A Guide to Education and Training for ICD-10 Implementation

Transcription

1 A Guide to Education and Training for ICD-10 Implementation

2 Table of Contents Chapter One: Phases of implementation Chapter Two: Timelines for implementation Chapter Three: Part One: Part Two: Part Three: Recommended education from Elsevier Content and descriptions Recommended education by type of learner Recommended education timeline based on need

3 Introduction With the 2013 implementation date for ICD-10 drawing closer, all healthcare organizations are facing new challenges. How you prepare for these challenges will dramatically impact the ease and success of your transition. There are many benefits to the adoption of ICD-10 in the United States, including improvements in patient outcomes and quality measures reporting; revenue cycle analytics and associated reimbursement; better data for research; and consistency with international coding systems. But improvements require change and change leads to uncertainty. And uncertainty only adds to the burden of preparing for future requirements while maintaining current workflow. There are solutions, however. Elsevier has developed a phased, comprehensive ICD-10 transition plan that will position your organization for a smooth implementation allowing you to reap the benefits of ICD-10, while minimizing the pain. Copyright Elsevier, Inc. All rights reserved. Details provided in this document are for information purposes only and, unless specifically agreed to the contrary by Elsevier in writing, are not part of any order or contract.

4 1 Chapter One: Phases of implementation

5 Phases of implementation1 Elsevier views the transition to ICD-10 as a longitudinal educational process. The phases identified below may OVERLAP and may be undertaken at different times by different departments/stakeholders based on unique needs. PHASE ONE Impact Assessment (Evaluation) Obtain executive sponsorship Assemble an implementation team Identify stakeholders and their unique needs Perform GAP analysis of staff and systems - workflow analysis - data flow analysis - workforce analysis Assess clinician and code set user knowledge Budget for resource and system needs Elsevier solutions > ICD-10 Readiness Assessment > EduCode ICD-10 Essentials > ICD-10 Webinar Series > ICD-10 White Papers PHASE TWO Identify Challenges and Planning Solutions (Planning) Budget and plan for stakeholder education Develop communication plans Define coding education plans Provide fundamental education of coding and CDI professionals Offer introductory ICD-10 courses for trainers Implement information systems changes Assess documentation practices and begin documentation improvement efforts Elsevier solutions > EduCode Documentation Improvement curriculum > Mosby s Medical Terminology > Mosby s Human Body Essentials (Anatomy & Physiology, Pathophysiology) > GEMS and Introduction to ICD-10-CM/PCS Courses ( release date) > White Papers such as Two Years and Counting Where You Should Be in Your Transition Plan; General Equivalence Mappings (GEMS); A Guide to Preparatory ICD-10 Training with appendix. > Webinar Series

6 Phases of implementation1 PHASE THREE Go Live Preparation (Action) Coordinate educational needs with meaningful use, quality measures, patient outcomes, and clinical decision support requirements Finalization and testing of systems changes Intensive education Monitoring coding accuracy and reimbursement impact Assess payer readiness and model revenue impact - prepare for more appeals Implement comprehensive evaluation to understand quality measures Policy development, trending and projection analysis; change of billing records and templates Elsevier solutions > Introductory and specialty-specific ICD-10 content > General Equivalence Mappings (GEMS) Courses > EduCode Clinical Documentation Improvement > EduCode Reimbursement Essentials > Mosby s Medical Terminology > Mosby s Human Body Essentials (Anatomy & Physiology, Pathophysiology) > Continuation of webinar and white paper series PHASE FOUR Measurement and Milestones (Management) Set milestones for each action item and monitor for compliance Measure coding accuracy and productivity and effect on reimbursement, e.g. Case Mix Index, reimbursement, assignment of MS-DRGs with and without MCCs/CCs Perform parallel reporting and comparison of historical data Monitor documentation improvement and effects of data use, e.g. patient outcomes Continue coding education and documentation education Elsevier solutions > Competencies used to evaluate knowledge, skills, and ROI > ICD-10 Coding education with associated reporting > Clinical Documentation Improvement with associated reporting > EduCode Reimbursement Essentials with associated reporting > Webinar and white paper series

