Physician practices’ ICD-10 readiness affects your organization ̶ensure ...schfma.org/PDFs/2014_AI/7_2014_AI_Navicure_ICD10_Presentation_Ken... · To move forward or not with ICD-10

Physician practices’ ICD-10 readiness

affects your organization ̶ ensure

they’re prepared

Presented by Ken Bradley

Agenda

ICD-10: Time to take a pulse

Reasons why practices haven’t prepared

Steps to prepare and how to prioritize them

Tools to include in your outreach programs

How to use collaboration to share knowledge

and reduce costs

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© 2014 Navicure, Inc.

ICD-10: Time to take a pulse

Remember ICD-10?

Must be used by everyone in

all HIPAA transactions:

October 1, 2013

October 1, 2014

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It Isn’t Going Away

HR 4302, the bill to delay SGR a

year and ICD-10 for at least a year

means we will have a new date.

The law doesn’t say ICD-10’s

implementation is repealed, only

that it is delayed.

New ICD-10 deadline is most likely

going to be October 1, 2015

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You Want Your Practices to Be Prepared

Worst Case Scenario

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You Want Your Practices to Be Prepared

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ICD-10 Road?

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Unfortunately, It’s More Like

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And Getting There Requires

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Who, Where, How, When, Why

Diagnosis codes are used everywhere by

everybody

Your entire staff • Administrative and clinical

In nearly all your paper and electronic systems

• A new format must be accepted.

Throughout most business processes • Likely represents changes to nearly all clinical, financial and administrative

processes.

Remember that all people, processes and systems must

be able to accommodate both code sets for some time.

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In Fact, ICD-10 May Be Healthcare’s

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Where Are Your Practices?

ICD-10 is not going to happen!

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Started? Maybe

We’ve started, I think. I’m not really sure.

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Started? Yes

We’ve started and have done some things!

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Finished (So They Think)

We’re done!

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Reasons why practices haven’t prepared

Practice Preparation Status

Navicure’s second national ICD-10

practice readiness survey 74% of respondents hadn’t begun

implementing their ICD-10 transition plan,

but most were confident they would be

prepared by the original October 1, 2014

deadline.

Learn more at: www.navicure.com/surveytwo

MGMA Reported in MGMA Connection April 2014

• Less than 10% of practices reported

significant ICD-10 progress

Learn more at: www.mgma.org

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http://www.navicure.com/surveytwo

http://www.mgma.org/

So Why Aren’t Practices More Prepared?

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Costs

*Nachisom Associates, 2014

• 201

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Typical Small Practice Typical Medium Practice Typical Large Practice

Total 2008 Costs Estimate $83,290 $285,195 $2,728,780

Training $2,700 ‐ $3,000 $4,800 ‐ $7,900 $75,100

Assessment $4,300 ‐ $7,000 $6,535 ‐ $9,600 $19,320

Software Upgrades $0 ‐ $60,000 $0 ‐ $200,000 $0 ‐ $2,000,000

Process Remediation $3,312 ‐ $6,701 $6,211 ‐ $12,990 $14,874 ‐ $31,821

Testing $15,248 ‐ $28,805 $47,906 ‐ $93,098 $428,740 ‐ $880,660

Total Pre-Implementation $25,560 ‐ $105,506 $65,452 ‐ $323,588 $538,034 ‐ $3,006,901

Productivity Loss $8,500 ‐ $20,250 $72,649 to $166,649 $726,487 ‐ $1,666,487

Payment Disruption $22,579 ‐ $100,349 $75,263 ‐ $334,498 $752,630 ‐ $3,344,976

Total Post-Implementation $31,079 ‐ $120,599 $147,912 ‐ $501,147 $1,479,117 ‐ $5,011,463

Total 2014 Costs Estimates $56,639 ‐ $226,105 $213,364 ‐ $824,735 $2,017,151 ‐ $8,018,364

Costs


• 201

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Training $2,700 ‐ $3,000 $4,800 ‐ $7,900 $75,100

Assessment $4,300 ‐ $7,000 $6,535 ‐ $9,600 $19,320



Testing $15,248 ‐ $28,805 $47,906 ‐ $93,098 $428,740 ‐ $880,660






Costs


• 201

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Training $2,700 ‐ $3,000 $4,800 ‐ $7,900 $75,100

Assessment $4,300 ‐ $7,000 $6,535 ‐ $9,600 $19,320



Testing $15,248 ‐ $28,805 $47,906 ‐ $93,098 $428,740 ‐ $880,660






Industry Confusion

Industry infighting

To move forward or not with ICD-10

Implementation date

History of delays

No one could discount the prospect of a delay happening

Difficult to plan with shifting goal dates

Lack of understanding

What ICD-10 is: annual update vs. new coding language

An “IT” project vs. something that requires education and affects all

business processes beyond just software systems

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Vendor Solutions

Vendor response to ICD-10 varied

ICD-10 enhancements separate from MU2

updates

Must know when vendor plans to release

updates.

• Be ready to install and test updates and

train staff

• Provides time to test externally.

• Likely provides improvements to revenue

and /or clinical work-flows.

