ICD-10: Business Office, HIM, Coding, Finance Teams. AAHAM ICD-10 Readiness Lunch n Learn March 4, 2011

Transcription

1 ICD-10: Business Office, HIM, Coding, Finance Teams AAHAM ICD-10 Readiness Lunch n Learn March 4, 2011

2 2 Welcome

3 Agenda Introduction ICD-10 Awareness Plan of Action ICD-10 Preparedness Actions Questions and Answers 3

4 Is this your reaction to the phrase ICD-10-CM/PCS? 4

5 Industry Trend for 5010 and ICD-10 Activity 5010 Preparedness 63% have a 5010 project in place 30% will start externaltesting with trading partners Q ICD-10 Preparedness 47% have a staffed and funded ICD-10 project 56% have started ICD-10 impact analysis 13% indicated they had completed this process Source: HIMSS Healthcare Information and Management Systems Society) Provider Readiness survey in December, 2010; Hospitals and Integrated Delivery Networks: 69%; Practices and Clinics: 18%; Other, such as Long Term Care providers: 13% 5

6 ICD-10-CM and ICD-10-PCS ICD-10-CM US clinical modification of the World Health Organization s ICD-10 Diagnosis portion, no procedure codes ICD-10-PCS (procedure coding system) Developed under contract by CMS specifically to replace ICD-9-CM procedural coding system Contains only procedure code portion 6

7 Federal Register Final Rule Adoption of ICD-10 has been in the works for a while Final Rule for adoption published January 2009 This final rule modifies the standard medical data code sets to ICD-10-CM/PCS. These new codes replace ICD-9- CM Volumes 1, 2 and 3. The compliance date for this regulation is October 1, The compliance date is firm and not subject to change There will be nodelays There will be no grace period for implementation 7

8 ICD classification uses ICD classifications most often associated with reimbursement but has significant role in furthering the value of EMRs original intent was NOT for reimbursement but rather a means to provide information from health records ICD classifications provide data for: Quality measurement research Policymaking decisions Adoption of ICD-10-CM and PCS is a significant step in the direction of increasing the use of EMRs and improving individual and population health in the U.S. 8

9 Why replace ICD-9-CM Has been in place since 1983 and is 30 years old It s 18,000 diagnosis and procedure codes are insufficient to allow for new codes at capacity, functionality exhausted Does not allow us to compare with other countries at the same level A number of countries have already moved to ICD-10 United Kingdom, France, Australia, Germany and Canada Never designed to provide for the increased level of detail needed today to support Biosurveillance Pay for performance Technology advances Today s Quality measurements and patient safety initiatives 9

10 Limitations of ICD-9-CM U.S. is the only industrialized country not yet using ICD-10 for tracking morbidity or causes of illness ICD-10 first draft was published in 1997 with updated drafts published in 2002, 2007, 2009, and 2010 ICD-9-CM has been exhausted by new and changing advancements in medicine 10

11 Compliance Date for ICD-10 Currently there is a single compliance date across the health care industry for ICD-10-CM and ICD-10-PCS Cannot realistically run dual systems Burdensome on providers to maintain Confusing to coders having to recall and apply codes from different systems Data incomparability 11

12 Who will be impacted by ICD-10 Hospitals (many departments within) Payers Physician offices Ambulatory care facilities Home Health Agencies Skilled care facilities. Coders must understand the importance and what is involved outside of the coding silo ICD-10-CM (diagnoses) adoption will affect all components of the healthcare industry. ICD-10-PCS adoption will only affect those components of the healthcare industry that currently utilize ICD -9-CM volume 3 inpatient procedures CPT will continue to be used in physician offices, for outpatient surgery cases and CDM driven cases in the hospital setting 12

13 People Coders Physicians Clinicians Information Technology Revenue Cycle Financial Management Payer Impact Others 13

14 Process Documentation practices Productivity and efficiency practices Contracts and business processes HIM practices Practice management processes Budget Payment conversions System logic and edits Claims edits Disease & Utilization management 14

15 Technology IT system changes Upgrade software Modified field lengths Modified system logic Update superbills/encounter forms and databases Data reporting elements Submitting ICD-9 and ICD-10 codes Retain access to historical coded data in ICD-9 format 15

16 Positives of implementing ICD-10 Better able to compare morbidity and mortality data with other countries who have adopted ICD-10 Assist with health policy planning Allows for expansion as new technology is developed Enhances ability to drill down to specificity Better Quality reporting and outcome measurement Medical terminology and classification of diseases more current and consistent with today s clinical practice. Fewer claims rejected and improper reimbursement Better and more specific data for conducting research, epidemiological studies, and clinical trials Allows for better justification of medical necessity Reduced coding errors Increased specificity will facilitate development of more sophisticated automated coding tools (computer assisted coding) 16

