ICD-10 and the Impact on Revenue Cycle October 1 2013, was to mark a seismic shift in the healthcare landscape. On this date, the U.S. government was set to retire the more than 30-year-old International Classification of Diseases, 9th Revision (ICD-9) diagnosis coding standard and officially adopt its successor, ICD-10, for ambulatory services and inpatient discharges. While the Department of Health and Human Services recently announced they will be extending this deadline, now is still time to act. While ICD-9 is a limited structure, ICD-10 is expansive, allowing for previously unseen precision in coding, billing, and reimbursement. For instance, rather than processing a simple diagnosis of fracture of forearm, healthcare providers will be able to get as detailed as a torus fracture of lower end of right radius, subsequent encounter for closed fracture with routine healing thanks to ICD-10s alphanumeric language. Being able to chart, measure, and bill against such intricacies will have long-lasting benefits for the healthcare industry, including better patient follow-up, more accurate claims, insight into population health, analytics about panhealthcare system diagnoses, and a decrease in fraud. To get to this coding nirvana, the healthcare industry has to start preparing for ICD-10 now. The cutover will impact critical systems including electronic health records (EHR), billing, encoding, referral management, contract management, and test ordering. Peripheral systems such as decision support, quality management, disease management, clinical trials and protocols, and modeling/trends also must be upgraded to take full advantage of the new coding structure. According to the mandating agency, the Centers for Medicare & Medicaid Services (CMS), the healthcare industry, including physicians, hospitals, insurance providers, and third- party billers, should already have started down the ICD-10 path. CMS published a timeline recommending that the first phase of ICD-10 deploymentassessment and planningbe completed by the second quarter of 2011 and that organizations should now be well into implementation preparations.
<ul><li> 1. READY Ready or Not, Here Comes ICD-10 OR NOT Here Comes ICD-10ICD-10 and the Impact on Revenue Cycle Sponsored By: Sponsored Material </li> <li> 2. Ready or Not, Here Comes ICD-10O ctober 1 2013, was to mark a seismic shift in the healthcare landscape. On this date, the U.S. government was set to retire the more than 30-year-old Interna- tional Classification of Diseases, 9th Revision (ICD-9) diagnosis coding standardand officially adopt its successor, ICD-10, for ambulatory services and inpatient discharg-es. While the Department of Health and Human Services recently announced they will beextending this deadline, now is still time to act. While ICD-9 is a limited structure, ICD-10 is expansive, allowing for previously unseenprecision in coding, billing, and reimbursement. For instance, rather than processing a sim-ple diagnosis of fracture of forearm,healthcare providers will be able to WHAT IS THE STATUS OF ICD-10 PREPARATIONget as detailed as a torus fracture of AT YOUR ORGANIZATION? 56%lower end of right radius, subsequentencounter for closed fracture withroutine healing thanks to ICD-10s 26%alphanumeric language. 16% Being able to chart, measure, and 3%bill against such intricacies will have We are Partway through In discovery/ We have notlong-lasting benefits for the healthcare ready now assessment started yet Base = 242industry, including better patient follow- SOURCE: ICD-10 Puts Revenue at Risk, HealthLeaders Media Intelligence, July 2011up, more accurate claims, insight intopopulation health, analytics about panhealthcare system diagnoses, and a decrease in fraud. To get to this coding nirvana, the healthcare industry has to start preparing for ICD-10 now. The cutover will impact critical systems including electronic health re-cords (EHR), billing, encoding, referral management, contract management, and testordering. Peripheral systems such as decision support, quality management, diseasemanagement, clinical trials and protocols, and modeling/trends also must be upgraded to takefull advantage of the new coding structure. According to the mandating agency, the Centers for Medicare & Medicaid Services (CMS),the healthcare industry, including physicians, hospitals, insurance providers, and third-party billers, should already have started down the ICD-10 path. CMS published a timelinerecommending that the first phase of ICD-10 deploymentassessment and planningbecompleted by the second quarter of 2011 and that organizations should now be well