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

P EACE , L OVE & ICD10 Kimberly Barca, RHIA HIM Regulatory & Project Manager Princeton Healthcare System 6/10/2014

A GENDA  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

H EALTHCARE T ODAY …

Why ICD10? The History of ICD-9  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? Consider ICD-9 Today  ICD-9-CM is OUTDATED  30 years old – technology, disease, and overall healthcare has evolved  Many categories are full and cannot expand  Not descriptive enough  Not flexible,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? • 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

Benefits of ICD-10  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

But wait… I thought ICD10 was: Delayed? Cancelled? Skipping ICD-10 and going to ICD-11?

ICD-10 D ELAY 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.

ICD-10 D ELAY – W HAT ’ S THE P LAN ?  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 Background 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 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 xxxxxxx outpatient services.

ICD-10 C HALLENGES : W HAT ’ S THE B IG D EAL ? ICD-9 Dog Large – Shepard Lab – Chocolate Male Dog – Large Large – Labrador Lab – Yellow Female Large – Chow Lab – Black ICD-10 Dog – Medium Dog – Small

E XAMPLE OF ICD-10 T RANSLATION

ICD-10-CA – T HE C ANADIAN E XPERIENCE 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”

ICD10 - Key Stakeholders 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 – Major Impacts & Gap Analysis Any area where a code or coded information enters, processes or exits your organization Revenue Clinical Cycle ICD 10 Information Financial Technology

What Does This Mean To My Organization? 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)

ICD10 – Project Planning & Milestones Phase 1 – Phase 2 – Phase 3 – Go Live Phase 4 – Post Impact Prepare for Preparation Implementation Assessment Implementation Establish “Monitor” Upgrade/Modify/ “Planning” Phase Steering Replace Analysis of and Vendor Design Committee/Stake Impact on Complete testing holders Begin staff Reimbursement and system education Determine & Claims training transition Determine impact Coding Complete strategy/goals of transition on education to all System data analysis Organizational impacted staff Performance readiness Review impact Parallel/Dual Audit Coding assessment Assess vendor & Coding Audit Processes payer readiness Determine payer Contract changes transition plans Address issues Coding Go Live real-time Assessment Planning/Support Assess financial Documentation Implementation impact Review Communication Constant Contract Plan evaluation of Analysis conversion IT Inventory Overall Vendor Adoption Readiness Management Implementation Budget Risk Assessment “Roadmap”

What Does This Mean to My Organization? 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

ICD10 – R ISKS & S TRATEGIES  Time  Budget  Training  Resources  Coordination  Testing & Validation  Productivity and Revenue  Internal vs. External Risks  Post Go Live Strategy 21  “What If” Scenarios

H UMOROUS S IDE 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 22 Z621 Parental overprotection

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