ICD-10 Transition Project Planning. Kristen Heffernan MicroMD Director of Prod Mgt and Marketing

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1 ICD-10 Transition Project Planning Kristen Heffernan MicroMD Director of Prod Mgt and Marketing 1

2 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 2

3 Pop Quiz! Win something funny for ICD-10 What s the new ICD-10 deadline? 3

4 What is ICD-10: Official CMS definition The World Health Organization (WHO) publishes the International Classification of Diseases (ICD) code set, which defines diseases, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. The WHO authorized US adaptation of the code set for government purposes. Currently, the United States uses the ICD code set, Ninth Edition (ICD-9), originally published in 1977, in the following forms: ICD-9-CM (Clinical Modification), used in all health care settings ICD-10 CM jumps from 13,000 to 68,000 diagnosis codes. ICD-9-PCS (Procedure Coding System), in inpatient hospital settings ICD-10 PCS jumps to 87,000 codes 4

5 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? Oct 1, 2014 is here! Now what? It s Nov 1, Now what? ICD-10 resources 5

6 Are you serious? Another change to how we work? Mandated: HIPAA-covered entities required to adopt Payers not able to analyze claims for 30 year old ICD-9 code set is going the way of the dinosaur Utilization Costs + outcomes Outdated medical terminology Resource use No room to add new codes Performance measures Detail and specificity - Anatomical descriptions - Differentiation of risk + severity - Parameters to differentiate disease manifestations - Optimize reimbursement ICD-9 6

7 Another change to how we work? Changes will allow for Better healthcare operations to process and reimburse claims - Streamline payment operations - Increased automation - Minimize provider inquiries - Decrease delays - Reduce denials Updated terminology + disease classifications New code additions 7

8 Another change to how we work? Changes will allow for Improved coding accuracy + specificity - Anatomic site - Etiology - Severity A repository of detailed data - Analyze disease patterns - Respond to heath outbreaks Support of alternative reimbursement models Development of new pricing + reimbursements Improved fraud detection 8

9 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 9

10 Ah, fiddlesticks. ICD-10 is so hyped up. Maybe it won t take that much time. With the 4/1/14 delay, we have plenty of time to prepare Our vendors will handle the transition for us This really only impacts coding, we only need to know new codes The doctors know this is required; they ll do what they need to. External stakeholders will get this right 10

11 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 11

12 ICD-9 vs. ICD-10: What s the diff? ICD-9 vs. ICD-10 CM: Diagnosis Code Comparison Source: ICD-10 Implementation Guide for Small and Medium Practices 12

13 Z89.419: Acquired absence of unspecified great toe ICD-10 Illustrated 2014 all rights reserved 13

14 Y23.1: Hunting rifle discharge, undetermined intent ICD-10 Illustrated 2014 all rights reserved 14

15 W61.62: Struck by duck, sequela ICD-10 Illustrated 2014 all rights reserved 15

16 ICD-10 Coding Example: AAPC External Cause: The falling cabinet caused the injury; description of the cause is required Source: AAPC 16

17 ICD-10 Coding Example: AAPC Activity: Of the patient needs to be documented; activity code only used for the initial encounter Source: AAPC 17

18 ICD-10 Coding Example: AAPC 7 th Character: Injury codes require a 7 th character extender identifying the encounter; documentation must be clear so the correct extender can be applied. Source: AAPC 18

19 ICD-10 Coding Example: AAPC Location: Of patient at time of injury, specifies actual room of the house. Source: AAPC 19

20 ICD-10 Coding Example: AAPC Applied Specificity for Concussion: Must indicate whether or not patient lost consciousness Source: AAPC 20

21 ICD-10 Coding Example: AAPC Relief or No Relief: Intractable vs. not intractable are part of the ICD-10 CM code for headaches and documentation needs to indicate in order to assign proper code. Source: AAPC 21

22 ICD-10 Coding Example: AAPC Acute vs. Chronic: Must be documented part of the patient s condition. Source: AAPC 22

23 What if providers don t meet ICD- 10 documentation requirements? Inadequate documentation = Unspecified coding Unspecified coding = Lack of medical necessity Lack of medical necessity = Denied claims Providers hold the key to ICD-10 success 23

24 Besides project planning, Pop Quiz! Win more funny stuff for ICD-10 what or who is the key to ICD-10 success? 24

25 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 25

26 What will ICD-10 impact? Everything but the kitchen sink. Patient registration: Forms and eligibility using ICD-10 Authorization/pre-certification forms Referral processes + forms Clinical documentation Manuals Superbills Coding productivity Payor relationships: Contracts/reimbursement model changes, business rules for case management, documentation required to support billing Patient hospital encounter + admission scheduling Physician orders: Labs + tests Research participation: Needing ICD-10 for study inclusion Staff: Training + commitment Billing/payment/cash flow 26

27 What will ICD-10 impact? All vendor solutions PM, EMR, Labs, Clearinghouses, HIE, Registries + Immunization, Billing/RCM, EMR: Documentation, forms, templates, interfaces, reports PM: Coding, claims submission, reports Labs: ICD-10 codes for orders and results Clearinghouse: Claim submission requirements HIE, Registries, Immunization: Update codes used for reporting Billing/RCM: Documentation needed for coding; must be using ICD-10; testing critical 27

