Nicole D. Harper, Ph.D., MBA, RHIA, CCS-P, C-CDIDirector, Training & Dev/Process Improvement
Revenue Cycle ManagementSt.Vincent Health – Indiana
AndBetty B. Bibbins, MD, BSN, CHC, C-CDI, CPEHR, CPHIT
President & Chief Medical OfficerPhysician Executive Educator
DocuComp LLC
Suggest ideas on ways to support non‐HIM Compliance Officers during the transition to ICD‐10
Provide tips on effective training & educational opportunities Communicate the positive outcome/WIIFM in understanding ICD‐10 implications for Compliance and Administrator stakeholders within healthcare facilities and systems.
Explore into how ICD‐10 compliance impacts all of the non‐clinical pieces of the revenue cycle.
Discuss strategies to mitigate loss (i.e. Quality of Care Profile Reporting, payments, compliance, regulatory agencies, etc).
Session Objectives
2
1. Background
2. Benefits/Consequences
3. Project Timelines
4. Budget
5. Estimated System/Implementation Costs
6. Code Comparison
7. Plan of Action
Agenda
3
551 DAYS…and counting!!!!
4
*Most winning national championship coach, UCLA* Named NCAA men’s basketball coach of the year six times, John Wooden won ten NCAA national championships in a 12‐year period —seven in a row— as head coach at UCLA, an unprecedented feat.Within this period, his teams won a record 88 consecutive games.
January 1, 2011 – began testing HIPPA compliant 5010 claim form with trading partners
October 1, 2011 – ICD‐9/10 code freeze October 2012 – Stage 2 MU criteria took effect
March 1, 2012 – full compliance with 5010 October 1, 2014 – ICD‐10‐CM‐PCS effective
Dates we need(ed) to ‘Pencil In’
6
Poland
Thailand
United States
Iceland
Denmark
Brazil
New Zealand
Argentina
Austria
Norway
Australia
Finland
Singapore
Canada
Sweden
China
Japan
Venezuela
Germany
SwitzerlandItaly
SpainPortugal
Colombia
Belgium
UKIreland
Czech RepublicThe Netherlands
France
Costa Rica
Source: 3M Information Systems, Inc.
Global Use of ICD-10
7
Source: Deloitte, July 29, 2010
ICD-10 Sits Among the Top
Issues the Industry Has to Weigh
8
It’s not just about coding!
9
More than Just a Larger Coding Inventory of SystemsAccording to the Healthcare Information Management Systems Society (HIMSS)
RegistrationRegistration and scheduling systemsAdvance Beneficiary softwarePerformance management systemsMedical necessity edits
Clinical SystemsClinical systemsClinical protocolsTest ordering systemsClinical reminder systemsMedical necessity softwareDisease management systemsDecision support systemsPharmacy systems
HIMDRG grouperEncoding softwareAbstract systemsCompliance softwareMedical record abstracting
ReportingProvider profilingQuality measurementUtilization managementDisease management registriesOther registriesState reporting systemsFraud managementAggregate data reporting Clinical systemsPatient assessment data sets (e.g. MDS, RAI, OASIS)
Support SystemsCase Mix systemsUtilization managementQuality managementCase Management
Billing/Financial DRG grouper Conversion of other payment methodologiesNational and local coverage determinationsSystem logic and editsBilling systems Financial systemsClaim submission systemsCompliance checking systems
Impacts
10
ICD‐9‐CM ◦ Current coding classification system◦ Introduced 40 years ago◦ No longer fits with 21st century health system
ICD‐10‐CM & ICD‐10‐PCS◦ International standard ‐ diagnostic classification for all general epidemiological and many health management purposes◦ Track, report and compare morbidity and mortality◦ Supports achievement of EHR benefits◦ Transition to ICD‐10 required by federal regulation
ICD‐10 Background & Overview
11
ICD‐10 Background & Overview (cont’d)
On October 1, 2014, the United States will move from the ICD‐9 system to ICD‐10
It is the first major change in diagnostic and procedural coding in the U.S. in over 30 years◦ The “most significant overhaul of the medical coding system since the advent of computers.” –The WEDI Workgroup
◦ Encompasses moving from 5 digit numeric codes to 7 digit alpha numeric codes with embedded logic in the new code structure and a different decision tree
◦ Approximately 9 times more ICD‐10 codes than ICD‐9 codes (16,000 ICD‐9 codes and 155,000 ICD‐10 codes)
A complex, time‐consuming and expensive compliance challenge ◦ More complex than HIPAA compliance◦ Will touch most operational and IT processes and dramatically influence data and financial reporting strategies
12
Comparison of the two systems:
◦ Expansion of codes 13,000 diagnosis codes in ICD‐9‐CM / 69,000 unique diagnosis codes in ICD‐10‐CM
ICD‐10‐CM allows for new code expansion within the code category, ICD‐9 does not have that capability Example: Adverse Effect and Poisoning codes
4,000 procedure codes in ICD‐9‐CM/ 72,000 procedure codes in ICD‐10‐PCS
◦ Different code structure, diagnoses for example ICD‐9‐CM: 3 ‐ 5 digits / limited alpha characters ICD‐10‐CM: 3 ‐ 7 digits / additional alpha characters
ICD‐10 Background & Overview (cont’d)
13
ICD‐9‐CM to ICD‐10: BASIC OVERVIEW
ICD‐9
• Over 14,000 Diagnoses Codes
• Numeric Codes:• Max of 5 digits• 4,000 Procedure Codes• Numeric Codes:• Max of 4 digits
ICD‐10
• Approximately 69,000 Diagnoses Codes
• Alphanumeric Codes:• Always Start with a Letter (Exc. U) Max of 7 Char.
