ICD-10: Anticipate the Impact

The Healthcare Peoplewww.thehealthcarepeople.com

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ICD-10: Anticipate the Impact

Presented by:American Consultants

Linda GerberV.P. Health Information

Technology

Darrell Jones, PMP, ITIL

Director, Health Information Technology

http://www.thehealthcarepeople.com/



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ICD-10 Agenda

• Background• Project Approach• Training• ICD-10 Impacts• Project Management• Readiness



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ICD-10 Background

• ICD-10 must be used for transactions with dates of service/date of discharge on or after October 1, 2014

• ICD-9 will no longer be accepted.• Deadline is firm, no further delays are expected.



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Coding Specificity

X X X X X.ICD-9 ICD-10

X X X X X X X

Category CategoryEtiology, anatomic site, manifestation

Etiology, anatomic site, manifestation

. .Extension

An Example of Structural Change

Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E 1 0 4 0.

Type 1 diabetes mellitus with diabetic mononeuropathy

E 1 0 4 1.

Type 1 diabetes mellitus with diabetic amyotrophy

E 1 0 4 4.

Type 1 diabetes mellitus with other diabetic neurological complication

E 1 0 4 9.

Diabetes mellitus with neurological manifestations type 1 not stated as

uncontrolled

2 5 0 6. 1

An Example of One ICD-9 code being Represented by Multiple ICD-10 Codes

One ICD-9 code is

represented by multiple

ICD-10 codes



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Project Approach

• Governance Structure is required.• ICD-10 Implementation is a project, there’s a deadline.• Needs Executive-Level Sponsorship & Leadership

o CEO, CFO, COO

• Needs input from many different sources.o Physicians, Vendors, Payers, etc…

• A path to Go-Live• Create your Implementation Plan



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Executive SponsorExecutive Steering Committee

CEO, CFO, CIO, CNO, CMIO, HR, IT, HIMICD-10 Program

Manager

Education

Physicians

Coders & Billers CDI Revenue

Cycle HIM

Governance Structure

ICD-10 Core team

Work Groups

Work Groups

Work Groups



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Path to Go-Live

Secure Budget, Impact Assessment, Gap Analysis

Establish Steering Committee & Project Program

System Design & Remediation External Partner Testing

Training – Coders & Physicians Operational Readiness Testing

October 1st, 2014 GO-LIVE



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ICD-10 Implementation Plan

Assess Plan Remediate Optimize

· Exec sponsors/stakeholders

· Coding Assessment· Documentation review· Organizational readiness· Contract analysis· IT product inventory· Vendor readiness· Process readiness· Risk assessment· Roadmap assessment· Budget assessment

· Exec sponsors/stakeholders

· Establish steering committee

· Establish PMO· Program Planning· Budget planning· Establish structure· Establish

communications & reporting

· Establish change mgmt.

· Application/Interface· Workflow· Payer

· Vendor coordination· Upgrade/Modify/replace· Testing· Coder education· Staff education· System training· Contract changes· Sensitivity analysis· Parallel Coding· Go-live planning· Go-live support· Change mgmt. &

awareness· Risk management

· Managing adoption· Reporting & analysis· AR/DNFB· Claims analysis· Process audits· Coding audits· Documentation

updates· Systems Monitoring· Vendor support· Go-live support· Program closure

ICD-10 Organization Wide Education

Formal Training—Provider, Coding, Clinical Documentation, etc...

On-going Sustainment training



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Who needs to be trained?

Administrative – Basic trainingRegistration, Schedulers, Office Managers

Non-Physician Clinician – Moderate training

PAs, Nurses, Lab, Radiology, Support Personnel

Physician – Training by specialty or codes

Family, Specialty, SurgeonsCoder/Billing – In-depth code training



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• Train coding professionals in high risk areas first.• Highest volume codes and codes with largest revenue impact.• Code areas with the most changes (e.g. diabetes).• Conduct training needs analysis, only train on codes

practitioners will use.• Train your best coders first and early. They will become super coders to help you train the rest.• Plan several shorter training sessions over time rather than marathon training sessions.• If, however, your staff prefers workshop style training, then plan “review” sessions to reinforce learning over time.

Training TimelineBreak it down



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Number of training hours needed:

• The Medical Group Management Association recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff

• Average Costs of training per doctor or coder = Provider and staff education and training, estimated between $500 to $2500 per individual.

ICD-10 Training



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We all know ICD-10 impacts clinical documentation and coding, but what is the impact to your organization?

ICD-10 Impact



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Impact Types

Impact

Types

Technology

People

Financial

Process



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• System upgrades, replacements, testing, and go-live

• Vendor readiness and management

• Potential clinical department workflow process changes

• Clinical Documentation changes

• Interface development and testing

Technology Impact



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Clinical Processes• Documentation• Training• Code Review

Revenue Cycle• Coding• Billing• Denials• Customer Service

Information Systems• System Upgrades• Reporting• Testing• Vendor

Management• Project

Management

Processes Impact



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•Documentation: The need for specificity dramatically increases by requiring laterality, stages of healing, weeks in pregnancy, episodes of care, and much more.

•Code Training: Code increases from 17,000 to 140,000. Physicians must be trained.

•Code Review: A practice of using coders to review physician diagnosis’ can drastically improve your denials and reimbursement.

People ImpactPhysicians



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• Patient Coverage: Health plan policies, payment limitations, and new ABN forms.

• Superbills: Revisions required and paper super-bills may be impossible.

• ABNs: Health plans will revise all policies linked to LCDs or NCDs, etc., ABN forms must be reformatted, and patients will require education.

People ImpactClinical



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• New Policies and Procedures: Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRI must be revised.

• Vendors and Payer Contracts: All contracts must be evaluated and updated.