7 2 Chapter Two: Timelines for implementation

8 Timelines for implementation 2 As the 2013 implementation date for ICD-10 draws closer, healthcare organizations are facing new and numerous challenges. Not only must they prepare for one of the most impactful changes in healthcare in 30 years, but they must do so with minimal disruption to current operations, workflow and revenue. In addition, there s a lot at stake, as failure to adequately prepare could have serious data quality and economic consequences. Along the pathway of the ICD-10 transition, there are concerns that will arise and need to be addressed, including: Short-term concerns: awareness of ICD-10 and meaningful use requirements; response to external fraud and abuse audits, such as RAC, and gear-up for more intensive fraud audits; system migration to 5010 ; GAP analysis of staff competency Mid-term concerns: planning and implementation of ICD-10 training; ensuring EHRs meet phase I and phase II meaningful use criteria; correlation of ICD-10, quality measure reporting, meaningful use, and Value-Based initiatives; mapping of data from ICD-9-CM to ICD-10 (data base conversion); standardizing documentation and data for future Health Information Exchange Long-term concerns: confidence that all staff have sufficient education on ICD-10-CM/PCS; understanding the impact of ICD-10 on reimbursement; quality outcomes and how they drive the new model of consolidated healthcare; Health Information Exchange Important Dates: > January 1, begin testing 5010 with trading partners > October 1, ICD-9/10 code freeze last regular updates to ICD-9-CM and ICD-10-CM/PCS > January 1, 2012 full compliance with 5010 > October 1, 2012 limited code updates for new technologies and diseases > October 1, 2013 limited code updates for new technologies and diseases > October 1, 2013 ICD-10-CM/PCS is effective > October 1, 2014 regular updates to ICD-10-CM/PCS begin

9 3 Chapter Three: Recommended education from Elsevier

10 Recommended education from Elsevier 3 To help your organization address the wide range of challenges it may face during the transition to ICD-10, Elsevier has created comprehensive solutions to meet your specific education needs. On average, it takes one hour to complete each Elsevier lesson. This includes reading all screens and sub screens of content, completing interactive knowledge checks, viewing slide shows or animations and completing lesson post tests. Continuing education credit is applicable to all content that promotes learning, including knowledge checks that provide rationale, but excluding tests. Recommendations within this document are meant as a guide only, recognizing that organizations will modify their educational plans to meet their individual requirements. Education is evolving and some titles of content are considered draft.

11 Recommended education from Elsevier 3.1 Part 1: Content and descriptions Curriculum/Course Need Met by Content Estimated Time ICD-10 Readiness Assessment and white paper with appendix A Guide to ICD-10 Preparatory Training Tools to aid with GAP analysis of fundamental knowledge needs for ICD-10 1 ½-2 hours General Equivalence Mapping (GEMS) Provides an overview of General Equivalence Mappings and Reimbursement Mappings. Explains how to interpret the data, the dos and don ts of using GEMS, and helps the learner to develop their own applied mappings. 4 hours to complete course Mosby s Basic Medical Terminology The Basic Medical Terminology course allows learners to develop an understanding of basic medical word structure and medical abbreviations. Audio teaches learners how to correctly pronounce terms. 8 hours to complete course Medical Terminology Plus Medical Terminology Plus enhances information provided in the basic med term course plus provides in-depth training for specific body systems. 95 lessons 15 min/lesson

12 Part 1: Content and descriptions (continued) Curriculum/Course Need Met by Content Estimated Time Mosby s Anatomy & Physiology for Health Professions An extensive online course designed to teach human anatomy and physiology by specialty. The course also can be used as a refresher for nursing and allied health professionals returning to practice. 26 lessons (7 systems) each specialty approx 2 hours to complete Mosby s Pathophysiology for Health Professionals An extensive online course designed to teach human anatomy and physiology by specialty. The course also can be used as a refresher for nursing and allied health professionals returning to practice. 26 lessons each lesson approx ½ hour to complete EduCode Clinical Documentation Improvement: Documentation for Clinicians* This course is designed to help providers identify critical documentation requirements based on settings and the type of service provided. Standardized terminology is presented, e.g. ICD-10-PCS terms. Activities such as correcting entries, identifying present on admission conditions, differentiating between observation and inpatient admission, and documenting medical necessity are covered. The focus is on documentation, not coding or reimbursement. 9 hours to complete course EduCode Clinical Documentation Improvement: Standards and Guidelines This course is designed for CDI specialists, HIM professionals, Quality Improvement and Compliance staff responsible for overseeing coding, documentation improvement and compliance functions. This course helps learners identify regulatory requirements surrounding documentation. Highlighted are efforts associated with documenting quality measures, seeking clarification through a physician query process, meeting Joint Commission and COP completion standards, and review of documentation requirements for evaluation and management services. 4 hours to complete course

