ICD-10 Transition Countdown - RSM USICD-9CM9 CM ICD-10 CM and PCS10 CM and PCS 4.85x 18 98x 68,069...
Transcript of ICD-10 Transition Countdown - RSM USICD-9CM9 CM ICD-10 CM and PCS10 CM and PCS 4.85x 18 98x 68,069...
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ICD-10 Transition Countdown: Ready, Set, CodeYour Complete Strategic Readiness Guide
To download slides: click on Presentation Assets
April 4, 2012
To download slides: click on Presentation Assetson the left side of your screen
To download slides: click on Presentation Assetson the left side of your screen
ICD-10 Transition Countdown: Ready, Set, CodeYour Complete Strategic Readiness GuideApril 4, 2012
Today’s Objectives
ICD diagnosis and patient care coding changes
T iti t t l d t t i Transition assessment tools and strategies Implementation steps, from training to final
evaluationevaluation Success stories and lessons learned from
organizations currently in ICD 10 transitionorganizations currently in ICD 10 transition
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Today’s Presenters
Alicia Faust – Director, National ICD 10 Lead847.413.6969 (office)847.413.6969 (office)312.498.4097 (cell)[email protected]
Jason Greer Manager Technology LeadJason Greer – Manager, Technology Lead515.281.9286 (office)[email protected] g @ g y
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Polling Question One
Where did you hear about this webcast?M l l HFMA h t- My local HFMA chapter
- McGladrey invitation / contact- McGladrey websiteMcGladrey website- Colleague / friend- Twitter / Facebook- Other
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Polling Question Two
What type of organization do you represent?PPS h it l / h lth t- PPS hospital / health system
- Sole community hospital- Critical access hospitalCritical access hospital- City/county hospital- Physician clinicy- Association- Other
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Polling Question Three
What role do you hold within your organization?- Board of Directors / Strategic Planningg g- CEO- CFO- COO/ CIO / CMO- Clinical Leadership- Patient Financial Services- Medical Records / Health Information ManagementMedical Records / Health Information Management- Reimbursement- Information Technology- Managed Care / FinanceManaged Care / Finance- Legal Counsel- Other
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ICD 10 Transition: Background
Federal mandate for transition to 5010 software and ICD 10 coding10 coding- Improve patient care- Improve diagnosis, coding, billing and reimbursement - Reduce health care cost
Original ICD 10 WEDI timeline shows that providers should have been approximately 50%+ through their transition to ICD 10- Providers should have developed an effective governance- Providers should have developed an effective governance
structure, completed planning, performed impact analyses and are in the process of identifying performance opportunities; also, training and education initiatives should be underway shortly
The Centers for Medicare and Medicaid Services (CMS) The Centers for Medicare and Medicaid Services (CMS) original implementation deadline of October 1, 2013 has been delayed. McGladrey continues to advocate to not wait!
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ICD 10: How many codes are affected?
Number of Codes and Size of IncreaseICD 9 CM ICD 10 CM and PCSICD-9 CM ICD-10 CM and PCS
18 98x4.85x
68,069 72,589
18.98x 4.85x
14,0253,824,
Diagnosis Procedures
ICD 10 CM: Clinical Modification (diagnosis) – Across all disciplinesICD 10 PCS P d C di S t ( i l d ) IP l
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ICD 10 PCS: Procedure Coding System (surgical procedures) – IP only
Types of ICD 10 Adopters
Late adopter – Just getting started with some potential internal/external training initiatives; need rapid assessment approach to assist in catching up to standard timelineg p
Intermediate or mainstream adopter – Potentially seeking on-site professional project management resources to lead internal readiness initiatives due to:- Limited project management resourcesj g- Formal acknowledgment of the complexities and number of resources,
processes and systems impacted by transition- Associated risks indicate a need in your organization for project
management support to drive timely completionProvider more than likely needs a rapid assessment scorecard to- Provider more than likely needs a rapid assessment scorecard to determine overall effectiveness
Early adopter – Evaluating/enabling technology-based tools/solutions; designed to provide “advanced,” “real-time” and “ongoing” data analytics of historical and prospective claims that will provideanalytics of historical and prospective claims that will provide measurement of claims coded, billed or grouped by ICD 10, DRG/MSDRG, MDC or other frame of reference/relevance
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Polling Question Four
What type of adopter would you classify your organization?organization?- Early
Intermediate/mainstream- Intermediate/mainstream- Late
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Original WEDI Timeline and Catch-up
Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13
Kick Off *
Organize Implementation Effort
Impact Assessment
Implementation PlanningImplementation Planning Identify and Implement Process Improvements
Training/Education Internal System Design/Development g p
Internal Testing
Vendor Code Deployment
External Testing
Transition/Implementation
Post Go Live
Ti li C t hTi li C t h NN
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Timeline CatchTimeline Catch--up Necessaryup Necessary
Hospital Associations: ICD 10 Survey Results
About 50% of providers responded that they have not started ICD 10 analyses and are considered to be late adopters
Between 10-15% of providers responded that they are in early stages of ICD 10 analyses and are considered to be late adopters
Almost 70% of providers responded that they are behind the WEDI timeline
