PEACE OVE & ICD10 - HFMA NJ€¦ · Preparation, Action and Evaluation ... Recognition of advances...
Transcript of PEACE OVE & ICD10 - HFMA NJ€¦ · Preparation, Action and Evaluation ... Recognition of advances...
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ICD-9-CM is OUTDATED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
or 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
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.
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 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
outpatient services. xxxxxxx
ICD-10 CHALLENGES: WHAT’S THE BIG DEAL? IC
D-9
IC
D-1
0
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/Stakeholders
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 of 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?
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http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html