13 Part 1: Content and descriptions (continued) Curriculum/Course Need Met by Content Estimated Time EduCode Clinical Documentation Improvement: Documentation Topics for CDI and Coding Specialists This course highlights highly visible, difficult to document, highly scrutinized, high-cost, high-volume conditions that pose documentation challenges to the practitioner and coder. This content will help learners understand the clinical presentation, treatment and associated terminology for conditions, while comparing and reconciling clinical terminology with classification terminology. Documentation for conditions impacted most by ICD-10 and national audits are included. 16 lessons, each about 1 hour long EduCode ICD-10 Essentials: ICD-10-CM Diagnosis Coding Fundamentals The ICD-10-CM Diagnosis Coding Fundamentals course is comprised of 21 lessons that provide an overview of ICD-10-CM diagnosis coding including the philosophy and functionality of the system. This course is designed to teach differences and similarities between ICD-9-CM and ICD-10-CM involving characteristics, conventions, structure, format, and core knowledge needed for coding with ICD-10. These lessons explain the application of ICD-10-CM codes for patients seen in the hospital as well as in physician offices and other outpatient settings. The lessons are organized by body system as seen in the code book itself. Approximately 20 hours to complete course EduCode ICD-10 Essentials: ICD-10-PCS Procedure Coding Fundamentals The ICD-10-PCS Procedural Coding Fundamentals course consists of 5 lessons that provide an overview of the structure, characteristics and application of medical, surgical and ancillary services. Learners will gain an understanding of the (draft) ICD-10-PCS coding guidelines as well. This content takes a first look at comparing the different coding systems and highlights major changes that learners will need to understand. Approximately 3 hours to complete course

14 Part 1: Content and descriptions (continued) Curriculum/Course Need Met by Content Estimated Time EduCode Coding: Introduction to ICD-10-CM Diagnosis Coding for Inpatients This introductory course offers basic education on using the ICD-10-CM diagnosis coding system. This is the first step in actually learning how to apply coding system guidelines and conventions to assign diagnosis codes for inpatients, following the direction of ICD-10-CM Official Guidelines for Coding and Reporting. Approximately 14 hours to complete Course EduCode Coding: Introduction to ICD-10-PCS Procedure Coding for Inpatients This introductory course offers basic education on using the ICD-10-PCS inpatient procedure coding system. This is the first step in actually learning how to apply procedure codes for inpatients using standard terminology, following the direction of ICD-10-PCS Coding Guidelines from CMS. Lessons emphasize root operations. 19 lessons, approximately 1 hour per lesson EduCode Coding: Introduction to ICD-10-CM Diagnosis Coding for Outpatients This introductory course offers basic education on using the ICD-10-CM diagnosis coding system. This is the first step in actually learning how to apply diagnosis codes for outpatients, following the direction of ICD-10-CM Official Diagnosis Coding and Reporting Guidelines for Outpatient Services. Approximately 15 hours to complete course EduCode Coding: ICD-10-CM/PCS Specialty Overview* This content is designed to provide an overview of specialty-specific coding information. Each specialty includes one lesson on specialtyspecific diagnosis coding with emphasis on fundamental health science knowledge pertinent to the specialty, and one lesson specific to procedure coding, emphasizing common root operations and character selection for the specialty, where appropriate. 17 specialties, approximately 2 hours per specialty

