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ICD-10 Transition Countdown: Ready, Set, CodeYour Complete Strategic Readiness Guide

To download slides: click on Presentation Assets

April 4, 2012

To download slides: click on Presentation Assetson the left side of your screen

To download slides: click on Presentation Assetson the left side of your screen

ICD-10 Transition Countdown: Ready, Set, CodeYour Complete Strategic Readiness GuideApril 4, 2012

Today’s Objectives

ICD diagnosis and patient care coding changes

T iti t t l d t t i Transition assessment tools and strategies Implementation steps, from training to final

evaluationevaluation Success stories and lessons learned from

organizations currently in ICD 10 transitionorganizations currently in ICD 10 transition

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Today’s Presenters

Alicia Faust – Director, National ICD 10 Lead847.413.6969 (office)847.413.6969 (office)312.498.4097 (cell)alicia.faust@mcgladrey.com

Jason Greer Manager Technology LeadJason Greer – Manager, Technology Lead515.281.9286 (office)jason.greer@mcgladrey.comj g @ g y

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Polling Question One

Where did you hear about this webcast?M l l HFMA h t- My local HFMA chapter

- McGladrey invitation / contact- McGladrey websiteMcGladrey website- Colleague / friend- Twitter / Facebook- Other

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Polling Question Two

What type of organization do you represent?PPS h it l / h lth t- PPS hospital / health system

- Sole community hospital- Critical access hospitalCritical access hospital- City/county hospital- Physician clinicy- Association- Other

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Polling Question Three

What role do you hold within your organization?- Board of Directors / Strategic Planningg g- CEO- CFO- COO/ CIO / CMO- Clinical Leadership- Patient Financial Services- Medical Records / Health Information ManagementMedical Records / Health Information Management- Reimbursement- Information Technology- Managed Care / FinanceManaged Care / Finance- Legal Counsel- Other

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ICD 10 Transition: Background

Federal mandate for transition to 5010 software and ICD 10 coding10 coding- Improve patient care- Improve diagnosis, coding, billing and reimbursement - Reduce health care cost

Original ICD 10 WEDI timeline shows that providers should have been approximately 50%+ through their transition to ICD 10- Providers should have developed an effective governance- Providers should have developed an effective governance

structure, completed planning, performed impact analyses and are in the process of identifying performance opportunities; also, training and education initiatives should be underway shortly

The Centers for Medicare and Medicaid Services (CMS) The Centers for Medicare and Medicaid Services (CMS) original implementation deadline of October 1, 2013 has been delayed. McGladrey continues to advocate to not wait!

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ICD 10: How many codes are affected?

Number of Codes and Size of IncreaseICD 9 CM ICD 10 CM and PCSICD-9 CM ICD-10 CM and PCS

18 98x4.85x

68,069 72,589

18.98x 4.85x

14,0253,824,

Diagnosis Procedures

ICD 10 CM: Clinical Modification (diagnosis) – Across all disciplinesICD 10 PCS P d C di S t ( i l d ) IP l

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ICD 10 PCS: Procedure Coding System (surgical procedures) – IP only

Types of ICD 10 Adopters

Late adopter – Just getting started with some potential internal/external training initiatives; need rapid assessment approach to assist in catching up to standard timelineg p

Intermediate or mainstream adopter – Potentially seeking on-site professional project management resources to lead internal readiness initiatives due to:- Limited project management resourcesj g- Formal acknowledgment of the complexities and number of resources,

processes and systems impacted by transition- Associated risks indicate a need in your organization for project

management support to drive timely completionProvider more than likely needs a rapid assessment scorecard to- Provider more than likely needs a rapid assessment scorecard to determine overall effectiveness

Early adopter – Evaluating/enabling technology-based tools/solutions; designed to provide “advanced,” “real-time” and “ongoing” data analytics of historical and prospective claims that will provideanalytics of historical and prospective claims that will provide measurement of claims coded, billed or grouped by ICD 10, DRG/MSDRG, MDC or other frame of reference/relevance

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Polling Question Four

What type of adopter would you classify your organization?organization?- Early

Intermediate/mainstream- Intermediate/mainstream- Late

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Original WEDI Timeline and Catch-up

Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13

Kick Off *

Organize Implementation Effort

Impact Assessment

Implementation PlanningImplementation Planning Identify and Implement Process Improvements

Training/Education Internal System Design/Development g p

Internal Testing

Vendor Code Deployment

External Testing

Transition/Implementation

Post Go Live

Ti li C t hTi li C t h NN

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Timeline CatchTimeline Catch--up Necessaryup Necessary

Hospital Associations: ICD 10 Survey Results

About 50% of providers responded that they have not started ICD 10 analyses and are considered to be late adopters

Between 10-15% of providers responded that they are in early stages of ICD 10 analyses and are considered to be late adopters

Almost 70% of providers responded that they are behind the WEDI timeline

For those providers who responded that they were “on target,” p p y g ,50% suggested that they were only focusing on I/P issues

Over 60% of providers responded that a rapid assessment would benefit their organizationg

We are finding that most hospitals have been slow to begin ICD 10 transition analyses

