A Guide to Education and Training for ICD-10 Implementation

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A Guide to Education

and Training for ICD-10

Implementation

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Chapter One: Phases of implementation

Chapter Two: Timelines for implementation

Chapter Three: Recommended education from Elsevier Part One: Content and descriptions

Part Two: Recommended education by type of learner

Part Three: Recommended education timeline based on need

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With the 2013 implementation date for ICD-10 drawing closer, all healthcare organizations are facing new challenges. How you prepare for these challenges will dramatically impact the ease and success of your transition.

There are many benefits to the adoption of ICD-10 in the United States, including improvements in patient outcomes and quality measures reporting; revenue cycle analytics and associated reimbursement; better data for research; and consistency with international coding systems.

But improvements require change – and change leads to uncertainty. And uncertainty only adds to the burden of preparing for future requirements while maintaining current workflow.

There are solutions, however.

Elsevier has developed a phased, comprehensive ICD-10 transition plan that will position your organization for a smooth implementation – allowing you to reap the benefits of ICD-10, while minimizing the pain.

Introduction

Copyright ©2011 Elsevier, Inc. All rights reserved. Details provided in this document are for information purposes only and, unless specifically agreed to the contrary by Elsevier in writing, are not part of any order or contract.

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Chapter One:

Phases of implementation

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PHASE ONE – Impact Assessment (Evaluation)

• Obtain executive sponsorship • Assemble an implementation team

• Identify stakeholders and their unique needs • Perform GAP analysis of staff and systems - workflow analysis

- data flow analysis - workforce analysis

• Assess clinician and code set user knowledge • Budget for resource and system needs

Elsevier solutions

> ICD-10 Readiness Assessment

> EduCode ICD-10 Essentials

> ICD-10 Webinar Series

> ICD-10 White Papers

PHASE TWO – Identify Challenges and Planning Solutions (Planning)

• Budget and plan for stakeholder education • Develop communication plans

• Define coding education plans

• Provide fundamental education of coding and CDI professionals • Offer introductory ICD-10 courses for trainers

• Implement information systems changes

• Assess documentation practices and begin documentation improvement efforts

Elsevier solutions

> EduCode Documentation Improvement curriculum

> Mosby’s Medical Terminology

> Mosby’s Human Body Essentials (Anatomy & Physiology, Pathophysiology)

> GEMS and Introduction to ICD-10-CM/PCS Courses (2011 release date)

> White Papers such as Two Years and Counting – Where You Should Be in Your Transition Plan; General Equivalence Mappings (GEMS); A Guide to Preparatory ICD-10 Training with appendix.

> 2011 Webinar Series

Phases of implementation

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Elsevier views the transition to ICD-10 as a longitudinal educational process. The phases identified below may OVERLAP and may be undertaken at different times by different departments/stakeholders based on unique needs.

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PHASE THREE – Go Live Preparation (Action)

• Coordinate educational needs with meaningful use, quality measures, patient outcomes, and clinical decision support requirements

• Finalization and testing of systems changes • Intensive education

• Monitoring coding accuracy and reimbursement impact

• Assess payer readiness and model revenue impact - prepare for more appeals • Implement comprehensive evaluation to understand quality measures • Policy development, trending and projection analysis;

change of billing records and templates

Elsevier solutions

> Introductory and specialty-specific ICD-10 content

> General Equivalence Mappings (GEMS) Courses

> EduCode Clinical Documentation Improvement

> EduCode Reimbursement Essentials

> Mosby’s Medical Terminology

> Mosby’s Human Body Essentials (Anatomy & Physiology, Pathophysiology)

> Continuation of webinar and white paper series

PHASE FOUR – Measurement and Milestones (Management)

• Set milestones for each action item and monitor for compliance

• Measure coding accuracy and productivity and effect on reimbursement,

e.g. Case Mix Index, reimbursement, assignment of MS-DRGs with and without MCCs/CCs • Perform parallel reporting and comparison of historical data

• Monitor documentation improvement and effects of data use, e.g. patient outcomes • Continue coding education and documentation education

Elsevier solutions

> Competencies used to evaluate knowledge, skills, and ROI > ICD-10 Coding education with associated reporting

> Clinical Documentation Improvement with associated reporting > EduCode Reimbursement Essentials with associated reporting > Webinar and white paper series

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Phases of implementation

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Chapter Two:

Timelines for implementation

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Timelines for implementation

As the 2013 implementation date for ICD-10 draws closer, healthcare organizations are facing new and numerous challenges. Not only must they prepare for one of the most impactful changes in healthcare in 30 years, but they must do so with minimal disruption to current operations, workflow and revenue. In addition, there’s a lot at stake, as failure to adequately prepare could have serious data quality and economic consequences.