17 ICD-9-CM vs. ICD-10-CM/PCS Comparison of codes ICD-9-CM Codes 14,315 Diagnosis codes 3,824 Procedure codes 18,139 total codes ICD-10-CM/PCS codes 69,099 Diagnosis codes 71,957 Procedure codes 141,056 total codes 17

18 Structural Differences Between the Code Sets ICD-9-CM ICD-10-CM ICD-9-CM 13,000 diagnosis codes 3-5 characters alpha/numeric 855 categories 120,000 diagnosis codes 3-7 characters alpha/numeric 2,033 categories 4,000 procedure codes 3-4 characters numeric only ICD-10-PCS 200,000 procedure codes 7 characters alpha/numeric 18

19 What will the new codes look like? ICD-9-CM ICD-10-CM 3-5 characters First character is numeric or alpha (E or V) Characters 2-5 are numeric Always at least 3 characters Use of decimal after 3 characters 3-7 Characters Character 1 is alpha All letters except U Characters 2-7 are numeric Use of decimal after 3 characters Use of dummy placeholder x Alpha characters are not case-sensitive 19

20 Code structure comparison: DIAGNOSIS CODE ICD-9-CM XXX.XX Category, Etiology, anatomic site, manifestations ICD-10-CM XXX.XXXX First 3 for category Second 3 for etiology, anatomic site, severity Last digit is for extension PROCEDURE CODE ICD-9-CM XX.XX ICD-10-PCS XXXXXXX 20

21 Productivity impact Short-term coder productivity declines are expected -up to 6 months anticipated Greater in the hospital setting due to having to learn both ICD-10-CM and ICD-10-PCS Degree of productivity loss will likely be offset by the fact logical structure and standardized terminology in ICD-10-PCS make it easier to learn than ICD-9-CM It is not clear with the productivity loss will be in the physician office, specialty practices will have more new diagnosis codes to use 21

22 Plan of Action ICD-10 Awareness Assess Timeline Facing the Coding Dilemma Executive Leadership Impact Assessment GAP Analysis Risk Assessment The Roadmap Budget Training Testing Go-Live Post Go-Live 22

23 ICD-10 Awareness Key word is awareness Leadership Information Technology Coders Medical Staff Others 23

24 Action Plan Timeline Q1 Q Q3 Q Q1 Q Program Charter Steering Committee Program Leadership Final 5010 Testing/Go-Live Activities ICD-10 Roadmap Budget Schedule Initiate ICD-10 Implementation Activities Education Technology Impact Analysis Resource Allocation Change Management 24

25 Action Plan Timeline Q3 Q Q1 Q Q3 Q Continue User Specific Education Finalize Implementation Budget Finalize Vendor andmanaged Care Contract Negotiations Conduct System Testing Comprehensive systems audit for same results Begin User Specific Training Real-time User Specific Training Final Testing Re-check and revise all systems and processes Implement Go-Live Activities Post Go-Live Activities Close Project 25

26 The Coding Dilemma Lack of experience Lack of qualified coders Continuing coding changes Paper HIM processes Changing technology Competition Demand for remote work opportunities 26

27 Coding Establish solid coding program Implement remote coding w or w/or EHR Evaluate Computer Assisted Coding Implement Clinical Documentation Improvement Train for ICD-10 27

28 Remote Coding Where to Begin Evaluate benefits Survey for interest and support Form implementation project team Network best practice Implement Electronic Medical Record Review staff and needs Compare outside services 28

29 Remote Coding Evaluation Coding process EMR functionality Budget Hardware Software Network Connectivity 29

30 Remote Coding -Implementation Requirements for remote coder Prioritizing roll out Testing Policies & Procedures Remote Coder agreement Training Go-live Follow up 30

31 Remote Coding -Monitoring Timekeeping Productivity Quality Audits Privacy Program Outcomes 31

32 Remote Coding -Management Daily work assignments Coding Questions Productivity & Quality System updates Coding meetings Coding education Annual reviews Communications Hospital activities 32

33 Remote Coding Issues Network connectivity Downtime Computer problems Onsite vs. Remote staff Self discipline, disruptions Lack of physician contact Isolation Missed hospital opportunities

34 Remote Coding -Benefits Happier Coders Longer retention & less turnover Wider geographic range for recruitment Greater productivity Reduced need for outsourcing More flexibility Increased ability to work Less interruptions Reduced supplies Less space needed at hospital Reduced DNFB 34

35 Computer-Assisted Coding (CAC) Problem - Lack of qualified coders - Changes affecting Coding - Low productivity Definitions -CAC -EHR -EMR:A Background 35