• Budgets: Changes to software, training, new contracts, and new paperwork will have to be paid for.

• Training Plan: Everyone in the practice will need training on the changes.

People ImpactManagers



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•Policies and Procedures: All payer reimbursement policies may be revised.

•Training: Billing department must be trained on new policies and procedures and the ICD-10-CM code set.

People ImpactBilling



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•Code Set: Codes will increase from 17,000 to 140,000. As a result, code books and styles will completely change.

•Clinical Knowledge: More detailed knowledge of anatomy and medical terminology will be required with increased specificity and more codes.

•Concurrent Use: Coders may need to use ICD-9- CM and ICD-10-CM concurrently

People ImpactCoding



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•Systems: Updates to systems may impact patient encounters. Testing of interfaces and documentation will take time away from operational work.

•Vendor Management: Projects should be underway to upgrade outdated systems.

•Project Management: Competing priorities with other projects, e.g. Meaningful Use

People ImpactTechnology



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• An Increase in Discharged Not Final Bill (DNFB) as more claims will be denied with the lack of specificity of codes.

• Productivity in the Coding and Billing Departments will decrease during the adjustment to the new codes sets.

• Beyond Coding and Billing, a decrease in productivity will occur for anyone else involved in coding: Physicians, Revenue Cycle, Case Management, Clinical Documentation. NEED TO GET SPECIFICS - unspecified means unpaid!

• Payers and Vendors will also experience delays since they are going through this same transition for the first time.

• Dual coding will bring a need for additional coders, as the work load will be doubled.

• Payer contract management & Payer readiness

Financial Impact



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• Many IT systems will have to be updated, upgraded, or replaced.

• The transition will bring new Workflows that will need to be monitored, adjusted, and documented. Think continuous improvement

• Many reporting systems will need to be adjusted or replaced.• Backfilling for work hours used for employee training. A good

percentage of the employees will need to complete some level of education.

• Backfilling for Physician training will be difficult, which will have a direct effect on patient volumes.

Financial ImpactCont.



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Identify processes, people and technology gaps between the current state and desired target state:•Work flow issues•System Issues•Revenue Cycle/Charge Master•Other issues that were not evident

Gap Analysis



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• Develop roadmap / work plan that includes all tasks required to ensure all people, processes, training, and technology are ICD-10 ready.

• Plan for modifying systems to accommodate code structure in all functional systems.

• Plan for modifying business process to manage revised components of the value chain.

• Determine approach and timing for updating analytics and reporting to support effort.

• Plan for testing, go-live, and contingencies.

Roadmap / Work Plans



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ImplementationTimeline

ICD-10 Area AMA Recommended Actual

Impact Analysis 3-6 Months 1-3 WeeksAssess Vendors readiness 2-3 Months 1 MonthAssess Payers, Billing Service, and Clearinghouse readiness 2-3 Months 1 MonthInstallation of Vendor Upgrades 3-6 Months 2 MonthsInternal Testing 2-3 Months 2-3

MonthsUpdate Internal Processes 4-6 Months 2-3

MonthsFormal Staff Training 4-6 Months 4-6

MonthsExternal Testing with Clearinghouses, Billing Service, and Payers 6-9 Months 4-6

MonthsICD-10 Go live: October 1, 2014



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ReadinessAre you ready?



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Readiness:Assessment Areas

Operations Financial External

Revenue CycleClinical DocumentationCodingClinical OperationsHuman ResourcesAdministrationMarketingCredentialingCompliance

BudgetingReimbursementManaged Care ContractingA/R Management and Cash FlowDNFB ManagementReporting and PlanningResearch and Intellectual Property

PatientsPhysiciansPayorsOutsourced SolutionsTrading Partners Outsourced Operations Coders ClearinghousesSolution Vendors



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• What applications, databases, interoperability feeds, and reporting are impacted by ICD-10?

• Are your people/process/technology analyzed and assessed?

• Will the ICD-10 change be vendor-supported or require in-house changes?

• For vendor-supported systems, is there an acceptable upgrade/remediation path, or will the systems need to be replaced?

Readiness:Internal



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• What are the vendor-related and internal actions required to prepare for and conduct the migration?

• What is the estimated timeline, level of effort and anticipated costs?

• What staffing resources are needed to support multiple replacements/upgrades?

• How will the IT department sequence system replacements/upgrades and conduct unit and integration testing?

Readiness:Vendors



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• When can you begin testing ICD-10 transactions? When will your clearinghouses/billing services, payers begin testing?

• Do they have any upgrades that need to be completed?• Are your payer contract negotiations/medical policies

completed to accommodate the ICD-10 code set?Ask them about:

• Review, auditing, coverage, and medical policy changes• Impact on coverage decisions and reporting requirements

Readiness:External Partners

This phase can take 2-3 months to complete and needs to be completed

during the assessment phaseEspecially if you start late!



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• Evaluate the options for implementation and compliance.• Focus on competitive advantage and strategic imperatives to

support evaluation.• Select future-state solution that best meets the objectives and

constraints.• Develop more detail on the technology, operations and people

impacts of the solution.• Include a bucket for unplanned hurdles in the budget (10% of

budget).

Technology Alternatives

Be prepared to change direction if needed:



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Q & A


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Play Offense not Defense – Start Now

Let us help you determine your game plan





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Contact Information

AMERICAN CONSULTANTS ~ ICD-10 Informationhttp://www.thehealthcarepeople.com/health-information-technology/icd-10-transition/

Darrell Jones, PMP, ITILDirector, Health Information Technology (O) 866-319-6795(C) 303-956-5716

Linda GerberV.P., Health Information Technology(O) 866-319-6795(C) 913-515-0290


http://www.thehealthcarepeople.com/health-information-technology/icd-10-transition/



Documents

ICD-10: Anticipate the Impact