• 72,000 Procedure Codes (ICD‐10‐PCS)• Alpha/Numeric Codes:• Start with a Number or Letter (Exc. O or I to avoid confusion with 0/1)
ICD‐10 CODE COMPARISON EXAMPLES
Tobacco Abuse
ICD‐9‐CM: 1 Codes
ICD‐10‐CM: 5 Codes
Diabetes Mellitus
ICD‐9‐CM: 10 Code
ICD‐10‐CM: 318 Codes
Fracture of Radius
ICD‐9‐CM: 33 Codes
ICD‐10‐CM: 1818 Codes
Mechanical complication of other vascular device,
implant or graftICD‐9‐CM: 1 CodeICD‐10‐CM: 156 Codes
Suture of ArteryICD‐9‐CM: 1 CodeICD‐10‐PCS: 276 Codes
AngioplastyICD‐9‐CM: 1 CodeICD‐10‐PCS: 854 Codes
ICD‐10 CODE COMPARISON EXAMPLES (cont’d)
More‐accurate payments for new procedures Fewer miscoded, rejected, and improper reimbursement claims
Better understanding of the value of new procedures
Improved disease management Better understanding of health care outcomes Higher quality information for measuring healthcare service quality, safety, and efficiency
The Expected Benefits of ICD‐10
17
Increased claims rejections and denials◦ Physician offices need to make sure their diagnosis codes match up with hospital coding
Increased delays in processing authorizations and reimbursement claims ◦ Physician offices get pre‐auth’s on different dx codes
Improper claims payment Coding backlogs Compliance issues Decisions based on inaccurate data
Problems can be mitigated with proper advance preparation
Consequences of Poor Planning
18
3M Health Information Systems: 2012 Countdown to ICD-10 Calendar
19
20
Planning◦ Make sure you have the right “people on the bus”◦ Engage your Project Management Office◦ Use standard Project Management methodologies◦ Solid decision‐making and escalation process◦ Don’t reinvent ICD‐10 planning activities (many industry resources available)
◦ Conduct a Stakeholder Analysis◦ Use existing modes of communication◦ Have an action plan before people start working◦ Start outlining your ICD‐10 Training Plan
Phases of ICD-10 Implementation - 1
21
Assessment◦ Carefully select your assessment team◦ Define ICD‐10 stakeholders and align expectations◦ Awareness education is needed prior to Assessment◦ Spend time outlining scope and vet with process owners◦ Approach the assessment from a business process workflow perspective
◦ Streamline your reporting, create document repository such as Microsoft SharePoint
◦ Conduct feasibility studies on opportunities that are strategic to determine if “nice to have”, process improvement for later, or required for compliance
◦ Ensure stakeholders are thinking holistically in developing recommendations
Phases of ICD-10 Implementation - 2
22
Operational Implementation◦ “It’s better to measure twice and cut once” ◦ Ensure an integrated project schedule is developed and approved◦ Be persistent in contacting vendors for readiness preparedness◦ Monitor Subcommittee progress◦ Don’t be afraid to escalate issues
Phases of ICD-10 Implementation - 3
23
Testing Identify existing testing plans that can be built upon for ICD‐10 testing◦ Engage stakeholders across functional areas in developing test plans◦ Approach end‐to‐end testing plans by business process workflows◦ Specifically for IS system changes, vendors are making more than just ICD‐10 change and as these changes ripple through the organization the desire is to be proactive instead of reactive
Phases of ICD-10 Implementation - 4
24
Transition◦ Engage your Audit Committee to perform project health checks◦ Foster collaboration among all stakeholders◦ Joint Ventures – awareness training, meetings, check status of remediation, offer guidance/support
◦ Some vendors already have ICD‐10 compliant software (start testing now if you can)
Phases of ICD-10 Implementation - 5
25
TheRevenue
Cycle
PatientRegistration
Clinical Service
SchedulingPre-Registration
Insurance
Denial Management
Charge Capture
BillingCash
Management
Chart Processing & CodingAR Follow-Up
26
A failure modes and effects analysis (FMEA) is an inductive failure analysis used in operations management for analysis of failure modes within a system for classification by the severity and likelihood of the failures.
