The Healthcare People 866-319-6795 The Healthcare People 866-319-6795.

The Healthcare Peoplewww.thehealthcarepeople.com

866-319-6795


866-319-6795

ICD-10: Anticipate the Impact

Presented by:

American Consultants

Linda GerberV.P. Health Information

Technology

Darrell Jones, PMP, ITIL

Director, Health Information Technology

http://www.thehealthcarepeople.com/



866-319-6795

ICD-10 Agenda

• Background

• Project Approach

• Training

• ICD-10 Impacts

• Project Management

• Readiness



866-319-6795

ICD-10 Background

• ICD-10 must be used for transactions with dates of service/date of discharge on or after October 1, 2014

• ICD-9 will no longer be accepted.

• Deadline is firm, no further delays are expected.



866-319-6795

Coding Specificity

X X X X X.ICD-9 ICD-10

X X X X X X X

Category CategoryEtiology, anatomic site, manifestation

Etiology, anatomic site, manifestation

. .Extension

An Example of Structural Change

Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E 1 0 4 0.

Type 1 diabetes mellitus with diabetic mononeuropathy

E 1 0 4 1.

Type 1 diabetes mellitus with diabetic amyotrophy

E 1 0 4 4.

Type 1 diabetes mellitus with other diabetic neurological complication

E 1 0 4 9.

Diabetes mellitus with neurological manifestations type 1 not stated as

uncontrolled

2 5 0 6. 1

An Example of One ICD-9 code being Represented by Multiple ICD-10 Codes

One ICD-9 code is

represented by multiple

ICD-10 codes



866-319-6795

Project Approach

• Governance Structure is required.

• ICD-10 Implementation is a project, there’s a deadline.

• Needs Executive-Level Sponsorship & Leadershipo CEO, CFO, COO

• Needs input from many different sources.o Physicians, Vendors, Payers, etc…

• A path to Go-Live

• Create your Implementation Plan



866-319-6795

Executive Sponsor

Executive Steering CommitteeCEO, CFO, CIO, CNO, CMIO, HR, IT, HIM

ICD-10 Program Manager

Education

Physicians

Coders & Billers CDI Revenue

Cycle HIM

Governance Structure

ICD-10 Core team

Work Groups

Work Groups

Work Groups



866-319-6795

Path to Go-Live

Secure Budget, Impact Assessment, Gap Analysis

Establish Steering Committee & Project Program

System Design & Remediation

External Partner Testing

Training – Coders & Physicians Operational Readiness Testing

October 1st, 2014 GO-LIVE



866-319-6795

ICD-10 Implementation Plan

AssessAssess PlanPlan RemediateRemediate OptimizeOptimize

· Exec sponsors/stakeholders

· Coding Assessment· Documentation review· Organizational readiness· Contract analysis· IT product inventory· Vendor readiness· Process readiness· Risk assessment· Roadmap assessment· Budget assessment

· Exec sponsors/stakeholders

· Establish steering committee

· Establish PMO· Program Planning· Budget planning· Establish structure· Establish

communications & reporting

· Establish change mgmt.

· Application/Interface· Workflow· Payer

· Vendor coordination· Upgrade/Modify/replace· Testing· Coder education· Staff education· System training· Contract changes· Sensitivity analysis· Parallel Coding· Go-live planning· Go-live support· Change mgmt. &

awareness· Risk management

· Managing adoption· Reporting & analysis· AR/DNFB· Claims analysis· Process audits· Coding audits· Documentation

updates· Systems Monitoring· Vendor support· Go-live support· Program closure

ICD-10 Organization Wide Education

Formal Training—Provider, Coding, Clinical Documentation, etc...

On-going Sustainment training



866-319-6795

Who needs to be trained?

Administrative – Basic training

Registration, Schedulers, Office Managers

Non-Physician Clinician – Moderate training

PAs, Nurses, Lab, Radiology, Support Personnel

Physician – Training by specialty or codes

Family, Specialty, Surgeons

Coder/Billing – In-depth code training



866-319-6795

• Train coding professionals in high risk areas first.• Highest volume codes and codes with largest revenue

impact.• Code areas with the most changes (e.g. diabetes).