Survey results benchmark consistently betweenSurvey results benchmark consistently between associations/counsels across the country

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Enterprise-Wide Approach

Physician PracticesICD 10-CMCPT/HCPCS

Emergency CareICD 10-CM

CPT/HCPCSHospital I/PCPT/HCPCS CPT/HCPCS Hospital I/PICD 10-CMICD 10PCS

Hospital O/PHospital O/PICD 10-CM

CPT/HCPCS

Other AmbulatoryICD 10-CMCPT/HCPCS

Post-AcuteICD 10-CM

CPT/HCPCS

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Enterprise-Wide ICD 10 Risk Areas and ConsiderationsCo s de a o s

GOVERNANCE: Steering committee, sub‐workgroups, project charter, communications plan, issues escalation plan, project management office, ICD 10 l d j l i l d ibl i f

ConsiderationsRisk Areas

MEDICAL RECORDS/HIM:  Number of coders (IP, OP, physicians), current skill levels, credentialing, productivity and accuracy levels, retention, recruitment, out‐sourcing, system coding staff pool, dual coding, clinical documentation improvement, GEM mapping, educationManaged Care / 

FiResources

ICD 10 lead, project plan to include persons responsible, timeframes, milestones and due dates

IT: Systems inventory for hardware and software, clinical and financial applications, interfaces, registries, implementations and upgrades, sunsets and replacements, testing storage and back‐up, dual coding

REVENUE CYCLE: Central billing office and key performance indicators i.e. days in AR, days of unbilled, bad debt write off , insurance 

Finance

Medical Records / 

HIM

IP/OP/Physician

VENDORS: Vendor inventory, contract negotiations, communications, readiness timelines, testing

y , y , ,verification, patient registration, initial denials and denials write offs, etc.

Information Vendors

Governance

/ d h ld

RESOURCES:  Competing objective: EMR and meaningful use, software implementations, upgrades and training, CDI, CPOE, ICD 10, consolidation and integration, daily operations and tasks

DOCS:  IP Hospitalists, OP, physician practices, GEM mapping, clinical documentation improvement, education

Systems

Revenue Cycle

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MANAGED CARE/FINANCE: MCR  and private pay GEM mapping, hold harmless contract provisions ($ neutrality), analysis pre and post ICD 10 (financial impacts), contract negotiation implications i.e. right to audit pre and post impacts, external financial to support operations

Polling Question Five

Looking at all the risk areas, has your organization completed a risk basedorganization completed a risk-based assessment for ICD 10?- Yes- Yes- No

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ICD 10 Translator Technology Screenshots

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ICD 10 Translator Technology Screenshots (continued)( )

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ICD 10 Translator Technology Screenshots (continued)( )

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ICD 10 Translator Technology Screenshots (continued)( )

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ICD 10 Demo

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ICD 10 Translator Technology

Background and platform

Demo

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Polling Question Six

Have you conducted any type of code translation within your organization from ICDtranslation within your organization from ICD 9 to ICD 10?- YesYes- No

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Polling Question Seven

How much training time has been built into your ICD 10 project plan to prepareyour ICD 10 project plan to prepare employed physicians?- Less than 15 MinutesLess than 15 Minutes- Less than 1 Hour- Less than 4 Hours- Less than 8 Hours

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Lessons Learned from Early Adopters: Why is a smooth ICD 10 transition so important?s a s oo C 0 a s o so po a

Decreased payment due to non-compliant physician documentation

I d li i k Increased compliance risk Decreased payment due to unanticipated changes in

commercial, Medicare and Medicaid DRG/MSDRG classifications

Increased denials due to ICD 10-revised/dependent national/local coverage determination policies

Increased A/R due to log-jammed internal/external

Governance

StrategicPerformance

Vendor Analysis

Increased A/R due to log jammed internal/external claims processing operations

Increased claims processing complexities, A/R management challenges due to expected concurrent coding ICD-9/ICD 10 and HIPAA 4010/5010 transmission capabilities due to:

Information system complexities/interdependencies D d di d ti it l di t HIM di

ICD 10 Lessons Revenue

CycleTechnology Decreased coding productivity leading to HIM coding

under-staffing due to significant unplanned learning curve related to:

- Sheer volume of codes increasing- Increased significance of coder

competencies in medical terminology and clinical practice variations

Learnedy

Managed CEducation

- Significant number of complex (combination) codes with scenarios and choices

- Significant number of ICD-9 clusters that now map to single ICD 10 codes

- Significant number of ICD 10 clusters that previously mapped to an ICD-9 code

Coding personnel shortages due to increased

Care

Coding andDocumenta-

tion

Education

Coding personnel shortages due to increased demand for coding

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Questions?

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Thank You!

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Contact Information

Alicia Faust – Director, National ICD 10 Lead847 413 6969 (office)847.413.6969 (office)312.498.4097 (cell)alicia.faust@mcgladrey.comalicia.faust@mcgladrey.com

Jason Greer – Manager Technology LeadJason Greer Manager, Technology Lead515.281.9286 (office)jason.greer@mcgladrey.comjason.greer@mcgladrey.com

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