36 Computer-Assisted Coding (CAC) Software Approaches - Structured Input (SI) - Natural Language Processing (NLP) -Standards Utilization -Clinics - Hospital Outpatient Services Benefits - Productivity -Accuracy - Consistency - Transparency - Reimbursement 36

37 Computer-Assisted Coding (CAC) Reality -Key Areas Used - Coder Impact - Cost Savings Evaluating Next Steps -Need - Software Options - Outsourcing - Coder & Physician Education Face the Future - Expectations - AHIMA/HIMSS - CAC Coding 37

38 Clinical Documentation Improvement (CDI) Concurrent Coding vsclinical Documentation Improvement The importance of CDI An effective program The benefits of CDI 38

39 An Effective CDI Program Staffing Strategic and Operational Metrics Concurrent focus Physician Queries Medical Staff Education Ongoing monitoring Preparing for ICD-10 39

40 Getting Ready for ICD-10 CM/PCS Project Planning 1. Executive Sponsor 2. Interdisciplinary Steering Committee 3. Project Manager 4. Implementation Strategy 5. Project Team 6. Success Factors 7. Work Breakdown Structure 8. Project Schedule 9. Implementation Timeline 10. Impact Awareness 11. Change Management Strategies 12. Project Budget 13. Communications Management Plan 14. Organization-wide Strategy 40

41 41 ICD-10 Program Architecture

42 ICD-10 Program Roles & Responsibilities Sponsoring the Charter, lead Steering Committee Executive Co-Sponsors Provide strategic direction, authorize work of program, allocations resources and defining scope of work for each project within the overall program and spread buy-in. Steering Committee must reinforce adherence to IT governance Steering Committee Implement scope of work outlined by the Steering Committee. Develop, maintain and distribute project planning documents. Lead project team to complete tasks and deliverables Project/Program Manager 42

43 Impact & Risk Assessment Strategy 1. Identify technology modifications 2. Outreach 3. Education required 43

44 Impact & Risk Assessment Activities * Information Systems 1. Project Team & Tasks 2. Awareness Campaign 3. Impact to Systems & Technology 4. Vendor & Third Party Contracts * HIM 1. Project Team 2. Project Plan 3. Work Breakdown Structure 44

45 Impact & Risk Assessment Activities * Coding 1. Coding Assessment Coordinator 2. Educational Requirements 3. Education Process 4. Staffing Needs 5. Organizational Coding Functions * Clinical Documentation Improvement 1. Existing Documentation Process 2. Documentation Review 3. Physician Documentation Tools 4. ICD-10-CM/PCS Documentation Awareness 45

46 Impact & Risk Assessment Activities * Patient Access 1. Work Breakdown Structure 3. Medical Necessity Process 4. Training Needs * Business Office Readiness 2. Work Breakdown Structure 3. Staffing Needs 4. Training Needs 5. Managed Care Contracting 46

47 Impact Assessment -Data Collection Stakeholder Interviews Interviews conducted both inperson and remotely Stakeholders representing Information Services Interfaces and Reporting Patient Access/Scheduling Health Information Management Clinical Documentation Improvement Patient Financial Services ED Charge Capture Review Ancillary Services Quality Management Physician Billing Group Data Review System Listing for coded data Interface Diagrams Data Extracts System Reports System Tailoring System Edits 47

48 Impact Assessment Inventory Registration Registration and Scheduling Systems Appointment reminder systems Advanced beneficiary software Medical necessity edits ICD-10 Clinical Systems Clinical Protocols Test ordering systems Clinical reminder systems Medical necessity software Disease mgmt systems Decision support systems Clinical systems Pharmacy systems 48

49 Technology Assessment Recommendations Develop a plan with your software vendors to determine when the upgrades will be available and applied Determine the staffing requirements for the interface, extract, and report changes and recruit early Eliminate applications with redundant features rather than upgrade them and modify their interfaces Proactively implement as many changes as possible during your HIPAA 5010 efforts Engage your business partners early and clearly identify any risks of their preparedness 49

50 Project Ranking Ranking Level Ranking Area Impact Risk Cost Range (in thousands) Minor Modest Medium High An event that, if it occurs, will cause little or no measurable impact to business operations. Business operations will continue with minimal or routine modifications to the process An event that, if it occurs, will cause small delays in business operations that, in most cases, can be absorbed by the current staff. Business operations will continue will intermittent modifications to the process An event that, if it occurs, will cause noticeable delays in business operations. Business Operations may be interrupted without complete stoppage An event that, if it occurs, will cause significant delays in business operations. Business operations will stop, work will cease at time of transition $ $$ $$$ $$$$ 50

51 Talking Points For Information Systems Managers For Senior Managers Ancillary Department Managers Clinical Department Managers Healthcare Providers 51