A successful FMEA activity helps a team to identify potential failure modes based on past experience with similar products or processes or based on common failure mechanism logic, enabling the team to design those failures out of the system with the minimum of effort and resource expenditure, thereby reducing development time and costs. It serves as a form of design review to erase weakness out of the design or process. It is widely used in development and manufacturing industries in various phases of the product life cycle. Effects analysis refers to studying the consequences of those failures on different system levels.
The outcomes of an FMEA development are actions to prevent or reduce the severity or likelihood of failures, starting with the highest‐priority ones. It may be used to evaluate risk management priorities for mitigating known threat vulnerabilities. FMEA helps select remedial actions that reduce cumulative impacts of life‐cycle consequences (risks) from a systems failure (fault).
Failure Mode & Effect Analysis (FMEA)
27
Identify each process step Identify potential failure modes – all the manners in which the process could fail
Identify any potential effect(s) of failure – consequences on other systems, parts or people
Rank Severity of the effect(s) of failure Identify potential cause(s) Rank the possibility of occurrence List your current controls that would detect these occurrences Rank your ability to detect a failure using these controls Calculate the risk priority number (RPN = severity*occurrence*detection)
Design recommended improvement actions Assign responsibility and target completion date Monitor actions and effects on RPN
FMEA Process Steps
28
Budget $$’s◦People◦Process◦Technology◦Other…
The ‘B’ Word
29
POTENTIAL BUDGETING CATEGORIES
2010 2011 2012 2013 2014
PEOPLE (HUMAN RESOURCE)# FTEs/ Contract Workers
Program Manager w/ Admin Support x x x x x
Staff to review payer contracts/ renegotiate
x x x
HIM temporary during cross over period
x x
PFS temporary during transition x x
PROCESSES (not including potential process improvement gains)
Assessment/ Gap Analysis (internal +/or external )
x x
Documentation Improvement x x x x
Dual Systems? X X
Decision Support /Home Grown System Remediation (and/or Translation Software)
X
Payer Integration and/or Readiness (mitigation)
x x x x
Communications to internal/ external constituents
X X X X
TECHNOLOGY X X X X
Vendor Systems (ICD-10fees? x x x
Vendor Interface charges? X X X
New Vendors? x
30
Sullivan, Tori. "Budgeting for ICD-10: Hardware Costs Should be Peaking Next Year, Contract Support Rising." Journal of AHIMA 81, no.9 (September 2010): 30-33.
•Internal communication•External communication•Printing and postage•Survey or data gathering
Communication and marketing
•Software modifications that require hardware changes•Production server•Test server(s)•Workstations•Testing workstations
hardware
•Vendor contractual fees (software upgrade)•New software•Interfaces•Software programming•Testing application•Supporting applications (e.g., project management, quality control, or budget management software products)
Software
•Program management•Overall program management•Project management•Assessment/gap analysis activities•Technology upgrades, implementation, and testing
Supportive resources
Subject matter expertise
•Regulation awareness and understanding•Coding format, anatomy and physiology•Classes, software, books, materials, travel expenses, etc.
