P EACE , L OVE & ICD10 Kimberly Barca, RHIA HIM Regulatory - - PowerPoint PPT Presentation

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ICD-9-CM is OUTDATED 30 years old – technology, disease, and overall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

• r 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

• ne 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

• peration.

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

• utpatient services.

xxxxxxx

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

ICD-9 ICD-10

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/Stake holders 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

• f 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?

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