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Workflow Analysis: A founda)onal piece of transi)oning - - PowerPoint PPT Presentation

Jan 28, 2024 243 likes •489 views

Workflow Analysis: A founda)onal piece of transi)oning to ICD-10 Triche Guenin 303-777-9680 Partners Through Change, Inc.

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SLIDE 1

Workflow ¡Analysis: ¡

A ¡founda)onal ¡piece ¡of ¡ ¡ ¡ transi)oning ¡to ¡ICD-­‑10 ¡ ¡

Triche ¡Guenin ¡ 303-­‑777-­‑9680 ¡ Partners ¡Through ¡Change, ¡Inc. ¡ tguenin@partnersthroughchange.com ¡

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SLIDE 2

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 2

Robin Schiffbauer Elizabeth Etzler  Facilitator  Guest Volunteers Triche Guenin

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SLIDE 3

Triche Guenin 303-777-9680 www.partnersthroughchange.com 3

What Why

Identify where, in daily

  • perations, the ICD-9 codes

are used Better understand where the new ICD-10 codes could make an impact Train personnel on how to read and draw process maps Provide foundation for

  • ngoing capability to

standardize and document processes Identify opportunities for improvement Chance to streamline process while making changes to accommodate ICD-10 compliance

CMS – ICD-10 Impact

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SLIDE 4

 Demonstrate how understanding workflow can

facilitate the transition to ICD-10.

 Show how workflows can:

  • be leveraged as the umbrella that supports all other

studies/initiatives;

  • provide a construct from which all other changes to
  • rganization/policies & procedures can be shared and

shown how they interconnect.

 Specifically points to where ICD-9

activity currently occurs and will be impacted by changes to ICD-10.

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 4

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SLIDE 5

 Pictoral description of work  Shows the “big picture”  Quickly surfaces unexpected complexity, problem

areas, redundancy, unnecessary loops

 Focuses on work, not WHO does it  Shows interconnectedness of work activities  Identifies locations where additional data can be

collected and problem areas investigated

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 5

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SLIDE 6

Triche Guenin 303-777-9680 www.partnersthroughchange.com 6 CMS – ICD-10 Impact

 In development

pa tie nt ba la nc e? Complete consideration form (incl claim/appeal form) Codin g Billing Medic al Recor ds Correct claim Receive status from payor Print & send to payor Spool claims & forward to clearinghouse Distribute to insurance rep (internal) Review
  • utstanding
claims Fix error El ec tro nic ? Er ror s fo un d? Charge pt Write-off Contact payor Receive & post payment 3rd de ni al ? Is cla im co rre cti bl e? Ap pr
  • v
ed ? End N N Write-off criteria

 Completed and in

electronic format (e.g. ppt)

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SLIDE 7
  • 1. Identify key process areas in organization
  • 2. Develop a SIPOC* diagram of each process area
  • 3. For each process area, understand current state
  • Gather stakeholders together
  • Create a process map
  • Identify not only work activities but other areas of interest (e.g.

ICD-9 touch point, systems used, metrics)

  • Identify opportunities for improvement
  • Validate with “others”
  • 4. Perform analysis of workflow for changes towards

compliance and streamlining for efficiency

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 7 *SIPOC = Supplier, Input, Process, Output, Customer

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SLIDE 8

 Start with patient processes

  • Example 1: Patient Pre-Encounter, Patient/Doc Encounter, Fulfill

Physician Order, Patient Discharge

  • Example 2: Patient Intake, Nurse Visit, Patient Encounter,

Physician Orders, Patient Exit

 Identify “other” supporting processes:

  • Medical Records
  • Coding
  • Claims
  • Billing/Superbill/Documentation
  • Referrals/Precerts/Pre-Authorization
  • Contracting
  • Analytics
  • Risk Mgmt

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 8

There is no “right” number/series/naming for your processes!

  • Internal Auditing
  • EMR/IT Updates/Maintenance
  • Research Participation
  • Appeals
  • Public Health Reporting
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SLIDE 9

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 9

PROCESS

Supplier 1 Supplier 2 Supplier 3 Customer 2 Customer 1

  • utput

input

  • utput

input input Definitions:

  • Supplier - whomever provides input into the process
  • Input – materials, resources, information, data, guidelines, etc.

required to execute the process

  • Process - sequence of related activities that

transform inputs into outputs to provide value for the customer

  • Output – products/services resulting from the process,

addressing the customer’s needs

  • Customer – whomever receives the output(s) of the process –

may be an internal or external entity

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SLIDE 10

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 10

Suppliers Input Process Output Customers

Patient Encounter

Patient Physician Admit Team Ancillary Services Payor

Self Pt Hx/Vitals Pre- Authorization SME

D/C Team

Physicians Orders

Ancillary Services Referring Physician

Physicians Orders Test/ Lab Results Encounter Form Information/ Physician Notes

Coding Personnel

Physicians Orders

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SLIDE 11

 Identify scope (start/stop) points  Understand the handoffs between other processes

