© Copyright 2009 American Health Information Management Association. All rights reserved.
ICD-10-CM/PCS Impact Assessment
Webinar May 5, 2009
Practical Tools for Seminar Learning
Disclaimer
AHIMA 2009 HIM Webinar Series i
The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.
CPT® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein.
As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.
The faculty has reported no vested interests or disclosures regarding this presentation.
Faculty
AHIMA 2009 HIM Webinar Series ii
Caroline Piselli, RN, MBA, FACHE
Caroline Piselli, RN, MBA, FACHE, is pay for performance and ICD-10 program manager for 3M Health Information Systems in Wallingford, CT. Prior to joining 3M, Ms. Piselli served in management positions in several healthcare organizations. She is also a certified Six Sigma Black Belt, a Fellow with the American College of Healthcare Executives, and is on the board of directors of its Connecticut state chapter.
Allison Viola, MBA, RHIA
Allison Viola, MBA, RHIA, is director of federal relations for AHIMA’s Washington, DC office, where she educates and works with federal officers and staff on HIM-related issues in order to further AHIMA’s public policy positions, mission, and goals. Prior to joining AHIMA, Ms. Viola served as an associate with a consulting firm, leading health IT projects for clients such as the Veterans Health Affairs and the Department of Defense Military Health System.
Table of Contents
AHIMA 2009 HIM Webinar Series
Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii Polling Question #1 ........................................................................................................ 1 Global Use of ICD-10 (WHO version) ............................................................................... 1 What If We Were Mandated to Speak Greek on One Day? ................................................. 2 Agenda ........................................................................................................................ 2 ICD-10-CM/PCS Final Rule Issues .................................................................................... 3 The Transition from ICD-9 to ICD-10 ............................................................................... 3 ICD-10-CM Diagnoses – Structure Overview ..................................................................... 4 Specificity Looks Like This in ICD-10-CM .......................................................................... 4 ICD-10-PCS – Structure Overview .................................................................................... 5 Each Code Tells a Story .................................................................................................. 5 Start Now! ..................................................................................................................... 6 ICD-10-CM/PCS Implementation: Critical Success Factors .................................................. 6 Polling Question #2 ........................................................................................................ 7 ICD-10-CM/PCS Provider Integrated Implementation Team ................................................ 7 Key 1st Step: Risk/Opportunity Assessment ....................................................................... 8 AHIMA Team Summary: ICD-10-CM/PCS Organizational Transition Planning ....................... 8 Snapshot of Transition Planning Framework ..................................................................... 9 Risk/Opportunity Tool ..................................................................................................... 9 People ....................................................................................................................... 10 Process ....................................................................................................................... 10 Technology ................................................................................................................... 11 Key Words of Wisdom ................................................................................................... 11 Risk/Opportunity Assessment ‘Simulation’ Guidelines (For Your Implementation) ................ 12 Health Care: Provider/Payer Enterprise ........................................................................... 12 Strategic Plans: Provider/Payer ...................................................................................... 13 ICD-10 Implementation Strategic Decision Tree (Example) ............................................... 13 Risk Opportunity Assessment Process ........................................................................ 14-17 Polling Question #3 ....................................................................................................... 17 Next Steps – Get Started and Realize Results .................................................................. 18 ICD-10 Implementation Summary ................................................................................... 18 Discussion and Recommendations .................................................................................. 19 Audience Questions ....................................................................................................... 19 Audio Seminar Discussion .............................................................................................. 20 Become an AHIMA Member Today ! ................................................................................ 20 Audio Seminar Information Online .................................................................................. 21 Upcoming Audio Seminars ............................................................................................ 21 AHIMA Distance Education online courses ....................................................................... 22 Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 22
(CONTINUED)
Table of Contents
AHIMA 2009 HIM Webinar Series
Appendix .................................................................................................................. 23 Resource/Reference List ....................................................................................... 24 CE Certificate Instructions
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 1
Notes/Comments/Questions
Polling Question #1
What functional area do you represent?a) Health Information Management b) Clinicalc) Clinical Qualityd) Financee) Information Systemsf) Strategyg) Operationsh) C-suitei) Other
1
Poland
Global Use of ICD-10 (WHO version)
Thailand
United States
Iceland
Denmark
Brazil
New Zealand
Argentina
Austria
Norway
Australia
Finland
Singapore
Canada
Sweden
China
Japan
Venezuela
Germany
SwitzerlandItaly
SpainPortugal
Colombia
Belgium
UKIreland
Czech RepublicThe Netherlands
France
Costa Rica
2013
2
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 2
Notes/Comments/Questions
What If We Were Mandated to Speak Greek on One Day?