15 Part 1: Content and descriptions (continued) Curriculum/Course Need Met by Content Estimated Time EduCode Coding: ICD-10-CM/PCS Specialty Detail* This content provides topicspecific detailed ICD-10-CM/ PCS coding education within each specialty. Complex, high-volume or high-cost diagnoses and procedures are covered within these lessons. Average of 6 hours per specialty EduCode Reimbursement Essentials This content offers education on the fundamentals of reimbursement systems for inpatient and outpatient services. This detailed education defines the OPPS and IPPS payment systems and associated edits and challenges within each system. Also included are courses on the hospital HAC and HQI programs that affect reimbursement, along with lessons on the various CMS auditing (RAC and CERTS) and medical review programs. The Revenue Cycle is presented in an easy to understand format within the Revenue Cycle Orientation Course for those who are unfamiliar with the Revenue Cycle. Approximately 30 hours for the course (can be divided by area of job responsibility) *draft titles

16 Recommended education from Elsevier 3.2 Part 2: Recommended education by type of learner

17 Part 2: Recommended education by type of learner Every occupation in the hospital requires different training in preparation for the ICD-10 implementation. For example an experienced inpatient cardiology coder: > ICD-10 Essentials 6 hours > Medical Terminology Plus (7 lessons) 2 hours > Mosby s Pathophysiology (8 general & 3 specialty lessons) 5.5 hours > EduCode Clinical Documentation Improvement (8 lessons) 8 hours 2012 > Introduction to ICD-10-CM Diagnosis Coding for Inpatients 14 hours > Introduction to ICD-10-CM Procedure Coding for Inpatients 18 hours 2013 > ICD-10-CM Specialty Overview 2 hours > ICD-10-CM Specialty Detail 15 hours

18 Part 2: Recommended education by type of learner The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Health Information Management Experienced Coder ICD-10 Readiness Assessment GEMS (to help with data conversion and reporting) ½ hours ICD-10 Essentials 23 hours (may select specialty) Mosby s Medical Terminology Plus min/lesson Mosby s Anatomy & Physiology for Health Professions hours per specialty Mosby s Pathophysiology for Health Professionals hours Introduction to ICD-10-CM Diagnosis Coding for Inpatients 2012 (Trainers may take in ) 14 hours Introduction to ICD-10-PCS Procedure Coding for Inpatients 2012 (Trainers may take in ) 19 hours Introduction to ICD-10-CM Diagnosis Coding for Outpatients (some duplication between inpatient and outpatient) hours EduCode Clinical Documentation Improvement: Standards and Guidelines 4 hours EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies hours (may be taken by specialty or condition) EduCode Coding: ICD-10-CM/PCS Specialty Overview 2013 (trainers may start in 2012) 2 hours per specialty EduCode Coding: ICD-10-CM/PCS Specialty Detail 2013 (trainers may start in 2012) 6 hours per specialty

19 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Health Information Management Novice or outpatient coder ICD-10 Readiness Assessment Mosby s Basic Medical Terminology Mosby s Medical Terminology Plus 1 ½ hours 2 hours per specialty Mosby s Anatomy & Physiology for Health Professions hours per specialty Mosby s Pathophysiology for Health Professionals hours ICD-10 Essentials 23 hours (may select specialty) EduCode Clinical Documentation Improvement: Standards and Guidelines hours EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies (if applicable to job function) hours (may be taken by specialty or condition) Introduction to ICD-10-CM Diagnosis Coding for Outpatients 15 hours Introduction to ICD-10-CM Diagnosis Coding for Inpatients (if applicable to job function some duplication with outpatient introduction course) 14 hours Introduction to ICD-10-PCS Procedure Coding for Inpatients (if applicable to job function) 19 hours EduCode Coding: ICD-10-CM/PCS Specialty Overview (if applicable to job function) hours per specialty EduCode Coding: ICD-10-CM/PCS Specialty Detail (if applicable to job function) hours per specialty

20 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Clinical Documentation Improvement Specialist ICD-10 Readiness Assessment EduCode Reimbursement Essentials, Revenue Cycle Orientation course 1 ½ hours EduCode Coding: MS-DRG Fundamentals and MS-DRG Training 21 hours (may be split by specialty) ICD-10 Essentials 23 hours (may select specialty) Mosby s Medical Terminology Plus (if refresher needed) hours per specialty Mosby s Anatomy & Physiology for Health Professions hours per specialty Mosby s Pathophysiology for Health Professionals hours Introduction to ICD-10-CM Diagnosis Coding for Inpatients 2012 (Trainers may take in ) 14 hours Introduction to ICD-10-PCS Procedure Coding for Inpatients 2012 (Trainers may take in ) 19 hours EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies hours (may be taken by specialty or condition) EduCode Clinical Documentation Improvement: Standards and Guidelines hours EduCode Clinical Documentation: Documentation for Clinicians hours EduCode Coding: ICD-10-CM/PCS Specialty Overview* 2013 (trainers may start in 2012) 2 hours per specialty