Along the pathway of the ICD-10 transition, there are concerns that will arise and need to be addressed, including:

Short-term concerns:

awareness of ICD-10 and meaningful use requirements; response

to external fraud and abuse audits, such as RAC, and gear-up for more intensive fraud audits; system migration to 5010 ; GAP analysis of staff competency

Mid-term concerns:

planning and implementation of ICD-10 training; ensuring EHRs meet phase I and phase II meaningful use criteria; correlation of ICD-10, quality measure reporting, meaningful use, and Value-Based initiatives; mapping of data from ICD-9-CM to ICD-10 (data base conversion); standardizing documentation and data for future Health Information Exchange

Long-term concerns:

confidence that all staff have sufficient education on ICD-10-CM/PCS; understanding the impact of ICD-10 on reimbursement; quality outcomes and how they drive the new model of consolidated healthcare; Health Information Exchange

Important Dates:

> January 1, 2011 – begin testing 5010 with trading partners

> October 1, 2011 – ICD-9/10 code freeze – last regular updates to ICD-9-CM and ICD-10-CM/PCS

> January 1, 2012 – full compliance with 5010

> October 1, 2012 – limited code updates for new technologies and diseases

> October 1, 2013 – limited code updates for new technologies and diseases

> October 1, 2013 – ICD-10-CM/PCS is effective

> October 1, 2014 – regular updates to ICD-10-CM/PCS begin

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Chapter Three:

Recommended education from Elsevier

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Recommended education from Elsevier

3

To help your organization address the wide range of challenges it may face during the transition to ICD-10, Elsevier has created comprehensive solutions to meet your specific education needs.

On average, it takes one hour to complete each Elsevier lesson. This includes reading all screens and sub screens of content, completing interactive knowledge checks, viewing slide shows or animations and completing lesson post tests. Continuing education credit is applicable to all content that promotes learning, including knowledge checks that provide rationale, but excluding tests.

Recommendations within this document are meant as a guide only, recognizing that organizations will modify their educational plans to meet their individual requirements. Education is evolving and some titles of content are considered “draft.”

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3.1

Part 1:

Content and descriptions

ICD-10 Readiness

Assessment and white paper with appendix “A Guide to ICD-10 Preparatory Training”

General Equivalence Mapping (GEMS)

Mosby’s Basic Medical Terminology

Medical Terminology Plus

Tools to aid with GAP analysis of fundamental knowledge needs for ICD-10

Provides an overview of General Equivalence Map-pings and Reimbursement Mappings. Explains how to interpret the data, the dos and don’ts of using GEMS, and helps the learner to develop their own applied mappings. The Basic Medical

Terminology course allows learners to develop an understanding of basic medical word structure and medical abbreviations. Audio teaches learners how to correctly pronounce terms. Medical Terminology Plus enhances information pro-vided in the basic med term course plus provides in-depth training for specific body systems.

1 ½-2 hours

4 hours to complete course

95 lessons – 15 min/lesson

Curriculum/Course Need Met by Content Estimated Time

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Part 1:

Content and descriptions

(continued)

Mosby’s Anatomy & Physiology for Health Professions

Mosby’s Pathophysiology for Health Professionals

EduCode Clinical Documentation Improvement:

Documentation for Clinicians*

EduCode Clinical Documentation

Improvement: Standards and Guidelines

An extensive online course de-signed to teach human anatomy and physiology by specialty. The course also can be used as a re-fresher for nursing and allied health professionals returning to practice. An extensive online course designed to teach human anatomy and physiology by specialty. The course also can be used as a re-fresher for nursing and allied health professionals returning to practice. This course is designed to help providers identify critical documen-tation requirements based on settings and the type of service provided. Standardized terminol-ogy is presented, e.g. ICD-10-PCS terms. Activities such as correcting entries, identifying present on ad-mission conditions, differentiating between observation and inpa-tient admission, and documenting medical necessity are covered. The focus is on documentation, not coding or reimbursement. This course is designed for CDI specialists, HIM professionals, Qual-ity Improvement and Compliance staff responsible for overseeing coding, documentation improve-ment and compliance functions. This course helps learners identify regulatory requirements surround-ing documentation. Highlighted are efforts associated with docu-menting quality measures, seeking clarification through a physician query process, meeting Joint Commission and COP completion standards, and review of documen-tation requirements for evaluation and management services.