How might you apply a dictionary or mapped document for every spoken word?• Conversations, Documents, Email, Complete
tasks
How does this concept apply to ICD-10?
I-9
I-10
I-10
I-10
I-10
I-10
3
Agenda
ICD Situational AnalysisKey Critical Success FactorsRisk/Opportunity AssessmentTool SimulationDiscussion and Recommendations
4
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 3
Notes/Comments/Questions
ICD-10 CM/PCS Final Rule Issues
Implementation date October 1, 2013• Single date for all users
• Date of service for ambulatory & physician reporting
• Date of discharge for inpatient settings• ICD-9-CM codes will not be accepted for
services provided on or after October 1, 2013
• ICD-9-CM claims for services prior to implementation date will continue to flow through systems for a period of time
Source: CMS Final Rule and 3M HIS ICD-10 Awareness Hour- March 2009 5
The Transition from ICD-9 to ICD-10
ICD-10 is the language of healthcare• ICD-10-CM: Diagnosis coding- Used for in and outpatient• ICD-10-PCS: Procedure coding- Used for inpatient only
• CPT codes will continue to be used for Outpatient Procedure Coding
All healthcare providers will transition from ICD-9 to ICD-10 on October 1, 2013
ICD-9 to ICD-10 Code Transition
13,0004,000
68,000
87,000
0
20,000
40,000
60,000
80,000
100,000
Diagnosis Codes Procedure Codes
Comparison of ICD-9 and ICD-10 Codes
# Co
des
ICD-9(thru 9/30/13)
ICD-10(after 10/1/13)
Characters from 3-5 Alphanumeric to 3-7
Characters from 3-4 Numeric to 7 Alphanumeric
Note:
• With ICD-10’s increased detail and alphanumeric characters the width of the codes have increased
•In contrast- Y2K simply impacted 1 character
6
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 4
Notes/Comments/Questions
ICD-10-CM Diagnoses –Structure Overview
ICD-10-CM has 3 – 7 digitsDigit 1 is alpha (A – Z, not case sensitive)Digit 2 is numericDigits 3 – 7 are alpha (not case sensitive) or numeric• A66 Yaws• A69.20 Lyme disease, unspecified• O9 .311 Physical abuse complicating pregnancy,
first trimester• S42.001A Fracture of unspecified part of right
clavicle, initial encounter for closed fractureX– ask about filler digit
7
Specificity Looks Like This in ICD-10-CM…
ICD-10-CMK35.0 Acute appendicitis with generalized peritonitisK35.1 Acute appendicitis with peritoneal abscessK35.9 Acute appendicitis, unspecified
M84.362A Stress fracture, left tibia, initial encounter for fracture
M84.362D Stress fracture, left tibia, subsequent encounter for fracture with routine healing
M84.362G Stress fracture, left tibia, subsequent encounter for fracture with delayed healing
8
ICD-10-CM/PCS Impact Assessment
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Notes/Comments/Questions
ICD-10-PCS – Structure Overview
A character is a stable, standardized code component• Holds a fixed place in the code• Retains its meaning across a range of codes
A value is an individual unit defined for each character
Section Body Root Body Approach Device QualifierSystem Operation Part
9
0 D B 6 8 Z X
Med/Surg
Gastrointestinal
Excision
Stomach
TransorificeIntraluminalEndoscopic
None
Diagnostic
Each Code Tells a Story
SectionBody
SystemRoot
OperationBodyPart Approach Device Qualifier
10
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 6
Notes/Comments/Questions
Start Now!
Will you be ready?• Payer, Provider, Vendor?