•Procedural changes
Training
•Lowered coding productivity•Slow adjudication, slower turn-around for payment•Increased claim rejections
Revenue Loss
Contingency reserve
Implementation Project Expenses
31
Bed Size Cost
400 + $1.5 Million ‐ $5 Million
100 – 400 $500, 000 ‐ $1.5 Million
<100 $100,000 ‐ $250,000
Carmichael, Angela. “ICD‐10‐CM/PCS: What Every Hospital Needs to Know Now.” PowerPoint presentation. Georgia Hospital Association Audio Conference, Telnet 2673. 12 May 2011
Estimated Organizational Cost by Bed Size
ICD‐10 Organizational Costs
32
An example of structural change
ICD-9
X X X XX.Category Etiology, anatomic site,
manifestation
X X X XX.Category Etiology, anatomic site,
manifestation
ICD-10
X X.Extension
An example of (1) ICD-9 code being represented by multiple ICD-10 codes
2 5 0 16.Diabetes mellitus with neurological Manifestations type I not stated as uncontrolled
E 1 0 04
E 1 0 14
E 1 0 44
E 1 0 94...
. Type I diabetes mellitus with diabetic neuropathy, unspecified
Type I diabetes mellitus with diabetic mononeuropathy
Type I diabetes mellitus with diabetic amyotrophy
Type I diabetes mellitus with other diabetic neurological complication
The Basics of the ICD-10 Change
33
ICD-9-CM821.01 Fracture of femur, shaft, closed
ICD-10-CMS72301A Unspecified fracture of shaft of right femur, initial encounter for closed fracture
S72322A Displaced transverse fracture of shaft of left femur, initial encounter for closed fracture
S72326A Nondisplaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture
S72301G Unspecified fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72322G Displaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72326G Nondisplaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72302A Unspecified fracture of shaft of left femur, initial encounter for closed fracture
S72323A Displaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture
S72331A Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture
S72302G Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72323G Displaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72331G Displaced oblique fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72309A Unspecified fracture of shaft of unspecified femur, initial encounter for closed fracture
S72324A Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture
S72332A Displaced oblique fracture of shaft of left femur, initial encounter for closed fracture
S72309G Unspecified fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72324G Nondisplaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72332G Displaced oblique fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72325A Nondisplaced transverse fracture of shaft of left femur, initial encounter for closed fracture
S72333A Displaced oblique fracture of shaft of unspecified femur, initial encounter for closed fracture
S72321A Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture
S72325G Nondisplaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72333G Displaced oblique fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72321G Displaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
34
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
SURGICAL
RESPIRATORY EXCISION LOWER LOBE BRONCHUS,
RT
OPEN NO DEVICE
DIAGNOSTIC
0(zero) B B 6 0(zero) Z X
ICD-10-PCS
A glimpse at ‘specificity’
35
• Greater specificity
• Clinical data documented
• Information relevant to patient care encounters
• Makes it possible to document risk factors
• Physician peer‐to‐peer education most effective
• Recruit physician champions
ICD‐10 Incorporates:
36
WIN – WIN SITUATION? YES!
Better Documentation
Clearer Picture of Patient’s Severity of Illness
Better Coding for Facilities & Physicians
Improved Reimbursement & Quality representing TRUE acuity & resources utilized per case
COMMON ICD‐10 CLINICAL EXAMPLES: RESP. FAILURE ‐ 1
• RESPIRATORY FAILURE• ‐ 518.81 Acute• ‐ 518.83 Chronic• ‐ 518.84‐ Acute‐on‐Chronic
ICD‐9
• J96.00‐ Acute respiratory failure, unspecified with hypoxia or hypercapnia
• J96.01‐ Acute respiratory failure with hypoxia
• J96.02‐ Acute respiratory failure with hypercapnia
ICD‐10
• J96.10‐ Chronic respiratory failure, unspecified with hypercapnia or hypoxia
• J96.11‐ Chronic respiratory failure with hypoxia• J96.12‐ Chronic respiratory failure with hypercapnia
ICD‐10
• J96.20‐ Acute & Chronic respiratory failure, unspecified • J96.21‐ Acute and chronic respiratory failure with hypoxia
• J96.22‐ Acute and chronic with hypercapnia
ICD‐10
COMMON ICD‐10 CLINICAL EXAMPLES: RESP. FAILURE ‐ 2
• 599.7 Hematuria
ICD‐9
• R31.9‐Hematuria, unspecified•N30.01‐ Acute cystitis with hematuria•N02.0‐ Recurrent and persistent hematuria with minor glomerular abnormality
ICD‐10
COMMON ICD‐10 CLINICAL EXAMPLES: HEMATURIA ‐ 1
• N02.5‐ Recurrent and persistent hematuria with diffuse mesangiocapillary glomerulonephritis
• N02.6‐ Recurrent and persistent hematuria with dense deposit disease
ICD‐10
• N02.7‐ Recurrent and persistent hematuria with diffuse crescentic glomerulonephritis
• N3N02.8‐ Recurrent and persistent hematuria with other morphologic changes
• N02.9‐ Recurrent and persistent hematuria with unspecified morphologic changes
ICD‐10
COMMON ICD‐10 CLINICAL EXAMPLES: HEMATURIA ‐ 2
42
Only the Physician can document and treat a clinical diagnosis.