28 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 28

29 Giddy up! What should you start today? Implement Version 5010 electronic healthcare transactions. Engage providers and staff Create awareness of impact Get buy in Identify project Champions Administrative and clinical Vendor counterparts Perform impact + risk assessment Create a project plan... 29

30 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 30

31 Creating an ICD-10 project plan Basic steps Identify project champions and stakeholders: Internal clinical + administrative and external payor + vendor points of contact Communicate importance of change; get people engaged Perform impact + risk assessment Develop formal project plan Communicate project plan; keep people engaged Execute project tasks Go-live Monitor post-go-live; continue making improvements 31

32 Creating an ICD-10 project plan Identify champions + stakeholders Internal Champions Administrators Clinicians Coding Billing Front desk External Stakeholders Payors PM + EMR software Labs Clearinghouse Billing/RCM company Payors/Health plans HIEs + public health + immunization registries Hospitals 32

33 Creating an ICD-10 project plan Identify milestones + tasks Identify milestones Engage stakeholders Impact + risk assessment Task executions: Multiple planned tasks Testing Training Go-live Post go-live Identify the tasks that need to happen to reach each milestone 33

34 Creating an ICD-10 project plan Perform impact + risk assessment Training Front desk changes Coding + medical terminology Clinical documentation Software + other vendor solutions New processes and procedures Vendor preparation Code set maintenance Coding crosswalk tools Reference tools Clearinghouse integration Interfaces Upgrade timing Testing + training timing Go-live timing Support 34

35 Creating an ICD-10 project plan Perform impact + risk assessment Reimbursement impacts Slowed revenue: Payor readiness, inaccurate submissions Fee-for-service: Increased denials + payment delays Capitation, case-based or ACO payments: Alternate reimbursement definition changes Audits Staff attrition Budget limitations Increase focus on fraud detection Negative impact on payor + patient relations: More back and forth about delays, denials, referrals and authorization rejections 35

36 Creating an ICD-10 project plan Plan to mitigate risks Once you identified your risks Discuss risks with staff Plan for timely resolution strategies Create ways for staff to report issues Establish and communicate decision-making chain 36

37 Creating an ICD-10 project plan Next steps Add a timeline Set a budget Training Consulting Hardware upgrades Add-on tools + services Cover revenue impacts Identify additional funding/cash reserve sources Share the plan with stakeholders Get buy in Refine as needed 37

38 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 38

39 Keep on keepin on. What else should you do before the deadline? Regularly update staff on progress; good and bad Begin training: Provider documentation Begin internal system changes Document changes to policies, procedures, job responsibilities Upgrade software Train on software + internal system changes Train for competencies and skill gaps Tailor training to audience and learning styles Update codes in software 39

40 Keep on keepin on. What else should you do before Oct 1, 2014? Test software + internal systems Everything touching ICD-10 Software + interfaces System performance Test with payors/clearinghouse/billing service Try multiple test cases: High dollar/high risk Try to trigger errors Identify how to prevent errors 40

41 Keep on keepin on. What else should you do before Oct 1, 2014? Ongoing: Staff training Clinical documentation: Start today Coding: Start with high level ICD-10 changes Medical terminology; procedures and anatomy Map over Top 20 ICD-9 codes: GEMs Take advantage of available resources Train on dependencies; how each thing relies on others Train coders: Closest to go-live 41

42 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 42

43 Oct 1, 2014 is here. Now what? Next steps Go-live with ICD-10; put system changes into production Submit claims with date of service prior to 10/1 in ICD-9 Submit claims with date of service on of after 10/1 in ICD-10 Monitor for issues ID + implement process improvements Resolve issues quickly Continue training 43

44 Oct 1, 2014 is here. Now what? Measure success! Internal systems + processes Software usage Clinical documentation Coding practices Reimbursements Claim rejections; expect rejections Claim denials Avoiding fraud scrutiny 44

45 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 45

46 It s 1 month later. Now what? Lather. Rinse. Repeat. Continue measuring success of Internal systems + processes Software usage Clinical documentation Coding practices Reimbursements Claim rejections; expect rejections Claim denials Avoiding fraud scrutiny 46

47 ICD-10 Transition Project Planning Agenda What is ICD-10? Why ICD-10? Realistic expectations Comparing ICD-9 to ICD-10 What will ICD-10 impact? What should you do today? Creating a project plan What else should you do? The ICD-10 deadline is here! Now what? It s after the deadline. Now what? ICD-10 resources 47

48 Goodness! We need help! ICD-10 Resources MicroMD ICD-10 Transition Guide Step-by-step guidance on ICD-10 milestones to prepare your administrative, billing and clinical staff for the transition with MicroMD. What to plan for Timing guidance Contacts Resources + tools Will be updated with new ICD-10 deadlines and available on the MicroMD Lounge for clients continuing to work on their transition plans: ICD-10 Resources folder 48

49 Goodness! We need help! ICD-10 Resources MicroMD PM + EMR Information: CMS: AHIMA (American Health Information Management Association): Workgroup for Electronic Data Interchange (WEDI): AAPC (American Academy of Professional Coders): AAPC Code Translator: FREE Medscape ICD-10 Training Modules through CMS: ailableonicd10.pdf Consulting Resources: Medsys Consulting: NE Ohio practice consulting, or Phone: DoctorsManagement: National complex large practice consulting firm; 10% discount to Henry Schein clients, mention coupon code HS2013; Phone:

50 ICD-10 Transition Project Planning 50

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