(e.g. SIPOC)

 Determine what additional info needed

  • ICD-9 use
  • Metrics
  • System interface
  • Opportunities for Improvement

 Can be used when mapping current (As-Is) or

future state (To-Be) work environments

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 11

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SLIDE 12

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 12

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SLIDE 13

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 13

Starting/Stopping Point Activity Decision Process (out of scope) Work Movement

13

Data Movement

*caveat: there are many more standard icons, but these are the basic few needed to get started…some follow standard convention and others don’t to facilitate ease of use

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SLIDE 14

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 14

Suppliers Input Process Output Customers

Patient Encounter

Patient Physician Admit Team Ancillary Services Payor

Self Pt Hx/Vitals Pre- Authorization SME

D/C Team

Physicians Orders

Ancillary Services Referring Physician

Physicians Orders Test/ Lab Results Encounter Form Information/ Physician Notes

Coding Personnel

Physicians Orders

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SLIDE 15

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 15 Review pt. symptoms Assess pt. Treat pt.

Furth er testin g? Furth er testin g?

Provide clinical summary

N N Y Y

Basic P Basic Process rocess

Start Stop

*WIP = Work in process

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SLIDE 16

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 16 Review pt. symptoms Assess pt. Treat pt.

Furth er testin g? Furth er testin g?

Provide clinical summary Patient Exit Physici an Order Patient Intake Physici an Order Coding

N N Y Y

Validate te handoff processes (and associate ted inputs ts/outp tputs ts) from SIPOC

Coding

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SLIDE 17

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 17 Review pt. symptoms Assess pt. Treat pt.

Furth er testin g Furth er testin g

Provide clinical summary Patient Exit Physici an Order Patient Intake Physici an Order Coding

N N Y Y

Gath ther additi tional informati tion

EHR EHR EHR

Key: System ICD-9 Metrics

90% 10% 65% 35% x%

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SLIDE 18

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 18

Di Dig deeper in area need to to investi tigate te

Document diagnosis/ findings/notes Validate pt complaint/hx Determine initial diagnosis Perform Physical Confirmation

EHR

Coding .

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SLIDE 19

 Changes needed to achieve ICD-10 compliance

  • Content knowledge – clinical personnel/staff (FT/PT)
  • Template conversions (e.g. forms/screens/documents/policies/

training materials)

  • Payor coverage
  • Referral acceptance
  • Systems & system integration (e.g. # digits, vendor timing/

compliance capabilities)

  • …

 Streamlining for efficiency

  • Incorporate opportunities for improvement
  • Implement “lean” principles
  • Automate where possible
  • Clarify roles & responsibilities
  • Align skill sets
  • …

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 19

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 Complete current workflow analysis

 Get more specific where ICD-9 touches  Identify “other” opportunities for improvement  Learn nuances of ICD-10 codes applicable to specific practice

(e.g. content, combinations, # characters)

 Develop “new” improved compliant process(es)  Determine appropriate roles & responsibilities  Document via standard operating procedures  Integrate systems to handle/recognize the new codes  Train personnel on new processes/roles/forms/codes…..  ….

Triche Guenin 303-777-9680 www.partnersthroughchange.com 20

Deadline is Oct 2014!

CMS – ICD-10 Impact

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 “this session helped to expose areas where ICD9 shows up that

I’d forgotten”

 “now have an appreciation of how my work intersects with my co-

workers”

 “this is exciting to see our work laid out like this – I get it!”  “wish I could have been in all other mapping sessions – learned a

lot”

 “the referral process concerning ICD is huge”  “it created an awareness of other colleague and departmental

responsibilities”

 “really show how interconnected our processes are and how to tie

information between each”

 “should be done for whole organization”  “not just for ICD 10 transition – great to show where

improvements & streamlining can be done”

 “rude awakening, quite enlightening”

CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 21

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 Questions on workflow?  If don’t know where to start or need help in

 Facilitating mapping sessions  Analyzing workflows  Identifying opportunities for improvement  Developing streamlined work processes  Determining roles & responsibilities  Documenting new policy/procedures  …

Triche Guenin

303-777-9680 tguenin@partnersthroughchange.com

Triche Guenin 303-777-9680 www.partnersthroughchange.com 22 CMS – ICD-10 Impact (NWP)

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* Working ¡for ¡you! ¡

www.cms.org/icd-­‑10 ¡