21 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Clinical Documentation Improvement Specialist EduCode Coding: ICD-10-CM/PCS Specialty Detail* 2013 (trainers may start in 2012) 6 hours per specialty Physicians/clinicians/ nursing EduCode Clinical Documentation: Documentation for Clinicians hours - 1 hour/ lesson (lessons appropriate for type or site of practice) EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies hour/lesson (by specialty or condition) EduCode Clinical Documentation Improvement: Standards and Guidelines (E/M, completion standards, physician query) hours Health Information Technology General Equivalence Mappings (GEMS) ICD-10 Essentials: Comparison of ICD-9-CM to ICD-10-CM 4 hours 1 hour Finance & Revenue Cycle Analysts ICD-10 Essentials and introduction courses (Dependent on level of analysis generate & compare data will require more coding knowledge: involvement in mapping strategies will require coding knowledge, possibly by specialty) General Equivalence Mappings (GEMS) (depends on when parallel reporting begins) 4 hours

22 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Finance & Revenue Cycle Analysts EduCode Reimbursement Essentials (job function specific, e.g. inpatient (IPPS) 2013 Approx 1 hour/lesson Contracting rewriting coverage policies or forecasting General Equivalence Mappings (GEMS) EduCode Reimbursement Essentials (IPPS inpatient payment system) hours 9 hours Medical Terminology (specialty specific) min/lesson Anatomy & Physiology (specialty specific) min/lesson Pathophysiology (specialty-specific) min/lesson Introduction to ICD-10-CM for inpatients 14 hours Introduction to ICD-10-CM for outpatients (some overlap with intro to inpatient) Introduction to ICD-10-PCS for inpatients 1 hour/lesson ICD-10-CM/PCS Specialty-specific lessons 1 hour/lesson Administrative support in clinical departments Medical Terminology (specialty specific) Anatomy & Physiology (specialty specific) min/lesson 30 min/lesson Pathophysiology (specialty-specific) min/lesson Introduction to ICD-10-CM for inpatients 14 hours Introduction to ICD-10-CM for outpatients (some overlap with intro to inpatient)

23 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Administrative support in clinical departments ICD-10-CM Specialty-specific lessons 1 hour/lesson Quality Management Anatomy & Physiology (specialty specific) 30 min/lesson Pathophysiology (specialty-specific) 30 min/lesson EduCode Documentation Improvement (specialty-specific) 1 hour/lesson up to 18 hours EduCode Reimbursement Essentials (Quality Programs Affecting Reimbursement) hours EduCode Coding: MS-DRG Fundamentals and MS-DRG Training 21 hours (may be split by specialty) Introduction to ICD-10-CM for inpatients 14 hours Introduction to ICD-10-PCS for inpatients 1 hour/lesson ICD-10-CM/PCS Specialty-specific lessons 1 hour/lesson Health Data Professionals General Equivalence Mappings (GEMS) ICD-10 Essentials 4 hours 23 hours Mosby s Medical Terminology Plus min/lesson Mosby s Anatomy & Physiology for Health Professions hours per specialty Mosby s Pathophysiology for Health Professionals hours

24 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Health Data Professionals Introduction to ICD-10-CM Diagnosis Coding for Inpatients hours Introduction to ICD-10-PCS Procedure Coding for Inpatients hours Introduction to ICD-10-CM Diagnosis Coding for Outpatients (some duplication between inpatient and outpatient) hours EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies hours (may be taken by specialty or condition) EduCode Coding: ICD-10-CM/PCS Specialty Overview 2013 (trainers may start in 2012) 2 hours per specialty EduCode Coding: ICD-10-CM/PCS Specialty Detail 2013 (trainers may start in 2012) 6 hours per specialty Utilization Review and Case Management EduCode Reimbursement Essentials, Revenue Cycle Orientation course EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies hours 14 hours (may be taken by specialty or condition) EduCode Coding: MS-DRG Fundamentals and MS-DRG Training 21 hours (may be split by specialty) Researchers Same as clinicians, unless coding is involved, then Same as Coder Revenue Cycle Managers Same as finance and revenue cycle analysts