What seems like common clinical diagnosis to Physicians is not explicit in the medical record unless
specifically worded.
(coders cannot make diagnoses from assumptions or implicit wording)
43
……….means that the provider did not includepertinent patient facts (e.g., the patient’s overallcondition, diagnosis, and extent of servicesperformed) in the medical record documentationsubmitted.
“Insufficient Documentation”
It’s not so much that we’re afraid of change or so in love with the old ways, but it’s the place in between that we fear…. It’s like being between trapezes. It’s like Linus when his blanket is in the dryer. There’s
nothing to hold on to.”Marilyn Ferguson, American Futurist
MANAGING CHANGE
Change is: SituationalPsychological Isn’t optional, and Isn’t easy
Human behavior is the pivotal factor resulting an outcome of success or failure
COMMUNICATION DURING TRANSITION
Communications help people to feel connected Without communication‐‐‐worry, rumors, anxiety, & apathy
Protect Encourage Provide structure Consider developing a Transition Monitoring Team
You must first know and understand what the rules, regulations and requirements are regarding clinical documentation:
Only then can you truly become the change agent that you organization needs for success.
Remember...
47
Documentation Compliance
Quality Care =
“The Right Care →
At The Right Place →
At The Right Time”.
48
Compliance Action Plan:
Merge the Practice of Medicine, the Medical Necessity and the
appropriate Documentation of both=
Compliance to the communications of appropriate Severity‐of‐Illness and
Medical Necessity.
49
Key Strategies for Compliant Documentation
• Helping the provider understand what is necessary.
• Keeping the lines of communication open between providers and relevant staff.
• Ensure that providers/staff have access to current documentation education and materials.
• Encourage networking between peers.
50
Practice of Medicine + Language of Coding( the actual diagnosis that stays with the chart)
=Full Documentation of Medical Necessity regarding severity
of illness, mortality risk, and resource consumption=
Compliance and fiscal responsibility=
Stronger viability of your facility
IN A NUTSHELL
51
Early Preparation A well‐planned, well‐managed implementation
process will increase the chances of a smooth, successful transition.
Experience in other countries has shown that early preparation is the key to success.
An early start allows for resource allocation, such as costs for systems changes and education, process evaluation and change, as well as staff time devoted to implementation processes, to be spread over several years.
Supporting Continued Urgency Switch focus to Clinical Documentation
Improvement Engage Non‐HIM Stakeholders◦ WIIFT◦ Report Readiness◦ Process Flows◦ Vendor Awareness/Preparation
Use this time wisely!!◦ …keep your foot ‘on the gas’!!
Preparation is Key
52
Assess Readiness –What is your ‘Current State’? Identify Barriers/Challenges/Expectations/Needs
Introduce end‐users to change (Buy‐In) Milestone ReCap – How do you know you were successful?
Plan of Action
53
Audience TopicHIM/Coding/CDI Coding structure and rules; A&P*
Information Technology Interface, internal systems, & database impact
Finance/Auditors/Compliance/Consultants Impact on reporting, cost accounting, grouping & payment
Clinicians Proper documentation to capture specificity of ICD-10
Quality Impact on reporting, databases & cost accounting
Utilization Review Proper documentation to capture specificity of ICD-10; impact on reporting & databases
PFS ICD-10 Basics, Impact on grouping and payment
C-Suite Awareness Training…..
Patient Registration Proper documentation, impact on medical necessity & POA
Ancillary Departments/Staff Proper documentation to capture specificity of ICD-10
Trai
ning
Sug
gest
ions
54
Basic AwarenessLevel 1
IntermediateLevel 2
IntermediateLevel 2-P
AdvancedLevel 3
Recommended that everyone be exposed to this level, some will need to go on to next level training.
Minimum for all associates.