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Provider Engagement

Problem: getting physicians

engaged

They are busy

They may not understand the

issue and their role

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Solution:

Remind physicians:

• Billing and reimbursement depend on accurate clinical

documentation

• ICD-10 requires more specificity.

• Clinical documentation is the critical first step and everything

downstream depends on it.

Steps to take to prepare for ICD-10 and

how to prioritize them

Question: Why start or continue now?

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Answer: Because it’s a chance to get better at

what we do today and prepare for ICD-10.

Consider

ICD-10 will eventually be necessary

Risky not to plan and begin or continue

Many steps assist other initiatives

Momentum is difficult to restart

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ICD-10 Implementation Steps

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Steps to ICD-10 Success

Have an organizational ICD-10 champion/coordinator.

Have a defined ICD-10 planning team that has a basic

understanding of ICD-10 to account for the scope

and breadth of the effort.

Understand physicians and office staff’s awareness

of and commitment to ICD-10.

Educate physicians and staff

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IT (PMS/EMR, etc) and service vendor outreach

Vendors know about ICD-10?

Communicated update plans, timelines, costs?

Discussed required and enhanced capabilities and services?

Details to know and track for EACH VENDOR:

Updates and documentation availability

Contracts - what's included/not included, when, expiration date

Service level agreements?

Costs and when fees must be paid

training?

Contact information

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Why Update Technology Now?

Do PM system, EMR and other IT updates as they are

available so you can:

• Be an expert on the changes before ICD-10

• Maintain and improve productivity

• Participate in in-depth testing when it’s available

• Work out the kinks

• Work through internal clinical scenarios

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EMR templates can help keep your physicians’

productivity rates from slipping and ensure you

capture the necessary details for ICD-10, quality

and other programs your practices may be

participating in.


Assess clinical documentation for necessary changes

to meet ICD-10’s specificity requirements.

How to start?

Determine most frequently used diagnosis codes by

provider.

Assess whether or not current documentation meets

ICD-10 specificity.

Hint: it very likely does not.

Educate and work with physicians

Start including these details now.

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Why Look At Documentation Now?

Documentation improvement:

Assists with compliance now and with ICD-10

Permits advance review of documentation and

coding for clinical and financial accuracy

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Work with physicians to phase in more

clinical details that ICD-10 requires

Benefit: these details can help ensure

accurate ICD-9 coding and

reimbursement


Prepare a budget.

Account for pre and post transition costs

Consider obtaining a line of credit.

Documented ICD-10 education strategy for all staff

Education is not optional

Must understand:

Who needs to be trained and how/when will education take

place?

Who may need additional education

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Complete a diagnosis inventory

Document describes where, how and who uses diagnosis codes

Administrative and clinical

Front, middle and back office

Electronic and paper, e.g., Superbills, processes

Contracts, quality reporting, public health reporting, spreadsheets

Creators, senders and receivers

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Create the ICD-10 Plan

Review/assess facts and information obtained

Create a list of things that need to be done to be in compliance

For each item identify:

who is responsible

estimated delivery date

interim deliverable and follow-up dates

dependencies

priority

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Why Start Now?

Have time for a thorough review of your

diagnosis discovery processes – may identify

places where improvements can be made prior to

ICD-10.

Lets staff become experts with process

changes and new IT solutions.

Improvements may help your costs and

improve revenue today.

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Project Implementation and Monitoring

Do the things on your action plan

Measure and monitor that what you changed works

as expected.

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Revenue cycle and clinical workflow updates

Improve staff productivity

Automate everywhere you can

Eligibility

Appeals

Review clinical work-flow

Queries, clinical clarification

EMR templates, etc

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Tools to include in your outreach

program (Important- new tools NOW, help NOW)

The ICD-10 implementation steps (hint: we just discussed them)

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ICD-10 Hub (www.icd10hub.com)

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http://www.icd10hub.com/

ICD-10 Analyzer: Start Here

www.navicure.com/icd10analyzer

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ICD-10 Analyzer: Jump Start Your Transition

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ICD-10 Analyzer: Jump Start Your Transition

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Online Coding and Compliance Tools

Be more productive and accurate today.

Will be an expert when ICD-10 arrives.

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Denial Management Solution

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According to

CMS, in the early

stages of ICD-10,

denial rates will

increase by 100

to 200 percent

Use collaboration to share knowledge

and reduce costs

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Use Collaboration to Synergize Efforts

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Benefits of Collaboration

Revenue Cycle Solutions Can Help

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Will We Move Forward, or Not?

We now have more time

Will we do the same things and expect

different results?

Will we work together as an industry and

include everyone in the decision-making

process?

Will we make continuous improvement an

integral part of our day-to-day operations?

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Summary

ICD-10 is going to happen (eventually)

Your practices need to be prepared

They may need your help

Ken Bradley

VP of Strategic Planning

Navicure

[email protected]

Twitter: @Ken_Bradley

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mailto:[email protected]

Documents

Physician practices’ ICD-10 readiness affects your organization ̶ensure ...schfma.org/PDFs/2014_AI/7_2014_AI_Navicure_ICD10_Presentation_Ken... · To move forward or not with ICD-10