Five Things to Jump Start Your ICD-10 Transition. Denny Flint Complete Practice Resources Prepared for Availity

Transcription

1 Five Things to Jump Start Your ICD-10 Transition Denny Flint Complete Practice Resources Prepared for Availity

2 Important note The information in this handout may not match exactly to what you see during the webinar. There is some additional information that was added to the handout for your convenience and future reference.

3 Project News Introduction WEDI feedback, Texas/Tennessee Road Shows Payers will be ready - Testing? View from the road Uncertainty, Paralysis and Inactivity DHHS/CMS: ICD-10 WILL happen What we ve learned IT S JUST A PROJECT YOU CAN DO THIS!

4 A sane, measured and phased approach 1. Engaging and educating Physicians and Staff 2. Organizing your implementation effort 3. Creating your Timeline and Transition Plan 4. Implementing your Transition Plan 5. Post Transition Analysis and Reporting Most practices are in Phase 1 (CMS timeline?)

5 5 things to jump start your transition 1. Convert your top 20 ICD-9 codes 2. Create Documentation training aids 3. Perform simple chart reviews 4. Collect answers to key vendor and payer questions 5. Develop an overall project strategy that creates deadlines and accountabilities

6 A Virtual Implementation Did I mention It s just a project. You can do this! The real challenge is marshaling all the moving parts! The earmarks of a successful project: Organize a methodical, systematic approach Deadlines and Accountability are key Plan and Budget as you go Here s every step you ll need to achieve a successful ICD-10 transition

7 Providers are the cornerstone for ICD-10 Success 1. Convert your top 20 codes to ICD Capture the additional documentation elements 3. Create documentation tools 4. Asthma Example

8 3 Ways to conduct the ICD-10 Project 1. Manually (Do it yourself) 2. Consulting 3. Implementation Software

9 Components of Phase 1

10 Engaging & Educating Providers & Staff Securing buy-in from providers is the cornerstone to ICD-10 success Every member of the team needs to understand what ICD-10 is and how it will impact their job The team needs to understand the legislative mandate, ICD-10 general code structure, the importance of provider documentation, and relevant areas of impact

11 Components of Phase 2 Selecting an Executive Sponsor Selecting a Project Team Creating a Project Charter Creating a Communication Plan Conducting an Organizational Survey Chart Reviews Conducting an Impact Assessment

12 Selecting an Executive Sponsor The executive sponsor should be a top level administrator within your organization Their role will be to - Act as a vocal and visible backer for the project - Provide support to the project manager and team - Legitimize goals and objectives - Stay well informed about major activities - Remove obstacles that impede progress - Approve the project scope and associated changes

13 Selecting a Project Team You need a knowledgeable ICD-10 Project Manager Your project committee should represent one person from each of the following areas - Management - Medical records - Coding/compliance - Billing/revenue - Physicians/clinical staff - Administrative - Information Technology

14 The Project Committee Some project committee tasks will include: Attend the project committee meetings Develop assessment and implementation goals and provide cross-functional support and decisions for the project Develop tasks and associated timelines Assign responsibility and monitor task completion Oversee systems testing

15 Creating a Project Charter The purpose of the project charter is to have written goals, objectives, and responsibilities The project charter outlines: - The project manager and team members - Awareness and clear direction for the implementation - Identification of key stakeholders - Readiness plan for claims submission

16 Creating a Communication Plan The communication plan outlines: What information to communicate Who should get the information When the information should be made available How the information should be presented Possible communication gaps and FAQ

17 Monitoring Deadlines and Accountability are key!

18 Use a Calendar

19 Components of an Organizational Survey Identify internal stakeholders Identify external stakeholders Approach strategy Documentation improvement strategy In-house software assessment Training plan strategy Budget strategy

20 Stakeholders Your internal stakeholders are everyone in your organization that will be affected by ICD-10 Your external stakeholders are all your associated organizations that will be impacted by ICD-10 The toolkit auto-populates all your staff and users.

21 External Stakeholders Examples of your external stakeholders are: Software systems (PM/EHR/Other) Clearinghouses Coding & billing services Health plans Referring physicians/diagnostics Federal/State/local registries

22 Approach Strategy You can take a comprehensive approach that encompasses changes in business processes and workflow to take full advantage of ICD-10 You can take a minimalist approach that simply allows you to implement the ICD-10 code set We recommend a comprehensive approach.

23 Documentation Improvement Strategy The success of your ICD-10 Transition depends on providers documentation. Providers need to be given tools and education that illustrate the new documentation elements. It is also key to perform chart reviews and give providers examples that engage them in the ICD-10 process.

24 Training Plan Strategy A well trained staff is important for the success of your transition. Early on, you need to determine: - Who in your staff needs to be trained - What they need to be trained on - When they need to be trained The training plan you develop later will be heavily dependent on your budget.

