ICD-10: Planning for a Successful Implementation Contents 1. - PowerPoint PPT Presentation

ICD-10: Planning for a Successful Implementation

Contents 1. Introduction to ICD-10 2. Implementation Calendar 3. Getting Ready 4. Preparation Checklist 5. Resources 1

What is ICD-10?  10 th revision of the International Classification of Diseases (ICD) method of coding: ◦ The patient’s state of health, and ◦ Institutional procedures  Allows for: ◦ More information per code ◦ Better support for care management and quality ◦ Improved ability to understand risk and severity 2

Transition Facts  All HIPAA-covered entities must use new code sets as of October 1, 2015  CPT coding is not affected by the transition  ICD-10 CM/PCS consists of: ◦ ICD-10-CM for diagnosis coding ◦ ICD-10-PCS for inpatient procedural coding 3

Diagnosis Coding  Captures more specific data from clinical documentation: left side v. right side, initial v. subsequent encounter, routine v. delayed healing 4

Structure Changes 5

Side-by-Side 6

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Quarterly Calendar  Quarter 1: Technical Preparedness ◦ EHR system updates, Meaningful Use, CRISP  Quarter 2: Back Office Preparedness ◦ Staff training, vendor contact, A/R cleanup, coding review, financial planning  Quarter 3: Full Practice Readiness ◦ Implement new tools, review physician and staff roles, testing  Quarter 4: Implementation and Revenue Cycle Management ◦ Claims accuracy, payment processing, monitoring KPIs 8

Project Plan  Develop a comprehensive plan to govern the transition process  All personnel must be aware of the extent of this change  Assign clear responsibility for each step  Develop a comprehensive, realistic budget  Involve all stakeholders (physicians, vendors, payers, clearinghouses)  Include a transition timeline and adhere to it 9

Sample Template from the AMA 10

Transition Checklist  Identify current systems/structure/processes that use ICD-9 codes  Contact all EHR/PM vendors about updates and testing  Develop implementation plans with billing service and clearinghouse  Talk to payers about transition and potential contract changes  Review changes to workflow  Assess training needs  Budget for time and costs; consider ways to mitigate financial risk  Conduct full end-to-end testing 11

Impact Assessment  Analyze how codes are used throughout the practice ◦ Billing/submitting claims, eligibility checks, referrals  Identify commonly used ICD-9 codes and explore related ICD-10 codes  Identify paper and electronic forms to accommodate new structure 12

Systems Update  Contact Vendors ◦ EHR/PM systems should be updated and support may be available ◦ Clearing house and/or billing service will need to be reviewed  Complete Systems Tests ◦ Internal and external once all updates are installed 13

Minimizing Challenges  Eliminate coding backlogs prior to Oct 1, 2015  Prioritize medical records for coding  Provide refresher training ◦ ICD-10 accuracy ◦ Practice workflows and new efficiencies  Pre-determine steps for addressing errors and vendor issues 14

Resources  MedChi Network Services ◦ info@medchiservices.org or 888-507-6024  Centers for Medicare and Medicaid Services ◦ cms.gov/ICD10  Maryland DHMH ◦ dhmh.maryland.gov/icd10info  American Medical Association ◦ ama-assn.org/go/icd-10  Specialty Societies  Payors  Vendors 15

Questions? Colleen George 888-507-6024 (phone) Practice Services 888-507-6034 (fax) Administrator cgeorge@medchi.org MedChi Network Services 16

References  American Medical Association: The Current State of ICD-10 & Preparing for It ◦ http://www.ama-assn.org/ama/pub/physician- resources/solutions-managing-your- practice/coding-billing-insurance/hipaahealth- insurance-portability-accountability- act/transaction-code-set-standards/icd10-code- set.page  Centers for Medicare and Medicaid Services: ICD-10 ◦ cms.gov/ICD10  Department of Health and Mental Hygiene, ICD-10 Transition ◦ https://mmcp.dhmh.maryland.gov/SitePages/ICD -10%20Conversion.aspx 17