intoimplementation preparations.2 Sponsored Material </li> <li> 3. Ready or Not, Here Comes ICD-10 In reality, most organizations either havent started ICD-10 planning or are in theearly stages. A July 2011 survey on ICD-10 readiness by the HealthLeaders MediaIntelligence Unit found that only about half (56%) were in the discovery/assessment phase.Another 16% reported they hadnt started the ICD-10 migration process. More than a third ofrespondents hadnt come up with a projected cost for the labor, hardware, software,training, consultants, etc., that would be required for ICD-10 compliance. To play catch-up, healthcare companies will have to rely on the expertise of their solutionsproviders. The latest version of Centricity Business from GE Healthcare is a versatilerevenue cycle management solution that is ready to support ICD-10 requirements. Thesoftware is designed to help organizations, which continue to face surging costs for ICD-10and overall healthcare reform, achieve greater profitability and efficiency from the front deskto the billing office. In addition, GE Healthcare has amassed an ICD-10 knowledgebase toassist customers, such as hospital networks, academic medical centers, large practices,and physician billing groups, in adapting to this new environment.Deadline LoomingA look at the calendar shows that the ONCE ICD-10 TAKES EFFECT, DO YOUhealthcare community now has less than ANTICIPATE THAT YOUR ORGANIZATION WILL LOSE REVENUE AS A RESULT?two years to implement one of the mostmajor reforms in its history. And, as theHealthLeaders Media Intelligence surveyrespondents indicated, many haventeven begun preparations. 54% No 46% Yes Though they see the potential, health-care entities face numerous obstaclesin getting ICD-10 off the ground, suchas lack of physician cooperation, staff Base = 242training, funding, payer readiness, and SOURCE: ICD-10 Puts Revenue at Risk, HealthLeaders Media Intelligence, July 2011vendor readiness. Forty-one percent ofrespondents to the survey attributed their organizations lack of ICD-10 readiness to morepressing priorities. If ICD-10 were the only thing going on, it might not seem so challenging. Buthealthcare organizations are under a lot of different, simultaneous pressures, says3 Sponsored Material </li> <li> 4. Ready or Not, Here Comes ICD-10Michael Nolte, vice president and general manager for GE Healthcare IT. Others felt theyhave plenty of time or that the deadline will be extended. Organizations mulling over ICD-10 have balked at the cost. A quarter of respondentsestimated their project costs to be more than $500,000a tough pill to swallow in thesedifficult economic times. Some fear the effect on revenue even more than the project price tag. Forty-six percentanticipate lost revenue from ICD-10. More than 40% expect to suffer losses between 6%and 20%. Almost half predict those losses will drag on from six months to two years. Respondents are concerned about a push to ICD-10 leading to incomplete physiciandocumentation, payers not being ready in time, coding staff mistakes, and other issues. In addition to the financial impact, companies fret over the cultural one. ICD-10 is likelearning a new languageits a completely new way of thinking, suggests Nolte. The complexity of ICD-10 scales with the size of the healthcare system. If youre a singlephysician practice, ICD-10 is pretty straightforward, but a large healthcare organization willhave to do a complete review of their infrastructure, Nolte says. To start, organizations need to assess system and vendor readiness, training needs andfinancial impact, and document any gaps. A majority of survey respondents who indicatedthey completed their assessments (73%) had carried out a review of their system/vendorreadiness. But less than half (48%) had studied the financial impact. Nolte notes that a compli-cating factor of ICD-10 is that it coincides with so many other reforms, such as meaningful use. WHAT DO YOU FORESEE AS YOUR BIGGEST CHALLENGE OR CONCERN IN MEETING ICD-10 READINESS? 