26 lessons (7 systems) – each specialty approx 2 hours to complete

26 lessons – each lesson ap-prox ½ hour to complete

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Part 1:

Content and descriptions

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EduCode Clinical Documentation Improvement:

Documentation Topics for CDI and Coding Specialists

EduCode ICD-10 Essentials: ICD-10-CM Diagnosis Coding Fundamentals

EduCode ICD-10 Essentials: ICD-10-PCS Procedure Coding Fundamentals

This course highlights highly visible, difficult to document, highly scrutinized, high-cost, high-volume conditions that pose documentation challenges to the practitioner and coder. This con-tent will help learners understand the clinical presentation, treatment and associated terminology for conditions, while comparing and reconciling clinical terminology with classification terminology. Documentation for conditions impacted most by ICD-10 and national audits are included. The ICD-10-CM Diagnosis Coding Fundamentals course is comprised of 21 lessons that provide an overview of ICD-10-CM diagnosis coding including the philosophy and functionality of the system. This course is designed to teach differences and similarities

between ICD-9-CM and ICD-10-CM involving characteristics, conven-tions, structure, format, and core knowledge needed for coding with ICD-10. These lessons explain the application of ICD-10-CM codes for patients seen in the hospital as well as in physician offices and other outpatient settings. The les-sons are organized by body system as seen in the code book itself. The ICD-10-PCS Procedural Coding Fundamentals course consists of 5 lessons that provide an overview of the structure, characteristics and application of medical, surgical and ancillary services. Learners will gain an understanding of the (draft) ICD-10-PCS coding guide-lines as well. This content takes a first look at comparing the differ-ent coding systems and highlights major changes that learners will need to understand.

16 lessons, each about 1 hour long

Approximately 20 hours to complete course

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Part 1:

Content and descriptions

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EduCode Coding:

Introduction to ICD-10-CM Diagnosis Coding for Inpatients

EduCode Coding:

Introduction to ICD-10-PCS Procedure Coding for Inpatients

EduCode Coding:

Introduction to ICD-10-CM Diagnosis Coding for Outpatients

EduCode Coding: ICD-10-CM/PCS Specialty Overview*

This introductory course offers basic education on using the ICD-10-CM diagnosis coding sys-tem. This is the first step in actu-ally learning how to apply coding system guidelines and conven-tions to assign diagnosis codes for inpatients, following the direction of ICD-10-CM Official Guidelines for

Coding and Reporting.

This introductory course offers basic education on using the ICD-10-PCS inpatient procedure coding system. This is the first step in actually learning how to apply procedure codes for inpatients using standard terminology, fol-lowing the direction of ICD-10-PCS Coding Guidelines from CMS. Les-sons emphasize root operations. This introductory course offers basic education on using the ICD-10-CM diagnosis coding system. This is the first step in actually learning how to apply diagnosis codes for outpatients, following the direction of ICD-10-CM Official Diagnosis Coding and Reporting Guidelines for Outpatient Services.

This content is designed to provide an overview of specialty-specific coding information. Each specialty includes one lesson on specialty-specific diagnosis coding with emphasis on fundamental health science knowledge pertinent to the specialty, and one lesson specific to procedure coding, emphasizing common root opera-tions and character selection for the specialty, where appropriate.

Approximately 14 hours to complete Course

19 lessons, approximately 1 hour per lesson

17 specialties, approximately 2 hours per specialty

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Part 1:

Content and descriptions

(continued) EduCode Coding: ICD-10-CM/PCS Specialty Detail* EduCode Reimbursement Essentials *draft titles

This content provides topic-specific detailed ICD-10-CM/ PCS coding education within each specialty. Complex, high-volume or high-cost diagnoses and procedures are covered within these lessons. This content offers education on the fundamentals of reimbursement systems for inpatient and outpatient services. This detailed education defines the OPPS and IPPS payment systems and associated edits and challenges within each system. Also included are courses on the hospital HAC and HQI programs that affect reimbursement, along with lessons on the various CMS auditing (RAC and CERTS) and medical review programs. The Revenue Cycle is present-ed in an easy to understand format within the Revenue Cycle Orientation Course for those who are unfamiliar with the Revenue Cycle.