• Conduct training needs analysis, only train on codes practitioners will use.

• Train your best coders first and early. They will become super coders to help you train the rest.

• Plan several shorter training sessions over time rather than marathon training sessions.

• If, however, your staff prefers workshop style training, then plan “review” sessions to reinforce learning over time.

Training TimelineBreak it down



866-319-6795

Number of training hours needed:

• The Medical Group Management Association recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff

• Average Costs of training per doctor or coder = Provider and staff education and training, estimated between $500 to $2500 per individual.

ICD-10 Training



866-319-6795

We all know ICD-10 impacts clinical documentation and coding, but what is the impact to your organization?

ICD-10 Impact



866-319-6795



866-319-6795

Impact Types

Impact

Types

Technology

People

Financial

Process



866-319-6795

• System upgrades, replacements, testing, and go-live

• Vendor readiness and management

• Potential clinical department workflow process changes

• Clinical Documentation changes

• Interface development and testing

Technology Impact



866-319-6795

Clinical Processes• Documentation• Training• Code Review

Revenue Cycle• Coding• Billing• Denials• Customer Service

Information Systems• System Upgrades• Reporting• Testing• Vendor

Management• Project

Management

Processes Impact



866-319-6795

•Documentation: The need for specificity dramatically increases by requiring laterality, stages of healing, weeks in pregnancy, episodes of care, and much more.

•Code Training: Code increases from 17,000 to 140,000. Physicians must be trained.

•Code Review: A practice of using coders to review physician diagnosis’ can drastically improve your denials and reimbursement.

People ImpactPhysicians



866-319-6795

• Patient Coverage: Health plan policies, payment limitations, and new ABN forms.

• Superbills: Revisions required and paper super-bills may be impossible.

• ABNs: Health plans will revise all policies linked to LCDs or NCDs, etc., ABN forms must be reformatted, and patients will require education.

People ImpactClinical



866-319-6795

• New Policies and Procedures: Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRI must be revised.

• Vendors and Payer Contracts: All contracts must be evaluated and updated.

• Budgets: Changes to software, training, new contracts, and new paperwork will have to be paid for.

• Training Plan: Everyone in the practice will need training on the changes.

People ImpactManagers



866-319-6795

•Policies and Procedures: All payer reimbursement policies may be revised.

•Training: Billing department must be trained on new policies and procedures and the ICD-10-CM code set.

People ImpactBilling



866-319-6795

•Code Set: Codes will increase from 17,000 to 140,000. As a result, code books and styles will completely change.

•Clinical Knowledge: More detailed knowledge of anatomy and medical terminology will be required with increased specificity and more codes.

•Concurrent Use: Coders may need to use ICD-9- CM and ICD-10-CM concurrently

People ImpactCoding



866-319-6795

•Systems: Updates to systems may impact patient encounters. Testing of interfaces and documentation will take time away from operational work.

•Vendor Management: Projects should be underway to upgrade outdated systems.

•Project Management: Competing priorities with other projects, e.g. Meaningful Use

People ImpactTechnology



866-319-6795

• An Increase in Discharged Not Final Bill (DNFB) as more claims will be denied with the lack of specificity of codes.

• Productivity in the Coding and Billing Departments will decrease during the adjustment to the new codes sets.

• Beyond Coding and Billing, a decrease in productivity will occur for anyone else involved in coding: Physicians, Revenue Cycle, Case Management, Clinical Documentation. NEED TO GET SPECIFICS - unspecified means unpaid!

• Payers and Vendors will also experience delays since they are going through this same transition for the first time.

• Dual coding will bring a need for additional coders, as the work load will be doubled.

• Payer contract management & Payer readiness

Financial Impact



866-319-6795

• Many IT systems will have to be updated, upgraded, or replaced.

• The transition will bring new Workflows that will need to be monitored, adjusted, and documented. Think continuous improvement

• Many reporting systems will need to be adjusted or replaced.

• Backfilling for work hours used for employee training. A good percentage of the employees will need to complete some level of education.

• Backfilling for Physician training will be difficult, which will have a direct effect on patient volumes.

Financial ImpactCont.