1st 2nd 3rd 4th 5th 6th Ranked Ranked Ranked Ranked Ranked Ranked choice choice choice choice choice choice Physician cooperation 34% 33% 11% 9% 9% 4% Staff training 21% 24% 17% 19% 10% 9% Funding 18% 9% 17% 12% 22% 21% Payer readiness 12% 17% 22% 23% 16% 10% Vendor readiness 8% 11% 23% 25% 18% 15% Meeting the deadline 7% 6% 10% 12% 24% 40% Base = 242 SOURCE: ICD-10 Puts Revenue at Risk, HealthLeaders Media Intelligence, July 20114 Sponsored Material </li> <li> 5. Ready or Not, Here Comes ICD-10 ICD-10s Benefits While organizations might be overwhelmed by the timing, cost, and cultural impact of ICD-10, they have to think longer-term. Respondents to the HealthLeaders Media Intelligence survey concede that the new coding system will lead to improvements in evidence-based medicine, long-term healthcare quality, reimbursement, and the strength of their organization as a whole. The ICD-10 project team at one of the countrys leading healthcare systems, Orlando Health in Florida, says ICD-10 will enable the organization to streamline billing and reimburse- ment, track public health, and identify areas for improvement in administrative performance.Inside Orlando Health: ICD-10 PrepOrlando Health has a jump-start on its peers in terms of ICD-10 preparedness. Here are some tipsfrom this pioneering team:n Set up a cross-functional team to steer ICD-10 efforts. Select a subset of employees representing all of the impacted areas, such as coding, scheduling, systems, billing, and physician practices.n Communicate your intent to move to ICD-10 early on. Dont spring an ICD-10 migration on your users. Instead, let them know as soon as you form your team and allow them to have input. Many are aware of the impending cutover and will start to worry if they dont see movement toward ICD-10.n Tune in to the ICD-10 community. Sign up for updates on the standard through the Centers for Medicare & Medicaid Services (www.cms.gov) or through industry groups such as the Healthcare Information and Management Systems Society (www.himss.org).n Make sure your vendor is ICD-10 ready. Vendor readiness is key. Centricity Business has native ICD-10 support and Orlando Health is working with many of their vendors to ensure system readiness.n Understand the roles within your organization. Orlando Health found that there were four primary groups that interacted with codes that had to be prepared for ICD-10. Determining which users will be impacted helps focus limited resources.n Target ICD-10 training based on audience. Understand that physicians might absorb information differently than coders, so adjust your education program accordingly.n Prioritize systems for compliance. Not everything has to be ready on day one, so figure out which applications are connected to reimbursement and make sure they are compliant with ICD-10. 5 Sponsored Material </li> <li> 6. Ready or Not, Here Comes ICD-10 A comprehensive, private, nonprofit healthcare network, Orlando Health has more than 14,000 employees and 2,000 affiliated physicians supporting the regions only Level One Trauma Center for adults and pediatrics; specialty hospitals dedicated to children, women, and babies; and a statutory teaching hospital system. Orlando Health, which considers proper coding critical to its revenue cycle, has bumped up against the limitations of ICD-9. ICD-9 was initially created for statistical tracking purposes and over the years its been used for billing and quality measurement, says Tiffany Harris, inpatient coding manager and a co-lead on the ICD-10 project team at Orlando Health. Harris believes ICD-9s lack of specificity has rendered it obsolete and has made it difficult for organizations like Orlando Health to garner business improvement and insight from coding. Eager to remedy this, Orlando Health has embraced ICD-10 migration. In ICD-10, you can provide greater detail for complex procedures and youre less likely to produce incorrect codes, Harris says. The organization created a high- ly visible, cross-functional team thatIn addition, Orlando Health credits along with Tiffany Harris includesCentricity Business as key element to Jackie Weber, manager of revenuetheir ICD-10 readiness. management training; Kristy Summers, quality assurance manager and is led by project manager Linda Bjorklund. Together, they are responsible for the education, training, policies, processes, corporate communication, and systems assessment necessary for a successful ICD-10 rollout. Weber calls cross-functionality key to an ICD-10 deployment. ICD-10 is not just a systems-based change; its also about processes. We would have serious problems if the project was not aligned with the business, she says. The team recently finished its assessment phase, studying coders, physician practices, and other areas to understand the new standards impact. The early start has enabled them to begin training users and develop an awareness of the benefits of ICD-10 among all employees. For the past two years, Harris has been introducing users to ICD-10 root words and coding conventions via e-mail and the corporate intranet to get them used to the new terminology. The way weve approached this has cut the anxiety level among users, she says. 6 Spons...</li></ul>