“Take advantage of lead time!”Canadian and Australian Colleagues
“I wish I had taken the transition more seriously. In retrospect, I could have positively impacted
my organization if we had paid attention to ICD-10 opportunities rather than be consumed with
day-to-day operations.”Coding Services Manager
Canadian hospital
Source: 3M HIS ICD-10 Voice of Customer Research 11
ICD-10-CM/PCS Implementation: Critical Success Factors
Be ready by October 1, 2013• Strategic imperatives continue to be met
• e.g. Financials, Quality, Access
• ALL systems/ functions that currently have ICD-9 codes ready for ICD-10• Native or mapped
• Provider, Physician, Payer, Vendor integration across systems
• Contracting in place
12
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 7
Notes/Comments/Questions
Polling Question #2
Has Your Organization initiated ICD-10 Planning?
a) Yesb) Noc) Not Sure
13
ICD-10-CM/PCS Provider Integrated Implementation Team
InformationTechnology
Clinical Services Patients/Families Executives
HIM/CodersPatient FinancialServices/Finance
PayerIntegration
VendorIntegration
Source: 3M HIS ICD-10 Awareness Hour- March 2009 14
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 8
Notes/Comments/Questions
Key 1st Step: Risk/Opportunity Assessment
Defensive: Compliant Position• Perform Impact/ Gap Analysis• Implement minimum necessities
Offensive: Strategic - Optimize Position• Integrate opportunities across enterprise• Embrace the strategic advantage across the
spectrum• Quality Improvement – Accuracy and data
integrity• Provider/Payer integration/contracting -
Detailed information15
AHIMA Team Summary: ICD-10-CM/PCS Organizational Transition Planning
Initiated focus workgroup: “Think Tank” to hear from industry in early 2009• HIT vendors, developer, hospital HIM, physician
informaticist, help desk
What can AHIMA do to assist with the transition?What kind of tools are needed to jump start the process?Developed “Transition Planning Framework”
Think Tank Team Members: Racheal D’Andrea, Gina Sanvik, Karen Hope, Shelley Harward McDonald, Mary Bessinger, Gaylene Gladden, Amy Wang, Kathryn
Perron, Caroline Piselli, Eric Rose, June Bronnert, Rita Scichilone, Allison Viola 16
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 9
Notes/Comments/Questions
Snapshot of Transition Planning Framework
Transition planning components• Conduct impact assessment• Conduct risk assessment• Define dependencies• Define stakeholders
PrioritizationAdditional Considerations• Governance management• Communication strategy• Contingency planning• Dual system management
17
Risk/Opportunity Tool
PeopleProcessesTechnology• Tool Objectives• Instructions
18
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 10
Notes/Comments/Questions
People
Interdisciplinary Steering Committee• Charge:
• Develop and implement organization-wide cross functional implementation plan
• Critical Success Factors• Executive Leadership (may be appointed)• Stakeholder Champions• Linkage to Strategic Plan
• Perquisite Enablers of Success• Pre-committee- “stakeholder buy in
sessions”19
Process
Initial Process Focus-• Your organization
Evolved Process Focus• Expand to integration across functional areas
related to patient care, quality, operations and revenue
20
ICD-10-CM/PCS Impact Assessment
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Notes/Comments/Questions
Technology
Apply toolset to:• Link strategic objectives to ICD-10 Plan • Provide ability to prioritize according to
key organizational objectives• Focus on priorities and expand to
additional key implementation milestones• Project Plans• Resource Needs/ROI• Tracking• Cross- organization planning
21
Key Words of Wisdom
Focus on Initial Scope:• Develop and Prioritize Plan• Do not Boil the Ocean
Create “idea” list for future attentionGain additional stakeholder support with a well-done prioritized project…then move forward
22
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 12
Notes/Comments/Questions
Risk/Opportunity Assessment ‘Simulation’ Guidelines (For Your Implementation)
Let the Simulation Begin:Participant Roles Assigned• Example: Providers, Physicians, Payers, Vendors
• Financial, Clinical, HIM, IT, PFAS, Regulatory, Compliance, Quality
Tool Overview and InstructionTool ApplicationDiscussion• How did it go?
