10/2/2014 1 ® Physician Documentation Compliance: Strategies for Implementation versus Transition – There Is Still Plenty of Room to Get ICD-9 Improvement While Waiting for ICD-10 PRESENTERS: BETTYB. BIBBINS, MD, BSN, CHC, CI-CDI, CPEHR, CPHIT NICOLE D. HARPER, PH.D., MBA, RHIA, CCS-P, CI-CDI Objectives •Discuss expected industry impacts resulting from the ICD-10 implementation…you are not alone •Define a proactive approach to preparing for organizational success today…now that Implementation has begun •Summarize concurrent activities that can be used to support a positive implementation and identify pitfalls to avoid as we begin “go-live” Copyright 2014 DocuComp LLC 2 ICD-10 • ICD-10 delay • AMA Intervention • Other parties • AHIMA support • Two factions • Strategic planning and foresight • Delay and procrastination Copyright 2014 DocuComp LLC 3
Transcript
10/2/2014
1
®
Physician Documentation Compliance:
Strategies for Implementation versus Transition –
There Is Still Plenty of Room to Get ICD-9 Improvement While Waiting for ICD-10
•Discuss expected industry impacts resulting from the ICD-10 implementation…you are not alone
•Define a proactive approach to preparing for organizational success today…now that Implementation has begun
•Summarize concurrent activities that can be used to support a positive implementation and identify pitfalls to avoid as we begin “go-live”
Copyright 2014 DocuComp LLC 2
ICD-10
•ICD-10 delay
•AMA Intervention
•Other parties
•AHIMA support
•Two factions
•Strategic planning and foresight
•Delay and procrastination
Copyright 2014 DocuComp LLC 3
10/2/2014
2
Implementation Costs - Hospitals
•Estimated organizational cost by bed size is approximately $1.5 million to $5 million for a 400-plus bed institution
•A hospital bed size of 100-400 is estimated to incur costs between $500,000 to $1.5 million for implementation.
•An institution with fewer than 100 beds is estimated to spend between $100,000 to $250,000 to engage in ICD-10.
Copyright 2014 DocuComp LLC 4
Implementation Costs - Practices
•Small practices can expect to spend between $56,639 and $226,105 and medium-size practices can spend between $213,364 and $824,735 to implement ICD-10
•Expected costs include up to $100,000 in payment disruption for small practices, and up to $166,000 in productivity losses for medium-size practices.
Copyright 2014 DocuComp LLC 5
Implementation Costs - Practices (cont.)
•Large practices can expect to spend between $2 million and $8 million to implement the new coding system, according to the study.
•The study estimated that two-thirds of physicians will pay the upper range of cost estimates. In 2008, the AMA estimated that it would cost a small practice $83,290 to implement ICD-10
Copyright 2014 DocuComp LLC 6
10/2/2014
3
Proper Attention
•Seven Key Areas of Focus-Revenue Cycle requiring proper attention and planning to integrate into ICD-10
•Budget for potential cash flow impacts
•Prepare for delayed payment and claims adjudication
•Prepare for IT software updates, patches, conversion and testing
Copyright 2014 DocuComp LLC 7
Proper Attention (cont.)
•Adjust accounts receivable reserves as needed
•Prepare for health information management (HIM) productivity delays and educational expense outlays
•Prepare for increased denial tracking, trending and reporting needs
•Right size of staffing in patient access, HIM and patient accounting to handle increased workload and volume
Copyright 2014 DocuComp LLC 8
Costs of Delay
•Estimated costs of ICD-10 delay to October 1, 2015- $1 billion to $6 billion
•Excludes lost opportunity costs for failing to move to a more effective code set
•Training costs
•Current ICD-10 coding staff
•New coders trained in ICD-10, retraining for ICD-9 for a year
•Physician and clinical staff
Copyright 2014 DocuComp LLC 9
10/2/2014
4
Costs of Delay (cont.)
•Dual coding in ICD-9 and ICD-10
•13,000 ICD-9 vs. 169,000 ICD-10 codes
•72,000 ICD-PCS codes
•Consulting costs and decreased productivity of coding staff
•Time value of moneyCopyright 2014 DocuComp LLC 10
“Training Parameters”
•Focus upon
•Current documentation deficiencies
•Defining insufficient clinical documentation
•Recognizing insufficient documentation
•Addressing current documentation deficiencies under ICD-9
•Focus on good documentation, which directly impacts accurate code assignment clinical specificity
•Be aware of new documentation guidelines in order to evaluate provider documentation for thoroughness, completeness and establishment of medical necessity
Copyright 2014 DocuComp LLC 29
Fundamental
•Collaborative working relationship
•Medical record coders
•CDIS
•Case Management
•Utilization Management/Utilization Review
•Quality and Outcomes staff
•Denials and Appeals
Copyright 2014 DocuComp LLC 30
10/2/2014
11
ICD-10 Training
•Understanding of clinical concepts, disease processes and management
•Blending in of ICD-10 classification system
•Stressing clinical medicine documentation vs. ICD-10 documentation
•Clinicians are not coders, not inclined to be
Copyright 2014 DocuComp LLC 31
Salient Consideration
•Integrating ICD-10 into the “5 Ws” of Documentation
•Who- Who is performing the service?
•What –What type of services are performed
•Where- What is the place of service
•When- When is the date of service
•Why- Establishing medical necessity and diagnosis
Copyright 2014 DocuComp LLC 32
Salient Considerations (cont.)
•How much - What is the intensity of evaluation and/or treatment, including thought processes and the complexity of medical decision making
Copyright 2014 DocuComp LLC 33
10/2/2014
12
Only then…..
•Medical record coder training, education and reinforcement in ICD-10 can only be successful
•Avoiding ICD-10 training in a vacuum
•Garbage In, Garbage Out
•Starting from the Out-In
•Physician engagement and buy-in to clinically specific documentation