866-319-6795

Identify processes, people and technology gaps between the current state and desired target state:•Work flow issues

•System Issues

•Revenue Cycle/Charge Master

•Other issues that were not evident

Gap Analysis



866-319-6795

• Develop roadmap / work plan that includes all tasks required to ensure all people, processes, training, and technology are ICD-10 ready.

• Plan for modifying systems to accommodate code structure in all functional systems.

• Plan for modifying business process to manage revised components of the value chain.

• Determine approach and timing for updating analytics and reporting to support effort.

• Plan for testing, go-live, and contingencies.

Roadmap / Work Plans



866-319-6795

ImplementationTimeline

ICD-10 AreaAMA Recommended

Actual

Impact Analysis 3-6 Months 1-3 WeeksAssess Vendors readiness 2-3 Months 1 MonthAssess Payers, Billing Service, and Clearinghouse readiness

2-3 Months 1 Month

Installation of Vendor Upgrades 3-6 Months 2 Months

Internal Testing 2-3 Months2-3 Months

Update Internal Processes 4-6 Months2-3 Months

Formal Staff Training 4-6 Months4-6 Months

External Testing with Clearinghouses, Billing Service, and Payers

6-9 Months4-6 Months

ICD-10 Go live: October 1, 2014



866-319-6795

ReadinessAre you ready?



866-319-6795

Readiness:Assessment Areas

Operations Financial External

Revenue CycleClinical DocumentationCodingClinical OperationsHuman ResourcesAdministrationMarketingCredentialingCompliance

BudgetingReimbursementManaged Care ContractingA/R Management and Cash FlowDNFB ManagementReporting and PlanningResearch and Intellectual Property

PatientsPhysiciansPayorsOutsourced SolutionsTrading Partners Outsourced Operations Coders ClearinghousesSolution Vendors



866-319-6795

• What applications, databases, interoperability feeds, and reporting are impacted by ICD-10?

• Are your people/process/technology analyzed and assessed?

• Will the ICD-10 change be vendor-supported or require in-house changes?

• For vendor-supported systems, is there an acceptable upgrade/remediation path, or will the systems need to be replaced?

Readiness:Internal



866-319-6795

• What are the vendor-related and internal actions required to prepare for and conduct the migration?

• What is the estimated timeline, level of effort and anticipated costs?

• What staffing resources are needed to support multiple replacements/upgrades?

• How will the IT department sequence system replacements/upgrades and conduct unit and integration testing?

Readiness:Vendors



866-319-6795

• When can you begin testing ICD-10 transactions? When will your clearinghouses/billing services, payers begin testing?

• Do they have any upgrades that need to be completed?

• Are your payer contract negotiations/medical policies completed to accommodate the ICD-10 code set?Ask them about:

• Review, auditing, coverage, and medical policy changes

• Impact on coverage decisions and reporting requirements

Readiness:External Partners

This phase can take 2-3 months to complete and needs to be completed

during the assessment phaseEspecially if you start late!



866-319-6795

• Evaluate the options for implementation and compliance.• Focus on competitive advantage and strategic imperatives to

support evaluation.• Select future-state solution that best meets the objectives and

constraints.• Develop more detail on the technology, operations and people

impacts of the solution.• Include a bucket for unplanned hurdles in the budget (10% of

budget).

Technology Alternatives

Be prepared to change direction if needed:



866-319-6795

Q & A

The Healthcare People

www.thehealthcarepeople.com

866-319-6975

Play Offense not Defense – Start Now

Let us help you determine your game plan





866-319-6795

Contact Information

AMERICAN CONSULTANTS ~ ICD-10 Informationhttp://www.thehealthcarepeople.com/health-information-technology/icd-10-transition/

Darrell Jones, PMP, ITILDirector, Health Information Technology (O) 866-319-6795(C) 303-956-5716

Linda GerberV.P., Health Information Technology(O) 866-319-6795(C) 913-515-0290


http://www.thehealthcarepeople.com/health-information-technology/icd-10-transition/



Date post:	15-Dec-2015
Category:	Documents
Upload:	jett-mares
View:	219 times
Download:	3 times

The Healthcare People 866-319-6795 The Healthcare People 866-319-6795.

Documents