25 Chart Reviews Steps to performing chart reviews: 1. Convert your most commonly used diagnoses codes 2. Find charts that reflect your top codes 3. Review the charts for documentation shortfalls 4. Create a report card 5. Create education and training tools to learn documentation where appropriate

26 Plan for conducting chart reviews You can run reports on frequent diagnoses and ICD-9 codes in an EHR. If you are paper-based, this must be done manually. Determine how many codes and how many charts per provider your practice has bandwidth to review. Record your findings and create educational materials to address documentation shortfalls. Consider WHO will conduct chart reviews and WHEN they will be done. Plan to continually monitor problem areas.

27 A sample chart review

28 Chart Review Results Use the Toolkit s automatically generated report card (shown below) or a manual tracking template to analyze your chart review results.

29

30

31

32

33

34

35 Impact Assessment Conduct an impact assessment that analyzes issues, obstacles, options, and costs associated with ICD-10 implementation success. Every place that an ICD-9 code touches your practice will be an ICD-10 impact area.

36 Impact Areas EHR customization Clinical decision support Superbills/encounter forms Order entry Referrals Federal/State/local registries Patient registration Authorizations Scheduling Reporting Claims submission/claims denial management Coding/compliance Software Health plans Others?

37 Impact Considerations Where does ICD-10 impact your organization? How does ICD-10 impact each area? How will you handle each area of impact? Impacts can be POSTITIVE or NEGATIVE depending on how they are handled.

38 Questions for Payers BY WHEN will you be ready for ICD-10? BY WHEN will you be ready for testing? Will ICD-10 cause significant enough changes that we will have to renegotiate our contracts? Will you use a GEMs crosswalk or a custom form of ICD-10 mapping? What is your approach for reimbursement? Will there be any changes to payments made based on diagnosis?

39 Hardware/Software Talk to your vendors about Accommodation of ICD-10 codes Maintaining dual coding capabilities Their implementation plan- BY WHEN will they be ready for testing? BY WHEN will they be ready for ICD-10? The cost of system upgrades If you have capable hardware Any customization you have/think you will need

40 Budgeting- Impact Assessment Begin estimating the cost for each of your impact areas. Make sure to budget both money and time.

41 Components of Phase 3

42 Training: WHO? FIRST, identify everyone in your staff whose duties are impacted by diagnosis codes. Consider ROLE BASED TRAINING not everyone needs the same ICD-10 training Training suggestions (from AHIMA): hours for providers (6 hours to learn fundamentals, 4 to practice applying ICD-10 codes) - 16 hours for outpatient coders hours for other staff

43 Training: WHAT? Different staff will require different training, especially depending on their ROLE in the organization. This is an organization wide commitment For example, provider documentation should be periodically reviewed from now through implementation, and they should be given the necessary educational tools in order to improve their documentation.

44 Recommended Training Tasks Some of the tasks to consider: Refreshing A & P skills Understanding the fundamentals of ICD-10 Identifying specialty specific documentation requirements Understanding specialty coding Implementing clinical documentation practices Creating your ICD-10 resources Using coding skills/other testing

45 Reviewing Budget Keep track of your budget in real time. It can easily become one of the most challenging components of the transition, and financing could be an obstacle.

46 Budgeting Considerations Technology (PM software, EHR, hardware) Resource materials Consulting Training Printing hard paper items Loss of productivity Drop in revenue

47 Reviewing Budget

48 Components of Phase 4

49 Remember the 5 phased approach? If you successfully complete Phase 1, you will have the knowledge and commitment you need for phase 2. Once you complete Phase 2, you will have thorough information to use for Phase 3. Once you complete Phase 3, Phase 4 (IMPLEMENTATION!) will simply be a matter of following your plan.

50 Implement Training Plan

51 Components of Phase 5

52 Monitor Revenue by Payer

53 Monitor Revenue by Payer

54 Monitor Provider Productivity & Revenue

55 Monitor Expense Line Items Suggested Expense Line Items for tracking: Staff Payroll (admin) Staff Payroll (clinical) Outside Services IT Services Other

56 Monitor Denial Reports Consider the following reasons for claims denials: Medical necessity Timely filing Policy limitations/guidelines Lack of authorization/non Participating Physician/Medical Provider billed claim incorrectly Prescription drug related Usual and Customary/Out of Network Health Plan processed claim incorrectly Request for Medical Records Missing or Invalid codes

57 Recap: 5 things to jump start your project 1. Convert your top 20 ICD-9 codes 2. Create Documentation training aids 3. Perform simple chart reviews 4. Collect answers to key vendor and payer questions 5. Develop an overall project strategy that creates deadlines and accountabilities

58 3 ways to accomplish the project On your own Organize and update numerous spreadsheets, calendars, s, questions to ask, tasks and milestones to create, manual chart review, and post implementation monitoring Outside Consulting help not optimal depending on size and financial resources The Complete ICD-10 Implementation Solution Easy, affordable, and comprehensive Contains everything you need to achieve ICD-10 transition success

59 The Complete ICD-10 Implementation Solution $499 (Special Availity Pricing) Includes the project management component for 1 provider and up to 5 users (One time fee) Additional blocks of 1 provider/5 user licenses can be purchased for $49 per block Includes 2 licenses for the web-based translation component (annual renewal at $129 each) Additional translation licenses can be purchased for $129 each To purchase: Please visit Or call:

60 Questions? Denny Flint Complete Practice Resources ext