Average of 6 hours per spe-cialty

Approximately 30 hours for the course (can be divided by area of job responsibility)

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Recommended education from Elsevier

Part 2:

Recommended education by type of learner

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Part 2:

Recommended education by type of learner

Every occupation in the hospital requires different training in preparation for the ICD-10 implementation.

For example an experienced inpatient cardiology coder:

2011

> ICD-10 Essentials 6 hours

> Medical Terminology Plus (7 lessons) 2 hours

> Mosby’s Pathophysiology (8 general & 3 specialty lessons) 5.5 hours

> EduCode Clinical Documentation Improvement (8 lessons) 8 hours

2012

> Introduction to ICD-10-CM Diagnosis Coding for Inpatients 14 hours

> Introduction to ICD-10-CM Procedure Coding for Inpatients 18 hours

2013

> ICD-10-CM Specialty Overview 2 hours

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Part 2:

Recommended education by type of learner

The following chart breaks down the types of users, with recommended coursework and timing.

Health Information Management – Experienced Coder

ICD-10 Readiness Assessment

GEMS (to help with data conversion and reporting)

ICD-10 Essentials

Mosby’s Medical Terminology Plus Mosby’s Anatomy & Physiology for Health Professions

Introduction to ICD-10-CM Diagnosis Coding for Outpatients (some duplica-tion between inpatient and outpatient) EduCode Clinical Documentation Improvement: Standards and Guidelines EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies

EduCode Coding: ICD-10-CM/PCS Specialty Overview

EduCode Coding: ICD-10-CM/PCS Specialty Detail 2011 2011-2012 2011 2011-2012 2011-2012 2011-2012 2012 (Trainers may take in 2011) 2012 (Trainers may take in 2011) 2012 - 2013 2012-2013 2011-2013 2013 (trainers may start in 2012) 2013 (trainers may start in 2012) 1 ½ - 2 4 hours 23 hours (may select specialty) 15 min/lesson 2 hours per specialty 13 hours 14 hours 19 hours 15 hours 4 hours 14 hours (may be taken by specialty or condition) 2 hours per specialty 6 hours per specialty

Date for Estimated Type of User Content Education Contact Hours

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Part 2:

Recommended education by type of learner

(continued)

Health Information Management – Novice or outpatient coder

ICD-10 Readiness Assessment Mosby’s Basic Medical Terminology Mosby’s Medical Terminology Plus Mosby’s Anatomy & Physiology for Health Professions

ICD-10 Essentials

EduCode Clinical Documentation Improvement: Standards and Guidelines EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies (if applicable to job function)

Introduction to ICD-10-CM Diagnosis Coding for Outpatients

Introduction to ICD-10-CM Diagnosis Coding for Inpatients (if applicable to job function – some duplication with outpatient introduction course) Introduction to ICD-10-PCS Procedure Coding for Inpatients (if applicable to job function)

EduCode Coding: ICD-10-CM/PCS Specialty Overview (if applicable to job function)

EduCode Coding: ICD-10-CM/PCS Specialty Detail (if applicable to job function) 2011 2011 2011 2011-2012 2011-2012 2011 2012 2012 2012-2013 2012-2013 2012-2013 2013 2013 1 ½ - 2 8 hours 2 hours per specialty 2 hours per specialty 13 hours 23 hours (may select specialty) 4 hours 14 hours (may be taken by specialty or condition) 15 hours 14 hours 19 hours 2 hours per specialty 6 hours per specialty

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Part 2:

Recommended education by type of learner

(continued)

Clinical

Documentation Improvement Specialist

ICD-10 Readiness Assessment EduCode Reimbursement Essentials, Revenue Cycle Orientation course EduCode Coding: MS-DRG

Fundamentals and MS-DRG Training ICD-10 Essentials

Mosby’s Medical Terminology Plus (if refresher needed)

Introduction to ICD-10-CM Diagnosis Coding for Inpatients Introduction to ICD-10-PCS Procedure Coding for Inpatients EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies

EduCode Clinical Documentation Improvement: Standards and Guidelines EduCode Clinical Documentation: Documentation for Clinicians EduCode Coding: ICD-10-CM/PCS Specialty Overview* 2011 2011 2011 2011 2011-2012 2011-2012 2011-2012 2012 (Trainers may take in 2011) 2012 (Trainers may take in 2011) 2011-2013 2011-2012 2012 2013 (trainers may start in 2012) 1 ½ - 2 6 hours 21 hours (may be split by specialty) 23 hours (may select specialty) 2 hours per specialty 2 hours per specialty 13 hours 14 hours 19 hours 14 hours (may be taken by specialty or condition) 4 hours 9 hours 2 hours per specialty

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Part 2:

Recommended education by type of learner

(continued)

Clinical Documentation Improvement Specialist Physicians/clinicians/ nursing Health Information Technology

Finance & Revenue Cycle Analysts

EduCode Coding: ICD-10-CM/PCS Specialty Detail*

EduCode Clinical Documentation: Documentation for Clinicians

EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies

EduCode Clinical Documentation Improvement: Standards and Guidelines (E/M, completion standards, physician query)

General Equivalence Mappings (GEMS) ICD-10 Essentials: Comparison of ICD-9-CM to ICD-10-CM

ICD-10 Essentials and introduction courses (Dependent on level of analysis – generate & compare data will require more coding knowledge: involvement in mapping strategies will require coding knowledge, possibly by specialty) General Equivalence Mappings (GEMS)

2013 (trainers may start in 2012) 2011-2012 2011-2013 2011-2012 2011 2011 2012-2013 (depends on when paral-lel reporting begins) 6 hours per specialty 9 hours - 1 hour/ lesson (lessons appropriate for type or site of practice) 1 hour/lesson (by specialty or condition) 3 hours 4 hours 1 hour 4 hours

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Part 2:

Recommended education by type of learner

(continued)

Finance & Revenue Cycle Analysts Contracting – rewriting coverage policies or forecasting Administrative support in clinical departments

EduCode Reimbursement Essentials (job function specific, e.g. inpatient (IPPS) General Equivalence Mappings (GEMS) EduCode Reimbursement Essentials (IPPS –inpatient payment system) Medical Terminology (specialty specific) Anatomy & Physiology (specialty specific)

Pathophysiology (specialty-specific) Introduction to ICD-10-CM for inpatients Introduction to ICD-10-CM for

outpatients (some overlap with intro to inpatient)

Introduction to ICD-10-PCS for inpatients

ICD-10-CM/PCS Specialty-specific lessons

Medical Terminology (specialty specific) Anatomy & Physiology (specialty specific)

Pathophysiology (specialty-specific) Introduction to ICD-10-CM for inpatients Introduction to ICD-10-CM for

outpatients (some overlap with intro to inpatient) 2013 2011-2012 2012-2013 2012 2012 2012 2012-2013 2012-2013 2012-2013 2012-2013 2012 2012 2012 2012-2013 2012-2013 Approx 1 hour/lesson 4 hours 9 hours 15 min/lesson 30 min/lesson 30 min/lesson 14 hours 1 hour/lesson 1 hour/lesson 15 min/lesson 30 min/lesson 30 min/lesson 14 hours

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Part 2:

Recommended education by type of learner

(continued)

Administrative support in clinical departments Quality Management Health Data Professionals

ICD-10-CM Specialty-specific lessons

Anatomy & Physiology (specialty specific)

Pathophysiology (specialty-specific) EduCode Documentation Improvement (specialty-specific)

EduCode Reimbursement Essentials (Quality Programs Affecting Reimbursement)

EduCode Coding: MS-DRG

Fundamentals and MS-DRG Training Introduction to ICD-10-CM for inpatients Introduction to ICD-10-PCS

for inpatients

ICD-10-CM/PCS Specialty-specific lessons

General Equivalence Mappings (GEMS) ICD-10 Essentials

Mosby’s Medical Terminology Plus Mosby’s Anatomy & Physiology for Health Professions

Mosby’s Pathophysiology for Health Professionals 2012-2013 2011 2011 2011 2011-2012 2011 2012-2013 2012-2013 2012-2013 2011 2011 2011-2012 2011-2012 2011-2012 1 hour/lesson 30 min/lesson 30 min/lesson 1 hour/lesson up to 18 hours 4 hours 21 hours (may be split by specialty) 14 hours 1 hour/lesson 1 hour/lesson 4 hours 23 hours 15 min/lesson 2 hours per specialty 13 hours

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Part 2:

Recommended education by type of learner

(continued)