25 Part 2: Recommended education by type of learner (continued) The following chart breaks down the types of users, with recommended coursework and timing. Date for Estimated Type of User Content Education Contact Hours Auditors and Compliance Staff Dependent on auditing responsibility, same as coders Also include EduCode Reimbursement Essentials: Audits & Reviews, Quality Programs Affecting Reimbursement; and Revenue Cycle Orientation hours Patient Financial Services and Billing Mosby s Basic Medical Terminology Mosby s Medical Terminology Plus 8 hours 15 min/lesson (may split by specialty) Mosby s Anatomy and Physiology 26 lessons -30 min/lesson (may split by specialty) Introduction to ICD-10-CM for Inpatients/Outpatients (based on job function) 14 hours Introduction to ICD-10-PCS for Inpatients (based on job function) 19 hours (split by specialty) ICD-10-CM Specialty Overview hour/lesson EduCode Reimbursement Essentials (job function specific, e.g. inpatient (IPPS) 2013 Approx 1 hour/ lesson

26 Recommended education from Elsevier 3.3 Part 3: Recommended education timeline based on need

27 Part 3: Recommended education timeline based on need The following chart anticipates needs that may arise among various learners and provides suggestions for appropriate coursework. Need Audience Curriculum/Course Identify gaps in knowledge to know where education is necessary Basic understanding of the coding system to interpret or understand requests to modify or enhance systems Enhance fundamental knowledge to prepare for ICD-10 coding knowledge of Enhance fundamental knowledge to prepare for ICD-10 coding primary responsibility coding, trainers, and documentation improvement and quality reporting Abstracting and reporting of quality measures (ongoing through 2013) Improve clinical documentation Identify working DRG, utilization review and discharge planning Coders; Clinical Documentation Improvement Specialists HIT HIT; outpatient coders; billers; PFS; HIM/Coding; Clinical Documentation Improvement Specialists: Auditors and Compliance Staff; Quality Management staff Quality Management; Coders Clinicians; Clinical Documentation Improvement; Coding Case Management; nursing; Quality Management ICD-10 Readiness Assessment and white paper with appendix A Guide to ICD-10 Preparatory Training ICD-10 Essentials (course specific to job function) Reimbursement Essentials: Revenue Cycle Orientation Mosby s Basic Medical Terminology Mosby s Anatomy & Physiology for Health Professions (specific to specialty) Mosby s Anatomy & Physiology for Health Professions (specific to specialty) Mosby s Pathophysiology (specialty-specific) Clinical Documentation Improvement EduCode Reimbursement Essentials Clinical Documentation Improvement EduCode Clinical Documentation Improvement EduCode Reimbursement Essentials : QPAR, Revenue Cycle Orientation EduCode Coding-MS DRG Fundamentals and MS-DRG Training; EduCode Clinical Documentation Improvement EduCode Reimbursement Essentials

28 Part 3: Recommended education timeline based on need (continued) The following chart anticipates needs that may arise among various learners and provides suggestions for appropriate coursework. Need Audience Curriculum/Course Understand clinical phrases enough to assign a basic code, identify medical necessity statements, respond to request for information, communicate with payers Data Base Conversion including parallel reporting capability Understand clinical phrases enough to assign a basic code, identify medical necessity statements, respond to request for information, communicate with payers Abstracting and reporting of quality measures (ongoing through 2013) Rewrite: coding and compliance policies and procedures; billing records/charge tickets (charge capture processes) continue fundamental education (by specialty) through 2012 and begin revisions of charge capture processes late 2012, early 2013 to accommodate parallel coding evaluation Patient Financial Services (e.g. admissions, registration, scheduling); billing staff; HIT; Analysts; HIM (those responsible for identifying needs of report users) Patient Financial Services (e.g. admissions, registration, scheduling); billing staff; Quality Management; Coders HIM/Coders; Contracting; compliance auditors; Data Quality; clinical department administrative support; coders Mosby s Basic Medical Terminology Mosby s A&P General Equivalence Mappings (GEMS) Mosby s Basic Medical Terminology Mosby s A&P EduCode ICD-10-CM Introductory courses EduCode Reimbursement Essentials Clinical Documentation Improvement Medical Terminology Plus Mosby s A&P Mosby s Pathophysiology ICD-10-CM/PCS Introductory courses Clinical Documentation Improvement EduCode specialty-specific courses *assign applicable specialty lessons

