PEACE OVE & ICD10 - HFMA NJ€¦ · Preparation, Action and Evaluation ... Recognition of advances in Medicine and Technology Benefits of ICD-10 . But wait… I thought ICD10 was:

PEACE, LOVE & ICD10

Kimberly Barca, RHIA

HIM Regulatory & Project Manager

Princeton Healthcare System

6/10/2014

AGENDA

Brief History of ICD-10

Why ICD-10?

Implementation News

What Does ICD-10 Mean To My Organization?

Preparation, Action and Evaluation

Risk & Mitigation Considerations

Next Steps

Questions & Answers

HEALTHCARE TODAY…

World Health Organization (WHO) developed

ICD-9 for use globally

U.S. developed clinical modification (ICD-9-

CM) Implemented in 1979 in U.S.

It provided for an expanded number of

diagnosis codes

Developed procedure coding system

Uses: calculate payment, adjudicate coverage,

compile statistics, assess quality

Why ICD10? The History of ICD-9

ICD-9-CM is OUTDATED

30 years old – technology, disease, and overall

healthcare has evolved

Many categories are full and cannot expand

Not descriptive enough

Not flexible, not exact

Why ICD10? Consider ICD-9 Today

• Mandated by The Department of

Health and Human Services

(HHS)

• Currently 18,000 ICD9 codes

growing to more than 141,000

ICD10

• Will affect EVERYONE who

touches a medical record, claim

or information coming from

them

• Quoted as being “The Perfect

Storm”; Bigger than Y2K and

DRG’s combined

• Need to prepare NOW

Why ICD10?

Better quality of care

Greater coding accuracy and specificity

Better information for measuring quality,

safety and efficiency

Reduced coding errors

Alignment of the US with coding systems

worldwide

Improved ability to track and respond to

international public threats

Recognition of advances in Medicine and

Technology

Benefits of ICD-10

But wait… I thought ICD10 was:

Delayed?

Cancelled?

Skipping ICD-10 and going to ICD-11?

ICD-10 DELAY

ICD-10 is not cancelled.

On 3/31/2014, the Senate voted (64-35) to approve

a bill that included the delay in the

implementation of ICD-10-CM/PCS by at least

one year to 10/1/2015.

Since the decision to delay, it has been noted that

CMS has made numerous references to support

the new compliance date of 10/1/15; no later.

Stay the course

The delay is a “gift of

time”

Offers an opportunity

to re-evaluate processes

and in all areas of

operation.

Education and training

plan timelines

ICD-10 DELAY – WHAT’S THE PLAN?

ICD-10-CM: International Classification of Diseases,

10th Edition, Clinical Modifications (diagnosis coding)

ICD-10-PCS: International Classification of Diseases,

10th Edition, Procedure Coding System (procedure

coding)

ICD-10 was introduced internationally in 1992 by the

World Health Organization.

The U.S. is the last industrialized nation to use the

standard as part of its day to day operations.

ICD-10 Background

ICD-10 Background

• As of date of service *10/1/2015,

all health care claims will be

submitted to payers with

diagnoses coded in ICD-10-CM

for all provider types.

• As of date of service *10/1/2015,

health care claims will be

submitted to payers with

procedures coded in ICD-10-

PCS for hospital inpatient

services only.

• CPT and HCPCS codes will

continue to be used for

professional claims and

outpatient services. xxxxxxx

ICD-10 CHALLENGES: WHAT’S THE BIG DEAL? IC

D-9

IC

D-1

0

Dog

Dog – Small

Dog – Medium

Dog – Large Large – Shepard

Large – Labrador

Large – Chow

Lab – Chocolate

Lab – Yellow

Lab – Black

Male

Female

EXAMPLE OF ICD-10 TRANSLATION

Lessons Learned:

Training & Education

Resources

Physician Involvement

Documentation Improvement

Plan for Delays

Plan for Productivity Loss – Little Regain

Shared Process Across Organization

Cost of Conversion

Technical Considerations

AHIMA “Implementation of ICD-10: Experiences and Lessons Learned from a Canadian Hospital”

ICD-10-CA – THE CANADIAN EXPERIENCE

This is not just a “coding” thing…

Health Information Management

Clinical Documentation Improvement (CDI)

Revenue Cycle (Scheduling, PAS, PFS)

Medical Staff (Residents)

Clinical Staff

Information Technology

Contracts Management

Performance/Quality Improvement

Case Management/UR

Finance

Senior Leadership

Think about your organizational business lines

Think about payer and vendor integration

ICD10 - Key Stakeholders

Any area where a code or coded information enters, processes or

exits your organization

ICD10 – Major Impacts & Gap Analysis

Clinical Revenue

Cycle

Information Technology

Financial

ICD 10

Other Considerations

• Billing – every claim needs an ICD code

• Pre-Authorization for Services

• Referrals

• Gain Sharing / Clinical Quality

Incentive Programs (often based on

diagnosis)

• Insurance Company Reviews for

Utilization Management)

What Does This Mean To My Organization?

ICD10 – Project Planning & Milestones Phase 1 –

Impact Assessment

Establish Steering Committee/Stakeholders

Determine transition strategy/goals

Organizational readiness

Assess vendor & payer readiness

Coding Assessment

Documentation Review

Contract Analysis

IT Inventory

Vendor Readiness

Implementation Budget

Risk Assessment

“Roadmap”

Phase 2 – Prepare for

Implementation

“Planning” Phase

Vendor Design

Begin staff education

Determine impact of transition on data analysis

Review impact assessment

Determine payer transition plans

Phase 3 – Go Live Preparation

Upgrade/Modify/ Replace

Complete testing and system training

Complete education to all impacted staff

Parallel/Dual Coding

Contract changes

Go Live Planning/Support

Implementation Communication Plan

Phase 4 – Post Implementation

“Monitor”

Analysis of and Impact on Reimbursement & Claims

Coding

System Performance

Audit Coding

Audit Processes

Address issues real-time

Assess financial impact

Constant evaluation of conversion

Overall Adoption Management

Be prepared and avoid:

Rework – expect phone calls from

facilities you refer your patients to for

testing and other services

This will cause Delays in treatment for

your patients

Inaccuracy - Poor Data to support your

performance for Gain Sharing, Quality

Programs and Utilization Management

What Does This Mean to My Organization?

ICD10 – RISKS & STRATEGIES

Time

Budget

Training

Resources

Coordination

Testing & Validation

Productivity and Revenue

Internal vs. External Risks

Post Go Live Strategy

“What If” Scenarios

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HUMOROUS SIDE OF ICD10

W5922xS Struck by turtle, sequela

Z62891 Sibling rivalry

Z631 Problems in relationship with in-laws

V9107xD Burn due to water-skis on fire, subsequent encounter

V9733xD Sucked into jet engine, subsequent encounter

Y92253 Hurt at the opera

Z621 Parental overprotection

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Questions?

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http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html