Health Data Professionals

Utilization Review and Case Management

Researchers

Revenue Cycle Managers

Introduction to ICD-10-CM Diagnosis Coding for Outpatients (some duplica-tion between inpatient and outpatient) EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies

EduCode Coding: ICD-10-CM/PCS Specialty Overview

EduCode Coding: ICD-10-CM/PCS Specialty Detail

EduCode Reimbursement Essentials, Revenue Cycle Orientation course EduCode Clinical Documentation Improvement: Specialty Classification and Clinical Terminologies

EduCode Coding: MS-DRG

Fundamentals and MS-DRG Training Same as clinicians, unless coding is involved, then Same as Coder Same as finance and revenue cycle analysts 2012 2012 2012 - 2013 2011-2013 2013 (trainers may start in 2012) 2013 (trainers may start in 2012) 2011 2011-2013 2011 14 hours 19 hours 15 hours 14 hours (may be taken by specialty or condition) 2 hours per specialty 6 hours per specialty 6 hours 14 hours (may be taken by specialty or condition) 21 hours (may be split by specialty)

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Part 2:

Recommended education by type of learner

(continued)

Auditors and Compliance Staff

Patient Financial Services and Billing

Dependent on auditing responsibility, same as coders – Also include EduCode Reimbursement Essentials:

Audits & Reviews, Quality Programs Affecting Reimbursement;

and Revenue Cycle Orientation Mosby’s Basic Medical Terminology Mosby’s Medical Terminology Plus

Mosby’s Anatomy and Physiology

Introduction to ICD-10-CM for Inpatients/Outpatients (based on job function)

Introduction to ICD-10-PCS for Inpatients (based on job function) ICD-10-CM Specialty Overview EduCode Reimbursement Essentials (job function specific, e.g. inpatient (IPPS)

2011-2012 2011 2011 2011 2012-2013 2012-2013 2013 2013 15 hours 8 hours 15 min/lesson (may split by specialty) 26 lessons -30 min/lesson (may split by specialty) 14 hours 19 hours (split by specialty) 1 hour/lesson Approx 1 hour/ lesson

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Recommended education from Elsevier

Part 3:

Recommended education timeline based on need

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Part 3:

Recommended education timeline based on need

Identify gaps in knowledge to know where education is necessary

Basic understanding of the coding system to interpret or understand requests to modify or enhance systems

Enhance fundamental knowledge to prepare for ICD-10 coding – “knowledge of”

Enhance fundamental knowledge to prepare for ICD-10 coding – primary responsibility coding, trainers, and documentation

improvement and quality reporting

Abstracting and reporting of quality measures (ongoing through 2013)

Improve clinical documentation

Identify working DRG, utilization review and discharge planning

Coders;

Clinical Documentation Improvement Specialists HIT

HIT; outpatient coders; billers; PFS;

HIM/Coding; Clinical

Documentation Improvement Specialists: Auditors and Compliance Staff; Quality Management staff

Quality Management; Coders

Clinicians;

Clinical Documentation Improvement; Coding

Case Management; nursing; Quality Management

ICD-10 Readiness

Assessment and white paper with appendix “A Guide to ICD-10 Preparatory Training” ICD-10 Essentials

(course specific to job function)

Reimbursement Essentials: Revenue Cycle Orientation Mosby’s Basic Medical Terminology

Mosby’s Anatomy & Physiology for Health

Professions (specific to specialty) Mosby’s Anatomy & Physiology for Health Professions

(specific to specialty) Mosby’s Pathophysiology (specialty-specific) Clinical Documentation Improvement EduCode Reimbursement Essentials Clinical Documentation Improvement EduCode Clinical Documentation Improvement EduCode Reimbursement Essentials : QPAR, Revenue Cycle Orientation

EduCode Coding-MS DRG Fundamentals and MS-DRG Training; EduCode Clinical Documentation Improvement EduCode Reimbursement Essentials

Need Audience Curriculum/Course

The following chart anticipates needs that may arise among various learners and provides suggestions for appropriate coursework.

