Understanding the Impact of ICD 10 on Your Revenue Cycle LHIMA ICD-10 SUMMIT June 18, 2013 Presented by Patty Harper, RHIA AHIMA Approved ICD 10 CM/PCS Trainer Certified EHR Implementation Manager Clinical Workflow and Health Information Resign Specialist 1 Session Objectives To understand: the overall understanding of the facility-wide impact of ICD-10 on the revenue cycle; how to apply these concepts and ideas to overcome challenges and barriers at your facility; the importance of team-building and cooperation during transition and implementation/ 2 Isn t this just about coding? Well... YES and NO! The revenue cycle will be impacted at every juncture where either a diagnosis or a procedure code (or both) touches the encounter or episode of care. But, the facility wide impact reaches far beyond the walls of the HIM department. The overall impact may look differently from facility to facility based on the size of the facility, the organizational chart, and the type of facility. 3 1
Sample Revenue Cycle Registration Collection Provided Denial & Appeal Teamwork & PI Documentation 4 Registration ICD-10 and Patient Access Orders and Requisitions Referring and Admitting Physician Education Staff and Employee Training Medical Necessity More detailed diagnosis probably required; ICD 10 CM required for all environments of care (10/1/2014) LCDs and NCDs Remember that ICD 9 to ICD 10 mapping is not 1:1 Getting the information that we need before or at registration. 5 Provided ICD-10 and Rendering Medical Necessity, Pre-certs, Pre-authorizations, Referrals & Payer Coverage Policies ABNs and Financial Counseling Case Management and Utilization Review es Inpatient vs. Outpatient Coding What services are we providing for the patient and how will our processes change? 6 2
Documentation ICD 10 and Documentation > 5 X the diagnosis codes in ICD 10 CM More specificity required for diagnosis code assignment ICD 10 PCS is entirely new and can result in different inpatient procedure codes for patients with the same major type of operation or intervention. CDI Initiatives Medical Staff Education Chart Auditing as a Gap Analysis now and later as performance improvement. 7 ICD-10 & Need to redesign notes and forms paper and electronic processes to capture needed data elements Order Entry/CPOE (change on top of change) master (CDM) revisions (hard coding, ICD 10 PCS vs. CPT, more charge numbers?) Fee Schedules and Potential Mapping Revisions to respond to payers. (ICD 10, like all coding methodologies, is budget neutral. Sorta) Software updates and maintenance; Vendor Testing. 8 ICD-10 and Code Assignment Abstracting limitations based on need for more specificity Increased Physician Queries More collaboration with other revenue cycle related processes Changes in coding guidelines Potential shifts in MS-DRGs due to sequencing differences. Definitions of CCs and MCCs. Poor documentation may result in reimbursement changes 9 3
Example: Anemia Associated with Malignancy ICD 9 Code anemia as principle when the treatment is only for the anemia; Sequence the malignancy next. ICD 10 Code the malignancy as the firstlisted diagnosis; Sequence the anemia next. 285.22: Anemia in neoplastic disease 201.01: Hodgkin's paragranuloma, lymph nodes of head, face, and neck C81.71: Other Classic Hodgkin s lymphoma, head, face & neck D63.0 : Anemia in neoplastic disease DRG 812 Red blood cell disorders w/o MCC MDC 16 Medical Relative Weight: 0.7872 DRG 842 Lymphoma & non acute leukemia w/o CC/MC MDC 17 Medical Relative Weight: 1.045 10 ICD-10 and ing Increase in DNFB Changes in edits in your hospital information system, clearinghouse and payer systems. Changes in Payer EDI Programming logic working the bugs out! Procedure/Diagnosis Pointing for Outpatient claims Missing or Incomplete Documentation Results in unclean claim Medical Necessity and Coverage Determinations 11 Denial & Appeal ICD 10 & Denials and Appeals Is it a rejection or a denial? What kind of problems will increased specificity potentially bring? Trouble-shooting to resolve the problems and fix the revenue cycle. Team-work, cooperation, and good communication, internally and externally. 12 4
Collection ICD-10 and Reimbursement Monitoring and Auditing Reimbursement Plan for Cash Flow Crunch Reimbursement Analysis Denial Management Increase in A/R Days Tweaking the Revenue Cycle Performance Improvement 13 Sample Revenue Cycle Registration Collection Provided Denial & Appeal Teamwork & PI Documentation 14 Proactively Preparing Teamwork/Task Force Identify All the Stakeholders Analyzing Current Work es and Work Flow (clinical and administratively) GAP Analysis: Current weaknesses/potential weaknesses Education Communication Good relationships with vendors Continuous Performance Improvement 15 5
QUESTIONS/COMMENTS? CONTRACT INFO: PATTY HARPER, RHIA Principal, InQuiseek LLC Business & Healthcare Consulting AHIMA Approved ICD 10 CM/PCS Trainer Certified EHR Implementation Manager Clinical Workflow and Health Information Resign Specialist pharper@inquiseek.com www.inquiseek.com http://www.linkedin.com/pub/patty harper/4/83b/1b7 318 243 2687 16 6