement new

functionality– Offer your feedback (60 day comment period beginning 3/17)– Final should be ready by Summer– Builds on stage 1 with increased thresholds

• Exchange of information required• Electronic access for patients• Updates to quality measures

Stages of Meaningful Use

Meaningful Use Stage 3

– Ready by 2015 and required by 2016

– Builds upon Stages 1 and 2 with increased thresholds

– Enhanced bi-directional exchange with public health agencies:

• Immunization, lab, and syndromic surveillance data

– Demonstrate improvement in patient outcomes• Patient access to self management tools, upload data

GA-HITREC Online Education

ONC Workforce Curriculum Available:• ONC Component 1: Introduction to Health Care and Public Health in the U.S.

• ONC Component 3: Terminology in Health Care and Public Health Settings

• ONC Component 8: Installation and Maintenance of Health IT Systems

WEBINARS: • Patient Engagement Strategies

• Medicare/Medicaid Attestation

• Meaningful Use and Value Based Purchasing

• Using Patient Data to Improve Health Outcome

• The Secure Exchange of Health Information

• Planning, Management, Leading for Health IT

• Health Information Management Systems – Coding

• ICD-10

Resources

GA-HITREC877-658-1990www.ga-hitrec.org

CMS Incentive Programswww.cms.gov/ehrincentiveprograms

GA Medicaid Incentive Programwww.dch.georgia.gov/ehr

GA HIE

Email: hitt@dch.ga.gov

Stage 2 NPRM

http://www.healthit.gov/providers-professionals/meaningful-use-stage-2

ICD-10 Resourceswww.cms.gov/ICD10

QUESTIONS ????