29 Part 3: Recommended education timeline based on need (continued) The following chart anticipates needs that may arise among various learners and provides suggestions for appropriate coursework. Need Audience Curriculum/Course Analytics (analyze coded data) e.g for reimbursement, profiling, modelling, outcomes, research Standardization of clinical documentation for clinicians (reconciling clinical terminology to classification terminology Enhance fundamental knowledge to prepare for ICD-10 coding knowledge of Enhance fundamental knowledge to prepare for ICD-10 coding primary responsibility coding, trainers, and documentation improvement and quality reporting Maintain high level of productivity and accuracy for inpatient coding abstract, code and report (minimize disruption of secondary data use such as payment, research, modeling, etc) Rewrite/modify payer contracts Parallel reporting and analytics (data users) Analysts; Revenue Cycle professionals; Clinicians; Coders; CDI; Quality Management HIT; outpatient coders; billers; PFS; HIM/Coding; Clinical Documentation Improvement Specialists: Auditors and Compliance Staff; Quality Management staff Coders, CDI Contracting (anticipate coders and clinicians will be involved with the detail of this process and will have in-depth coding education) Finance and Revenue Cycle Analysts Researchers General Equivalence Mappings (GEMS) Clinical Documentation Improvement Mosby s Basic Medical Terminology Mosby s Anatomy & Physiology for Health Professions (specific to specialty) Mosby s Anatomy & Physiology for Health Professions (specific to specialty) Mosby s Pathophysiology (specialty-specific) Clinical Documentation Improvement EduCode Specialty-Specific Education Clinical Documentation Improvement (Build on fundamental education from and 2012) EduCode ICD-10 Essentials SEE ALSO full line of coding education EduCode Reimbursement Essentials : OPPS, IPPS GEMS General Equivalence Mappings (GEMS) **unique to user

30 Part 3: Recommended education timeline based on need (continued) The following chart anticipates needs that may arise among various learners and provides suggestions for appropriate coursework. Need Audience Curriculum/Course Learn how to assign codes for ancillary or outpatient settings Compile, edit & submit claims, and/or perform denial management, as needed Understand clinical phrases enough to assign a basic code, identify medical necessity statements, respond to request for information, communicate with payers Rewrite: coding and compliance policies and procedures; billing records/charge tickets (charge capture processes) continue fundamental education (by specialty) through 2012 and begin revisions of charge capture processes late 2012, early 2013 to accommodate parallel coding evaluation Outpatient Coders Patient Financial Services and Billing Patient Financial Services (e.g. admissions, registration, scheduling); billing staff; HIM/Coders; Contracting; compliance auditors; Data Quality; clinical department administrative support; coders Mosby s Anatomy & Physiology for Health Professions EduCode ICD-10-CM Introduction to Outpatient Coding EduCode Coding: ICD-10-CM Specialty Overview Mosby s Pathophysiology for Health Professionals EduCode ICD-10-CM/PCS introductory courses EduCode Coding: ICD-10-CM/ PCS Specialty Overview EduCode ICD-10-CM Introductory courses ICD-10 Specialty Overview (Build on fundamental education from and 2012) Medical Terminology Plus Mosby s A&P Mosby s Pathophysiology ICD-10-CM/PCS Introductory courses Clinical Documentation Improvement EduCode specialty-specific courses *assign applicable specialty lessons

31 Contact Elsevier at (866) or visit our website at ICD-10online.com Copyright Elsevier, Inc. All rights reserved. Details provided in this document are for information purposes only and, unless specifically agreed to the contrary by Elsevier in writing, are not part of any order or contract. Elsevier is committed to helping ease the burden of ICD-10 implementation with elearning tools to guide you and your staff through the transition process. As a proven leader in supporting and educating coders for more than 20 years, Elsevier has provided guidance through a myriad of coding changes in the past and has the experience necessary to support your organization into the ICD-10 era.