M Jahn Sep2011 Program Presentation

ICD-10 is one of the largest transformations in 30 years impacting:

• Many applications• Many applications

• 80% of business processes

• Most parts of the organizationp g

ICD-10 effort is large and complex

The transition date is actually closer than October, 2013

If you haven’t started your ICD-10 effort, you are behind

Understand the major steps involved and how the Mi ICD 10 C ll b i h lMinnesota ICD-10 Collaborative can help

2© Charter Solutions, Inc. 2011

TaxesDeath

ICD-10

TaxesDeath

ICD 10October 1, 2013


ICD-10 is primarily a business problem/business problem/ opportunity

You can’t just give the You can t just give the problem to a vendor

Challenges existg Opportunities to

create value Key lesson learned

from other countries: start early!start early!


10X more data options = more information to drive decisions

More “appropriate” levels of reimbursement

Support for new reimbursement models

Streamlined claims adjudication process; eventually – fewer rejected claims

Approval of new procedures Approval of new procedures

Phase out legacy systems

Opportunity to improve business processes

Most believe ICD-10 will improve quality of care


ICD 10 CMS72301A Unspecified fracture of shaft of right femur, initial encounter for closed fracture

S72322A Displaced transverse fracture of shaft of left femur, initial encounter for closed fracture

S72326A Nondisplaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture

S72301G Unspecified fracture of shaft S72322G Displaced transverse fracture f h ft f l ft f b t

S72326G Nondisplaced transverse fracture of shaft of unspecified femur

ICD-10-CM

pof right femur, subsequent encounter for closed fracture with delayed healing

of shaft of left femur, subsequent encounter for closed fracture with delayed healing

fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing

S72302A Unspecified fracture of shaft of left femur, initial encounter for closed fracture

S72323A Displaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture

S72331A Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture

S72302G Unspecified fracture of shaft S72323G Displaced transverse fracture S72331G Displaced oblique fracture of

ICD-9-CM

S72331A Di l d bli S72302G Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing

pof shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing

p qshaft of right femur, subsequent encounter for closed fracture with delayed healing

S72309A Unspecified fracture of shaft of unverified femur, initial encounter for closed fracture

S72324A Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture

S72332A Displaced oblique fracture of shaft of left femur, initial encounter for closed fracture

S72309G Unspecified fracture of shaft S72324G Nondisplaced transverse S72332G Displaced oblique fracture of

821.01 Fracture of femur

S72331A Displaced oblique fracture of shaft of right femur, initial encounter for closed fractureS72309G Unspecified fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing

S72324G Nondisplaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing

S72332G Displaced oblique fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing

S72321A Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture

S72325A Nondisplaced transverse fracture of shaft of left femur, initial encounter for closed fracture

S72333A Displaced oblique fracture of shaft of unspecified femur, initial encounter for closed fracture

S72321G Displaced transverse S72325G Nondisplaced transverse S72333G Displaced oblique fracture of

femur, shaft, closed

S72321G Displaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing

S72325G Nondisplaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing

S72333G Displaced oblique fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing


Implement Go livePlan and DesignAssessment/Strategy

• Engage providers & partners

• Business Decisions/ Model Options

• Technical Decisions• Design Solutions

• Application, data and business process changes

• Testing• Risk management• Transition planning

• Business Partner Testing

• Service ICD-10• Coordinate final roll-out

October 1

• Assign ICD-10 Czar• Education/ Awareness • Assess Business and

Technology Impacts• Corporate Strategy• Hi-level strategy design g

• Baseline performance• Financial Modeling• Establish Projects

p g• Coordinate

implementation & roll-out

October 1, 2013

gy g& scope identification

• Form Steering Committee

2013201220112010


Get physicians involved early Get physicians involved early There wasn’t enough time for

training It’s just not a systems problem Teach documentation sooner Plan for delays and cost

overrunsU d t d th t ill t Understand that you will not regain productivity

Collaborate and share the pain Collaborate and share the pain

9Source: Gillian Price, Project Director Canada

NUMBERS BETWEEN SEPTEMBER 22, 2011 AND,OCTOBER 1, 2013: 2 years, 9 days 24 months 9 quartersq 1or 2 budget cycles


Several ICD-10 solutions will actually yneed to be implemented well in advance of October, 2013

Organizations will begin transitioning g g gto ICD-10 months before the actual due date

Recommend a 25% schedule and Recommend a 25% schedule and budget contingency be added

Many not ready for the 5010 implementation; shortens the availableimplementation; shortens the available time for ICD-10 focus

2012 – Implementation 2013 Business Partner Testing 2013 – Business Partner Testing

and Go-Live11© Charter Solutions, Inc. 2011

Computer Assisted Coding (CAC)

Education and Training

BusinessClinical Documentation Improvement

Business Partner/ Vendor Management

Application Upgrades,

Testing

Remediation, Retirement

Custom ICD-9 to ICD-10 Mapping

B i PBusiness Process Assessment and Redesign Financial

Modeling

Analytics


EHRClinical

Documents

Coder1. Views documentation2 Views applicable codes

Abstractor/Encoder

Applicable Codes

2. Views applicable codes3. Selects codes to send

to abstractor/encoder system

Billing


Outcomes/DeliverablesApproach

Deliverable Outcomes

1 Organization/Structural

Review

► Customized analysis by department, function, & process

Organization

Departments

Review p

2

“SIPOC”

► Documented functional boundaries & accountabilities

► I.D. of specific Suppliers, Inputs, Process, Outputs

Functions

• Process 1Process 2 & Customers

3High-Level

Process Flow

► Breakdown of functional processes; High Level Process Flow:

► How many processes► Which work streams

Processes• Process 2• Process 3• ….etc.