• Positive• Improvement Recommendations
• How might you apply this in your organizationAwards
23
Health CareProvider Enterprise
Strategy, Budget, Planning and Reporting
Health CarePayer Enterprise
Strategy, Budget, Planning and Reporting
I-9/I-10 Translation
IT Integration
Vendor Integration
Critical Success Factors
I-9/I-10 Translation
Critical Success Factors24
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 13
Notes/Comments/Questions
Strategic Plans: Provider/PayerICD-10 Opportunities?
Strategic Plans emerge regardless of ICD-10
ICD-10 Strategy ChoicesDefensive ICD-10 Plan-• Compliant transitioning
from I-9 scenarioOffensive- Optimize ICD-10 Plan-• Opportunistic
transitioning to I-10 granularity to enhance strategic goals
How might payers/providers/ vendors integrate/coordinate?
Provider Strategic Plan Payer Strategic Plan
Strategic Goals Strategic Goals
Maximize Revenue Maximize Revenue/ Market Share
Comply w/ Regulatory mandates and P4P Requirements
Effectively and Effectively Manage Claims
Maximize Market Share Regulatory Compliance/ Litigation Prevention
Improve Clinical Quality Outcomes
Maintain Good Provider Relationships
Deliver most efficient/ effective services/ operations across the continuum of care
Monitor Clinical Quality
25
ICD-10 Implementation Strategic Decision Tree (Example)
26
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 14
Notes/Comments/Questions
Importance Weight
Strategic Category
ICD-
10-C
M/PC
S Co
mplia
nce
5010
Com
plian
ce
Integ
ratio
n with
othe
r reg
ulator
y co
mplia
nce p
rogr
ams (
RACs
, HAC
s, MA
Cs)
Regu
lator
y Sco
re
Drop
bill a
nd no
chan
ge in
A/R
days
Portf
olio m
anag
emen
t
Paye
r/Pro
vider
integ
ratio
n (Co
ntrac
ts)
Reve
nue C
ycle
Scor
e
IT S
ystem
Integ
ratio
n
Clini
cal in
tegra
tion
Func
tiona
l integ
ratio
n
Paye
r/Pro
vider
integ
ratio
n
Oper
atio
nal S
core
Accu
racy
Quali
ty re
portin
g pro
gram
s
Perfo
rman
ce M
anag
emen
t
Over
all IC
D-10
Prio
rity S
core
Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 5 5 5 5 5 5 469Case mix systems 3 5 3 4 3 3 4 4 4 4 4 4 384DRG grouper 5 5 3 5 3 3 3 3 3 4 5 5 403Compliance checking systems 5 5 2 4 1 2 2 2 1 1 4 2 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 4 2 5 2 3 3 4 4 4 401Claim submission systems 2 3 2 2 3 5 3 2 1 3 4 3 281Registration and scheduling systems 1 2 1 3 2 1 3 1 1 3 3 2 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 4 3 2 5 4 3 1 4 2 317Pharmacy systems 3 4 2 3 4 5 3 5 5 5 5 5 412Registries 2 2 1 4 5 4 1 3 4 5 3 2 306Patient assessment data sets (PAI, OASIS) 1 1 1 1 1 1 1 1 1 1 1 1 103
10 9
Regulatory Revenue CycleOperational Efficiency
Performance Management
8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
1. Identify Organizational Strategic Priority Categories
27
Importance Weight
Strategic Category
ICD-
10-C
M/PC
S Co
mplia
nce
5010
Com
plian
ce
Integ
ratio
n with
othe
r reg
ulator
y co
mplia
nce p
rogr
ams (
RACs
, HAC
s, MA
Cs)
Regu
lator
y Sco
re
Drop
bill a
nd no
chan
ge in
A/R
days
Portf
olio m
anag
emen
t
Paye
r/Pro
vider
integ
ratio
n (Co
ntrac
ts)
Reve
nue C
ycle
Scor
e
IT S
ystem
Integ
ratio
n
Clini
cal in
tegra
tion
Func
tiona
l integ