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Part 3:

Recommended education timeline based on need

(continued)

Understand clinical phrases enough to assign a basic code, identify medical

necessity statements, respond to request for information, communicate with payers Data Base Conversion including parallel reporting capability

necessity statements, respond to request for information, communicate with payers Abstracting and reporting of quality measures (ongoing through 2013)

Rewrite:

coding and compliance policies and procedures; billing records/charge tickets (charge capture processes) continue fundamental education (by specialty) through 2012 and begin revisions of charge capture processes late 2012, early 2013 to accommodate parallel coding evaluation

Patient Financial Services (e.g. admissions, registration, scheduling); billing staff;

HIT; Analysts; HIM (those responsible for identifying needs of report users) Patient Financial Services (e.g. admissions, registration, scheduling); billing staff;

Quality Management; Coders

HIM/Coders; Contracting; compliance auditors; Data Quality; clinical department administrative support; coders

Mosby’s A&P

General Equivalence Mappings (GEMS) Mosby’s Basic Medical Terminology Mosby’s A&P EduCode ICD-10-CM Introductory courses EduCode Reimbursement Essentials Clinical Documentation Improvement

Medical Terminology Plus Mosby’s A&P Mosby’s Pathophysiology ICD-10-CM/PCS Introductory courses Clinical Documentation Improvement EduCode specialty-specific courses

*assign applicable specialty lessons

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Part 3:

Recommended education timeline based on need

(continued)

Analytics (analyze coded data) e.g for reimbursement, profiling, modelling, outcomes, research Standardization of clinical documentation for clinicians (reconciling “clinical”

terminology to “classification” terminology

Enhance fundamental knowledge to prepare for ICD-10 coding –

“knowledge of”

Enhance fundamental knowledge to prepare for ICD-10 coding – primary responsibility coding, trainers, and documentation

improvement and quality reporting Maintain high level of productivity and accuracy for inpatient coding –abstract, code and report (minimize disruption of secondary data use such as payment, research, modeling, etc) Rewrite/modify payer contracts

Parallel reporting and analytics – (data users)

Analysts; Revenue Cycle pro-fessionals;

Clinicians; Coders; CDI; Quality Management

HIT; outpatient coders; billers; PFS;

HIM/Coding; Clinical Docu-mentation Improvement Specialists: Auditors and Com-pliance Staff; Quality Manage-ment staff

Coders, CDI

Contracting

(anticipate coders and clinicians will be involved with the detail of this process and will have in-depth coding education)

Finance and Revenue Cycle Analysts

Researchers

General Equivalence Mappings (GEMS)

Clinical Documentation Improvement

Mosby’s Anatomy & Physiology for Health Professions (specific to specialty)

(specific to specialty) Mosby’s Pathophysiology (specialty-specific) Clinical Documentation Improvement EduCode Specialty-Specific Education Clinical Documentation Improvement (Build on fundamental

education from 2011 and 2012) EduCode ICD-10 Essentials SEE ALSO full line of coding education

EduCode Reimbursement Essentials : OPPS, IPPS GEMS

General Equivalence Mappings (GEMS)

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Part 3:

Recommended education timeline based on need

(continued)

Learn how to assign codes for ancillary or outpatient settings

Compile, edit & submit claims, and/or perform denial

management, as needed

necessity statements, respond to request for information, communicate with payers Rewrite:

coding and compliance policies and procedures; billing records/charge tickets (charge capture processes) continue fundamental education (by specialty) through 2012 and begin revisions of charge capture processes late 2012, early 2013 to accommodate parallel coding evaluation

Outpatient Coders

Patient Financial Services and Billing

Patient Financial Services (e.g. admissions, registration, scheduling); billing staff;

HIM/Coders; Contracting; compliance auditors; Data Quality; clinical department administrative support; coders

EduCode ICD-10-CM Introduction to Outpatient Coding

EduCode Coding: ICD-10-CM Specialty Overview

EduCode ICD-10-CM/PCS introductory courses

EduCode Coding: ICD-10-CM/ PCS Specialty Overview EduCode ICD-10-CM Introductory courses ICD-10 Specialty Overview (Build on fundamental

education from 2011 and 2012) Medical Terminology Plus Mosby’s A&P Mosby’s Pathophysiology ICD-10-CM/PCS Introductory courses Clinical Documentation Improvement EduCode specialty-specific courses

*assign applicable specialty lessons

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Elsevier is committed to helping ease the burden of ICD-10 implementation with eLearning tools to guide you and your staff through the transition process. As a proven leader in supporting and educating coders for more than 20 years, Elsevier has provided guidance through a myriad of coding changes in the past and has the experience necessary to support your organization into the ICD-10 era. Copyright ©2011 Elsevier, Inc. All rights reserved. Details provided in this

document are for information purposes only and, unless specifically agreed to the contrary by Elsevier in writing, are not part of any order or contract.