For those providers who responded that they were “on target,” p p y g ,50% suggested that they were only focusing on I/P issues
Over 60% of providers responded that a rapid assessment would benefit their organizationg
We are finding that most hospitals have been slow to begin ICD 10 transition analyses
Survey results benchmark consistently betweenSurvey results benchmark consistently between associations/counsels across the country
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Enterprise-Wide Approach
Physician PracticesICD 10-CMCPT/HCPCS
Emergency CareICD 10-CM
CPT/HCPCSHospital I/PCPT/HCPCS CPT/HCPCS Hospital I/PICD 10-CMICD 10PCS
Hospital O/PHospital O/PICD 10-CM
CPT/HCPCS
Other AmbulatoryICD 10-CMCPT/HCPCS
Post-AcuteICD 10-CM
CPT/HCPCS
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Enterprise-Wide ICD 10 Risk Areas and ConsiderationsCo s de a o s
GOVERNANCE: Steering committee, sub‐workgroups, project charter, communications plan, issues escalation plan, project management office, ICD 10 l d j l i l d ibl i f
ConsiderationsRisk Areas
MEDICAL RECORDS/HIM: Number of coders (IP, OP, physicians), current skill levels, credentialing, productivity and accuracy levels, retention, recruitment, out‐sourcing, system coding staff pool, dual coding, clinical documentation improvement, GEM mapping, educationManaged Care /
FiResources
ICD 10 lead, project plan to include persons responsible, timeframes, milestones and due dates
IT: Systems inventory for hardware and software, clinical and financial applications, interfaces, registries, implementations and upgrades, sunsets and replacements, testing storage and back‐up, dual coding
REVENUE CYCLE: Central billing office and key performance indicators i.e. days in AR, days of unbilled, bad debt write off , insurance
Finance
Medical Records /
HIM
IP/OP/Physician
VENDORS: Vendor inventory, contract negotiations, communications, readiness timelines, testing
y , y , ,verification, patient registration, initial denials and denials write offs, etc.
Information Vendors
Governance
/ d h ld
RESOURCES: Competing objective: EMR and meaningful use, software implementations, upgrades and training, CDI, CPOE, ICD 10, consolidation and integration, daily operations and tasks
DOCS: IP Hospitalists, OP, physician practices, GEM mapping, clinical documentation improvement, education
Systems
Revenue Cycle
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MANAGED CARE/FINANCE: MCR and private pay GEM mapping, hold harmless contract provisions ($ neutrality), analysis pre and post ICD 10 (financial impacts), contract negotiation implications i.e. right to audit pre and post impacts, external financial to support operations
Polling Question Five
Looking at all the risk areas, has your organization completed a risk basedorganization completed a risk-based assessment for ICD 10?- Yes- Yes- No
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ICD 10 Translator Technology Screenshots
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ICD 10 Translator Technology Screenshots (continued)( )
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ICD 10 Translator Technology Screenshots (continued)( )
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ICD 10 Translator Technology Screenshots (continued)( )
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ICD 10 Demo
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ICD 10 Translator Technology
Background and platform
Demo
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Polling Question Six
Have you conducted any type of code translation within your organization from ICDtranslation within your organization from ICD 9 to ICD 10?- YesYes- No
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Polling Question Seven
How much training time has been built into your ICD 10 project plan to prepareyour ICD 10 project plan to prepare employed physicians?- Less than 15 MinutesLess than 15 Minutes- Less than 1 Hour- Less than 4 Hours- Less than 8 Hours
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Lessons Learned from Early Adopters: Why is a smooth ICD 10 transition so important?s a s oo C 0 a s o so po a
Decreased payment due to non-compliant physician documentation
I d li i k Increased compliance risk Decreased payment due to unanticipated changes in
commercial, Medicare and Medicaid DRG/MSDRG classifications
Increased denials due to ICD 10-revised/dependent national/local coverage determination policies
Increased A/R due to log-jammed internal/external
Governance
StrategicPerformance
Vendor Analysis
Increased A/R due to log jammed internal/external claims processing operations
Increased claims processing complexities, A/R management challenges due to expected concurrent coding ICD-9/ICD 10 and HIPAA 4010/5010 transmission capabilities due to:
Information system complexities/interdependencies D d di d ti it l di t HIM di
ICD 10 Lessons Revenue
CycleTechnology Decreased coding productivity leading to HIM coding
under-staffing due to significant unplanned learning curve related to:
- Sheer volume of codes increasing- Increased significance of coder
competencies in medical terminology and clinical practice variations
Learnedy
Managed CEducation
- Significant number of complex (combination) codes with scenarios and choices
- Significant number of ICD-9 clusters that now map to single ICD 10 codes
- Significant number of ICD 10 clusters that previously mapped to an ICD-9 code
Coding personnel shortages due to increased
Care
Coding andDocumenta-
tion
Education
Coding personnel shortages due to increased demand for coding
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Questions?
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Thank You!
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Contact Information
Alicia Faust – Director, National ICD 10 Lead847 413 6969 (office)847.413.6969 (office)312.498.4097 (cell)[email protected]@mcgladrey.com
Jason Greer – Manager Technology LeadJason Greer Manager, Technology Lead515.281.9286 (office)[email protected]@mcgladrey.com
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