Allscripts American Coders Axial Exchange Medical Center Cape Fear Valley Health System. Coastal Alliance CSC Cone Health Crescent Health Solutions
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2 ICD-10 Pilot Testing Participants Include Alamance Regional Allscripts American Coders Axial Exchange Medical Center BCBSNC Cape Fear Valley Health System Carolinas HealthCare System CCA Medical CIBER Clinical-Insights CMS CaroMont Health System Coastal Alliance CSC Cone Health Crescent Health Solutions Duke University Health System echobase FirstHealth of the Carolinas High Point Regional Health System HIMformatics HP Enterprise Services IBM Iredell Memorial Hospital LabCorp Mayo Clinic MedCost Nachimson Advisors NC Community Health NC DHHS NCHIMA NC Medical Group Center Association Managers NC Medical Society NC Nurses Assn. NC Psychiatric Assn. NC Psychological Assn. New Hanover Regional Novant Health System Oak Grove Technologies Pitt Community College Medical Center Rex Healthcare (UNC Health Care) Rural Health Group Siemens Southeastern Regional Health System The SSI Group TM Floyd & Company UNC Health Care System Wake Forest Baptist Health WakeMed Qualedix 2
3 NCHICA PILOT INTENDED BENEFITS Business Driven Approach to Testing Coding Analytics for Providers and Payers Shared Delivery Model vs. Silo Delivery Model Gives Healthplans More Clinical Data not Mapped Data Gives Healthplans Greater Provider Testing Involvement Visibility into Provider Contracts and Revenue Cycle Verifiable e Results to Assess Trading Partner Readiness ess 3
4 NCHICA PILOT SCOPE Top 3 DRGs Per Specialty/Clinical Data Known Payment Changes Positive, Negative & Neutral A Source-of-Truth of for Claim Scenarios Dual Coded ICD-9 and ICD-10 Transactions Experienced ICD-10 Coders and Clinician Peer Review Test Data Reusable Across All Trading Partners Agile Testing Know the Answer Prior to Start 4
5 4 STAGES OF TESTING USING COMMON DATA STAGE 1 STAGE 2 INTERNAL UNIT/INTEGRATION MEDICAL RECORD SELECTION DUAL CODING EXERCISE DUAL CODED CLINICAL RECORDS ICD 10 CODING ACCURACY WORKFLOW PROCESS IMPROVEMENT ICD 10 TRAINING COMPUTER ASSISTED CODING COMPLIANCE TESTING STAGE 3 TRADING PARTNER TESTING BUNDLED MEDICAL RECORDS DUAL CODING WORKSHEETS DRG ASSIGNMENTS 5010 TRANSACTIONS SHARED WITH ALL TRADING PARTNERS (EG. CLEARINGHOUSES, HEALTHPLANS AND VENDORS) ADDITIONAL CODING REVIEW BY TRADING PARTNERS (IF NECC SHARED CODING RESULTS DUAL CODED TRANSACTIONS CODING CONSENSUS ICD 10 CODING ACCURACY SHARED WITH ALL TRADING PARTNERS (EG. CLEARINGHOUSES, HEALTHPLANS AND VENDORS) ADDITIONAL CODING REVIEW BY TRADING PARTNERS (IF REQUIRED) BILLING TESTING DEFECT RESOLUTION STAGE 4 END TO END TESTING DUAL CODED TXN S END TO END TESTS COMPLIANCE TESTING DEFECT RESOLUTION HELP DESK
6 NCHICA PILOT STATUS The participating pilot hospitals have provided to date more than 200 highly relevant clinical dual coded and peer reviewed scenarios. Another 100+ scenarios are still in progress, and this dual coding exercise will continue through the end of January when we will begin the physical testing effort. Sharing of dual coded clinical scenarios with the participating healthplan is underway (BCBSNC). Healthplan (BCBSNC) is now conducting their initial scenario review, coding review and their internal mapping comparisons versus the actual ICD-10 coding in the medical records- Feedback through December 22, Defined the scope for Volume of charts and # of test cases from Physician Offices. Dual Coding of Physician practice cases began in November. 6
7 NCHICA PILOT LESSONS TO DATE The exercise has been both challenging and rewarding. Performing the dual coding exercise and participating in the assessment has demonstrated the complexity of this transition, and has given provided a sense of accomplishment. The ability to have an external review of our ICD-10 code by other coding experts and Payers helps demystify the doom that was predicted for the ICD-10. Receiving validation of our coding competency in ICD-9 ICD-10 is a great experience. Test Case integrity issues, including mix up on some of the records, due lack of clean and stringent process of sharing the documentation between submitters and reviewers. Would be helpful to see what auditors/reviewers are seeing.is is there an 80% agreement rate on ICD-10 dx and procedure codes, or less than 50% agreement rate? This will be helpful to share with the general Healthcare community to give providers/hospitals some insight into how coders are 'getting' ICD-10. If there is an 80% or higher agree rate, it may not be that big of an educational challenge for the coding community. However, if the rate is significantly less, what are the trends, what are the areas of disagreement? Is it just documentation or interpretation of the new codes? Is it diagnosis coding or procedural coding? Are there trends in specific codes/chapters/ areas that are causing the disagreements? Etc. 7
8 Thank You! 8
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