► Which work-streams

4

Risks & Impacts

► Map to processes► Estimate of Impacts (H,

M, L)► Business Partner &

Technology Touch-points

Impact 1 = High

Impact 2 = High

Impact 3 = Low…etc.

Impacts & Magnitude

15

gy p

© Charter Solutions, Inc. 2011

Areas Within a Provider’s Business Cycle I t d b ICD 10Impacted by ICD-10

PayerRelations

Revenue Mgmt

Customer Service

Point of Service

CareMgmt Finance Analytics Business

Associate

Payer Contracting

Claims Processing

Patient Portal Incoming Pre-

certifications

Disease & Case

Management

Accounting Business Rule Sets

Clearing houses

g g

Pricing Billing & Receivables

Call Center Hospital Data

Utilization Management

Resource Mgmt

Predictive Modeling

Third Parties

Medicare Reimburse-ment Review

Procedure, Diagnosis and D C di

DiseaseManagement

Financial Extracts

Comparative Effectiveness

Vendors

Drug Coding

Medicaid Patient Collection

Gaps in Care Population Management

Supply Chain Outcomes Analysis

Hospitals, Clinics, Labs

Policies and Procedures

Operational Reporting

Other TreatmentProcedures Reporting TreatmentModalities


ICD-10ICD-9 ONE TO ONEOne code in source to

ICD-10ICD-9 COMBINATION ENTRYOne code in source to

only one in target 3,458 codes or 24.5% of all

ICD-9 DX codes

multiple in target 629 codes or 4.46% of all

ICD-9 DX codes

ICD-10ICD-9 SINGLE ENTRY ICD-10ICD-9 NO MATCHOne code in sourceOne code in source to

only one of many in target 9,600 codes or

68.07% of all ICD-9 DX codes

One code in source –new code in target 416 codes or 2.95% of all

ICD-9 DX codes

17

Cerner 5/24/11

Health System Mental

Health

HospitalRevenue

Cycle Mgmt

Employers Manager

Cl iClaims

Processing

PBM

RadiologyLarge ClinicTPA

Clearinghouse

Health

UM

Plan

RBMStop Loss

Small ClinicReporting

DME

BenefitsConsultant

DM

18

LabReporting


Stakeholder Group Education/Training Requirements

Coders Medical terminology; anatomy andCoders Medical terminology; anatomy and physiology; coding structure and guidelines

Clinicians Documentation improvement needed

Compliance ICD-10 structure and coding

Financial Services Impact on grouping and payment

Information Interface and internal systems impactTechnology

y p

Researchers Impact of reporting

Patient registration Documentation; impact on medication necessity

Quality Management Impact on reporting and cost accounting

19Source: 3M

Begin

Form an ICD 10

Raise ICD-10 Awareness

gBusiness/ Clinical and Technology

Engage Executive S hi

ICD-10 Steering Committee

Impact Assessment

Assign an ICD-10 Czar

Sponsorship


Overall Strategy Major Initiatives Major Initiatives Timeline/Schedule/Milestones Budget/Costsg / Resource Requirements Organization Structureg Key Risk Mitigation Strategies

An ICD-10 Roadmap is critical for leading the organization through the ICD-10 effort


Business Plans

Maximize business benefits

Align Business and Technology

Alignment

IT Plans ICD-10IT Plans ICD-10Reduce overall costs and

timeline, coordinate upgrade h d l

22

schedules


col·lab·o·rate [kuh-lab-uh-reyt] Show IPA verb (used without object), -rat·ed, -rat·ing. 1. to work, one with another; cooperate, as on a literary work: They collaborated on a novel. 2 to cooperate usually willingly with an enemy nation especially with an2. to cooperate, usually willingly, with an enemy nation, especially with an enemy occupying one's country


To identify and evaluate opportunities to minimize theopportunities to minimize the disruption in health care billing, reporting, and related processes for a variety ofprocesses for a variety of stakeholders in the health care industry in connection with the ICD-10 conversion.

25 major health plans, providers, state agencies and associations participate in the Minnesota ICD-10 Collaborative


Operations Committee meets monthly ll dto set overall direction.

Work Groups meet 1x or 2x per month


C i ti d O t h Communications and Outreach• Webinar - November 8, 2011

S i 2012 S i• Spring 2012 Summit• Other events

W k G d li bl Work Group deliverables Website for sharing information Best Practices


ICD-10 is closer than you think! Large and complex (i e many rocks) Large and complex (i.e. many rocks) Jump start your ICD-10 effort, time is not

on your sidey Minnesota ICD-10 Collaborative can help


Contact information:

[email protected] (office)612-850-9510 (cell)


M Jahn Sep2011 Program Presentation

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Transcript of M Jahn Sep2011 Program Presentation