52 Talking Points Vendor Questionnaire 1. Applications 2. Contacts 3. Assessment Questions 52

53 ICD-10 Budget Impact and Risk Assessment GAP Analysis IT resources Training Coding resources 53

54 Budget Planning 1. Executive Budget 2. Detailed Budget (Planned/Actual/Variance) 3. Contract Management 54

55 Additional Budget Initiatives RAC Response EHR and Meaningful Use HIPAA/HITECH Compliance 55

56 Budgeting Funding Sources Department Capital Department Operational ICD-10 Project Capital IT Capital Budgets include funding and resource estimates Current allocation is based on industry recommendations Budgets are multi-year Goal will be to track and report ICD-10 costs 56

57 Implementation Plan Implementation Project Schedule ID % TASK NAME DURATION START FINISH RESOURCE NAMES 1 Final Regulations 2 Planning 3 Communication Management 4 Impact Assessment 5 Implementation 6 Go-Live Preparation 7 Post Implementation 57

58 Implementation Plan Work Breakdown Structure 1. Milestone 2. Deliverables 3. Dependencies 4. Duration 5. Resource 6. Start Date 7. Planned Completion 8. Estimate to Completion 9. Actual Completion 10. Status 58

59 Implementation Plan Coding Assessment Tool By Department to capture: OUTPATIENT VISIT TYPE PATIENT REGISTRATION ADMITTING DX CLINICAL DOCUMENTATION FINAL DX CLINICAL DOCUMENTATION WHO ASSIGNS FINAL CODES TO CLAIM SOURCE HIM Coding Source Assessment Tally Tool By Department to capture: ACCESS SOURCE DX CODE SOURCE CLINICAL DOCUMENTATION SOURCE FOR ADMIT DX CLINICAL DOCUMENTATION SOURCE FOR DISCHARGE DX FINAL CODES TO THE CLAIM SOURCE 59

60 Training Clinical Departments 1. Focus on documentation 2. Awareness/Education/Training 2. Who/What/Where/When/How 3. Ongoing Revenue Cycle Departments Same as above with focus on coding Coding Professionals 1. Assessment of educational requirements 2. Budget 3. Timelines 4. Develop or secure trainers 5. Determine vendor educational tools 60

61 Coder CE requirements -AHIMA To maintain CCS credential ICD-10 specific 18 CEs required per CE cycle Timeline to start obtaining ICD-10 specific training January 2010 December 31,

62 Go-Live Preparation Go-Live Plan 1. Information Systems Go-Live Preparation 2. HIM Go-Live Preparation HIM Go-Live Checklist - Participant List - Roles & Responsibilities - Key Milestones - Activity Timeline - Communication Plan - Back-out Plan - Activity Support - Problem Reporting Guide 62

63 Post-Implementation Activities Coding Quality Reviews Inpatient Worksheet Account Discharge MR # DRG Principal Dx Secondary Dx Principal Px Secondary Px POA Abstracting Comments No. Date Correct Total Correct Total Correct Total Correct Total Correct Total Correct Total Outpatient Worksheet Pt No. Date of First Listed Dx Secondary Dx Comments Service Correct Total Correct Total 63

64 In Summary: Revenue Cycle Impact of ICD-10 ICD-10 assessment and preparedness Education of healthcare providers Education of anyone utilizing codes Training of Coders Software upgrades and replacements Hardware to support software changes Reduced Coder productivity High Coder turnover Initial increase in edits and claim denials Ongoing coding compliance monitoring 64

65 In Summary: Next Steps Establish ICD-10 Charter Engage Senior Leadership, name executive sponsor. Identify and Kick-Off Steering Committee Activities Establish and kick-off formal ICD-10 Program Complete detailed Impact, Risk & Gap Analysis Include representation from all stakeholder groups. Set expectations for steering committee member participation Start as early as possible, technology modifications will be time consuming and most costly Be thorough in analysis, taking this opportunity to document findings for future project activities. Include workflow analysis in detailed analysis Develop Roadmap Detailed analysis findings will provide budget and schedule estimates, required for roadmap development Kick-off Implementation Activities Begin system modification, tailoring, training and change management activities 65

66 ICD-10 Resource List National Center for Health Statistics ICD-10-CM AHA s ICD-10 Resource Center AHIMA AHIMA s Implementing ICD-10-CM/PCS for Hospitals, A Project Guide & Toolkit Authors: Tori E. Sullivan, RHIA, MHA, PMP; Gale C. McNeill, RHIA, CCS; and Kathleen E. Wall, MS, RHIA 2010 Centers for Medicare and Medicaid Services ICD-10-PCS ICD-10 and HIPAA Federal Register

67 Thank you for your attention! Lisa Walter, RHIA Vice President, HIM Services C: Conifer Health Solutions, Inc. All Rights Reserved.