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

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ICD-10 Transition Countdown: Ready, Set, Code

Your Complete Strategic Readiness Guide

To download slides: click on Presentation Assets

April 4, 2012

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ICD-10 Transition Countdown: Ready, Set, Code

Your Complete Strategic Readiness Guide

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Today’s Objectives



ICD diagnosis and patient care coding

changes



T

iti

t t

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d t t

i



Transition assessment tools and strategies



Implementation steps, from training to final

evaluation



Success stories and lessons learned from

organizations currently in ICD 10 transition

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Today’s Presenters

Alicia Faust – Director, National ICD 10 Lead

847.413.6969 (office)

312.498.4097 (cell)

Jason Greer

Manager Technology Lead

Jason Greer – Manager, Technology Lead

515.281.9286 (office)

Polling Question One



Where did you hear about this webcast?

M l

l HFMA h

t

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My local HFMA chapter

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McGladrey invitation / contact

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McGladrey website

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Colleague / friend

-

Twitter / Facebook

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Polling Question Two



What type of organization do you represent?

PPS h

it l / h

lth

t

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PPS hospital / health system

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Sole community hospital

-

Critical access hospital

-

City/county hospital

-

Physician clinic

y

-

Association

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Polling Question Three



What role do you hold within your organization?

-

Board of Directors / Strategic Planning

g

-

CEO

-

CFO

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COO/ CIO / CMO

-

Clinical Leadership

-

Patient Financial Services

-

Medical Records / Health Information Management

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Reimbursement

-

Information Technology

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Managed Care / Finance

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Legal Counsel

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ICD 10 Transition: Background



Federal mandate for transition to 5010 software and ICD

10 coding

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Improve patient care

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Improve diagnosis, coding, billing and reimbursement

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Reduce health care cost



Original ICD 10 WEDI timeline shows that providers

should have been approximately 50%+ through their

transition to ICD 10

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Providers should have developed an effective governance

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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 Increase

ICD 9 CM ICD 10 CM and PCS

ICD-9 CM ICD-10 CM and PCS

18 98x 4.85x 68,069 72,589 18.98x 4.85x 14,025 3,824, Diagnosis Procedures

ICD 10 CM: Clinical Modification (diagnosis) – Across all disciplines

ICD 10 PCS P d C di S t ( i l d ) IP l

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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:

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Limited project management resourcesj g

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Formal acknowledgment of the complexities and number of resources, processes and systems impacted by transition

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Associated risks indicate a need in your organization for project management support to drive timely completion

Provider 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 provide analytics 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?

-

Early

Intermediate/mainstream

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Intermediate/mainstream

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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 Planning Implementation 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

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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 between Survey results benchmark consistently between

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Enterprise-Wide Approach

Physician Practices

ICD 10-CM CPT/HCPCS

Emergency Care

ICD 10-CM CPT/HCPCS

Hospital I/P

CPT/HCPCS

Hospital I/P

CPT/HCPCS ICD 10-CM ICD 10PCS

Hospital O/P

ICD 10-CM CPT/HCPCS

Other Ambulatory

ICD 10-CM CPT/HCPCS

Post-Acute

ICD 10-CM CPT/HCPCS

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Enterprise-Wide ICD 10 Risk Areas and

Considerations

Co 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 Considerations Risk 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, education Managed Care / Fi Resources 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 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

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Polling Question Five



Looking at all the risk areas, has your

organization completed a risk based

organization completed a risk-based

assessment for ICD 10?

-

Yes

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Yes

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ICD 10 Translator Technology Screenshots

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ICD 10 Translator Technology Screenshots

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ICD 10 Translator Technology Screenshots

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ICD 10 Translator Technology



Background and platform

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Polling Question Six



Have you conducted any type of code

translation within your organization from ICD

9 to ICD 10?

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Yes

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Polling Question Seven



How much training time has been built into

your ICD 10 project plan to prepare

employed physicians?

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Less than 15 Minutes

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Less than 1 Hour

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Less than 4 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

Strategic Performance 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

Cycle Technology

 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

Learned

y

Managed C Education

- 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 and

Documenta-tion Education

 Coding personnel shortages due to increased

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