The curriculum is an overview, expected to deliver a high level understanding of ICD-9-CM and ICD-10 .
Expected Total Hours: 1-1½ hours
People who may occasionally document in the chart but not much clinical documentation of patient’s condition – i.e. phone messages, but not patient encounters ,etc.
Any associate who currently works with ICD-9 codes as a job requirement for non-coding purposes.
General plus info necessary for clinical documentation.
Moderate level of understanding – structure, mapping, LCD, job related .
Expected Total Hours: up to 4 hours
Physicians and all other who document the patient’s clinical condition and or portions of their encounter, order sets, assign conditions to tests, etc.
Physicians, MLP, RN, LPN, Techs, Social workers, Perfusionists, Dietician, Counselor, Nurse Anesth, Midwife, Opticians, etc.
All will have clinical foundation – will need more condition specific information geared towards documentation needs versus ICD-10 structure and format.
Faster paced clinical focused.
Expected Total Hours: TBD
Recommended for anyone assigning the actual code who is not also documenting services and not a clinician .
All HIM/Coding professionals and any associate responsible for applying and/or reviewing appropriateness of ICD codes/auditing.
Will need to understand current methods and tools and access for the need to increase current baseline clinical knowledge of medical terminology, anatomy, physiology, pathophysiology, and pharma.
Expected Total Hours: 20+ hours
55
1. Important to maintain urgency of implementation2. Everyone will be affected3. Private and public health plans will not accept and
pay based on ICD‐9 codes4. Automated conversions are not possible (forward &
backward mapping of codes)5. ICD‐10 cannot wait for Electronic Health Records &
other health IT initiatives6. Must implement both 5010 and ICD‐107. ICD‐10 is more than a compliance activity8. Planning and implementation must begin now9. The first step is a comprehensive Risk Readiness
Assessment followed by an Impact Analysis10. There is still plenty of work to do!
Top Ten Things You Need to Know (to Prepare for ICD‐10)
56
ICD‐10 Steering Committee
Comprehensive assessment (including gap analysis and System Inventory)
Roadmap to guide implementation planning
Clinical Documentation Assessment
Claims analysis to identify top impacted specialties
Educational Needs within Organization
Identify top specialties and education to physicians
Implement education/documentation improvement plan for ICD‐10 (“ICD‐9 improvement”)
Open communication channels with system vendors and payers
Collaborate/combine efforts to maximize resource utilization
Keep yourself educated and in tune with the latest ICD‐10 news
Attend industry conferences to collaborate with providers, payers, and vendors
Buy‐in from the top‐level down throughout the organization
ICD‐10 cannot wait for Electronic Health Records & other health IT initiatives to be completed
Start early enough so that thorough testing can be performed
Continued urgency is a must!
There is still plenty of work to do!
What I Know for Sure
57
Do you fully understand the outcome of the impact assessment and are able to initiate resolutions?
Do you continue to evaluate effect on data analysis? Are you monitoring Trading Partner readiness? Have you implemented your Training and Education Plan (Awareness)? Do you update and reassess the project as necessary? What are your plans to continuing assessing CDI practices? Have you reviewed your reimbursement impact? Have you developed Risk Mitigation Strategies to minimize transition problems?
Have you developed plans to mitigate decreases in productivity and quality?
Do you continue to expand the ICD‐10 Communication Plan?AHIMA – 2011 Clinical Terminology/Classification Practice Council AHIMA – 2011 Clinical Terminology/Classification Practice Council
Implementation: ‘Self’ Status Questions
58
◦ Take a deep breath◦ Get organized◦ You CAN do this
http://www.icd10monitor.com/index.php?option=com_content&view=article&id=501:take-a-deep-breath-get-organized-you-can-do-this&catid=48:icd10-enews&Itemid=106
The Delay was a Gift
59
60
Nicole D. Harper, Ph.D., MBA, RHIA, CCS-P, C-CDIDirector, Training & Dev/Process Improvement
Revenue Cycle ManagementSt.Vincent Health – Indiana
Betty B. Bibbins, MD, BSN, CHC, C-CDI, CPEHR, CPHITPresident & Chief Medical Officer
Physician Executive EducatorDocuComp LLC
Contact Information
American Health Information Management Association (AHIMA)
Hay Group, Inc. Healthcare Information Management Systems Society (HIMSS)
RAND Robert E. Nolan Company Pricewaterhouse Coopers http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp
http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
3M Solutions 2011
References
62