ratio
n
Paye
r/Pro
vider
integ
ratio
n
Oper
atio
nal S
core
Accu
racy
Quali
ty re
portin
g pro
gram
s
Perfo
rman
ce M
anag
emen
t
Over
all IC
D-10
Prio
rity S
core
Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 5 5 5 5 5 5 469Case mix systems 3 5 3 4 3 3 4 4 4 4 4 4 384DRG grouper 5 5 3 5 3 3 3 3 3 4 5 5 403Compliance checking systems 5 5 2 4 1 2 2 2 1 1 4 2 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 4 2 5 2 3 3 4 4 4 401Claim submission systems 2 3 2 2 3 5 3 2 1 3 4 3 281Registration and scheduling systems 1 2 1 3 2 1 3 1 1 3 3 2 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 4 3 2 5 4 3 1 4 2 317Pharmacy systems 3 4 2 3 4 5 3 5 5 5 5 5 412Registries 2 2 1 4 5 4 1 3 4 5 3 2 306Patient assessment data sets (PAI, OASIS) 1 1 1 1 1 1 1 1 1 1 1 1 103
10 9
Regulatory Revenue CycleOperational Efficiency
Performance Management
8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
2. Identify importance weight of each strategic category Weight Range = 1-10 Do not duplicate
weight number
28
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 15
Notes/Comments/Questions
Importance Weight
Strategic Category
ICD-
10-C
M/PC
S Co
mplia
nce
5010
Com
plian
ce
Integ
ratio
n with
othe
r reg
ulator
y co
mplia
nce p
rogr
ams (
RACs
, HAC
s, MA
Cs)
Regu
lator
y Sco
re
Drop
bill a
nd no
chan
ge in
A/R
days
Portf
olio m
anag
emen
t
Paye
r/Pro
vider
integ
ratio
n (Co
ntrac
ts)
Reve
nue C
ycle
Scor
e
IT S
ystem
Integ
ratio
n
Clini
cal in
tegra
tion
Func
tiona
l integ
ratio
n
Paye
r/Pro
vider
integ
ratio
n
Oper
atio
nal S
core
Accu
racy
Quali
ty re
portin
g pro
gram
s
Perfo
rman
ce M
anag
emen
t
Over
all IC
D-10
Prio
rity S
core
Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 5 5 5 5 5 5 469Case mix systems 3 5 3 4 3 3 4 4 4 4 4 4 384DRG grouper 5 5 3 5 3 3 3 3 3 4 5 5 403Compliance checking systems 5 5 2 4 1 2 2 2 1 1 4 2 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 4 2 5 2 3 3 4 4 4 401Claim submission systems 2 3 2 2 3 5 3 2 1 3 4 3 281Registration and scheduling systems 1 2 1 3 2 1 3 1 1 3 3 2 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 4 3 2 5 4 3 1 4 2 317Pharmacy systems 3 4 2 3 4 5 3 5 5 5 5 5 412Registries 2 2 1 4 5 4 1 3 4 5 3 2 306Patient assessment data sets (PAI, OASIS) 1 1 1 1 1 1 1 1 1 1 1 1 103
10 9
Regulatory Revenue CycleOperational Efficiency
Performance Management
8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
3. Identify critical success objectives of each category
29
Importance Weight
Strategic Category
ICD-
10-C
M/PC
S Co
mplia
nce
5010
Com
plian
ce
Integ
ratio
n with
othe
r reg
ulator
y co
mplia
nce p
rogr
ams (
RACs
, HAC
s, MA
Cs)
Regu
lator
y Sco
re
Drop
bill a
nd no
chan
ge in
A/R
days
Portf
olio m
anag
emen
t
Paye
r/Pro
vider
integ
ratio
n (Co
ntrac
ts)
Reve
nue C
ycle
Scor
e
IT S
ystem
Integ
ratio
n
Clini
cal in
tegra
tion
Func
tiona
l integ
ratio
n
Paye
r/Pro
vider
integ
ratio
n
Oper
atio
nal S
core
Accu
racy
Quali
ty re
portin
g pro
gram
s
Perfo
rman
ce M
anag
emen
t
Over
all IC
D-10
Prio
rity S
core
Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 5 5 5 5 5 5 469Case mix systems 3 5 3 4 3 3 4 4 4 4 4 4 384DRG grouper 5 5 3 5 3 3 3 3 3 4 5 5 403Compliance checking systems 5 5 2 4 1 2 2 2 1 1 4 2 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 4 2 5 2 3 3 4 4 4 401Claim submission systems 2 3 2 2 3 5 3 2 1 3 4 3 281Registration and scheduling systems 1 2 1 3 2 1 3 1 1 3 3 2 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 4 3 2 5 4 3 1 4 2 317Pharmacy systems 3 4 2 3 4 5 3 5 5 5 5 5 412Registries 2 2 1 4 5 4 1 3 4 5 3 2 306Patient assessment data sets (PAI, OASIS) 1 1 1 1 1 1 1 1 1 1 1 1 103
10 9
Regulatory Revenue CycleOperational Efficiency
Performance Management
8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
4. Populate with ICD-10 Action Plan Milestones
30
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 16
Notes/Comments/Questions
Importance Weight
Strategic Category
ICD-
10-C
M/PC
S Co
mplia
nce
5010
Com
plian
ce
Integ
ratio
n with
othe
r reg
ulator
y co
mplia
nce p
rogr
ams (
RACs
, HAC
s, MA
Cs)
Regu
lator
y Sco
re
Drop
bill a
nd no
chan
ge in
A/R
days
Portf
olio m
anag
emen
t
Paye
r/Pro
vider
integ
ratio
n (Co
ntrac
ts)
Reve
nue C
ycle
Scor
e
IT S
ystem
Integ
ratio
n
Clini
cal in
tegra
tion
Func
tiona
l integ
ratio
n
Paye
r/Pro
vider
integ
ratio
n
Oper
atio
nal S
core
Accu
racy
Quali
ty re
portin
g pro
gram
s
Perfo
rman
ce M
anag
emen
t
Over
all IC
D-10
Prio
rity S
core
Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 5 5 5 5 5 5 469Case mix systems 3 5 3 4 3 3 4 4 4 4 4 4 384DRG grouper 5 5 3 5 3 3 3 3 3 4 5 5 403Compliance checking systems 5 5 2 4 1 2 2 2 1 1 4 2 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 4 2 5 2 3 3 4 4 4 401Claim submission systems 2 3 2 2 3 5 3 2 1 3 4 3 281Registration and scheduling systems 1 2 1 3 2 1 3 1 1 3 3 2 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 4 3 2 5 4 3 1 4 2 317Pharmacy systems 3 4 2 3 4 5 3 5 5 5 5 5 412Registries 2 2 1 4 5 4 1 3 4 5 3 2 306Patient assessment data sets (PAI, OASIS) 1 1 1 1 1 1 1 1 1 1 1 1 103
10 9
Regulatory Revenue CycleOperational Efficiency
Performance Management
8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
5. Prioritize Milestones according to strategic
priorities
Key Relation to Strategic Category
5‐ Highest Priority Direct
4‐ High Priority Indirect
3‐ Medium Priority Somewhat
2‐ Medium Priority Minimally1‐ Low Priority Not
31
Importance Weight
Strategic Category
ICD-
10-C
M/PC
S Co
mplia
nce
5010
Com
plian
ce
Integ
ratio
n with
othe
r reg
ulator
y co
mplia
nce p
rogr
ams (
RACs
, HAC
s, MA
Cs)
Regu
lator
y Sco
re
Drop
bill a
nd no
chan
ge in
A/R
days
Portf
olio m
anag
emen
t
Paye
r/Pro
vider
integ
ratio
n (Co
ntrac
ts)
Reve
nue C
ycle
Scor
e
IT S
ystem
Integ
ratio
n
Clini
cal in
tegra
tion
Func
tiona
l integ
ratio
n
Paye
r/Pro
vider
integ
ratio
n
Oper
atio
nal S
core
Accu
racy
Quali
ty re
portin
g pro
gram
s
Perfo
rman
ce M
anag
emen
t
Over
all IC
D-10
Prio
rity S
core
Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 99 5 5 5 5 120 5 5 70 469Case mix systems 3 5 3 110 4 3 3 90 4 4 4 4 96 4 4 56 384DRG grouper 5 5 3 130 5 3 3 99 3 3 3 4 80 5 5 70 403Compliance checking systems 5 5 2 120 4 1 2 63 2 2 1 1 32 4 2 42 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 150 4 2 5 99 2 3 3 4 80 4 4 56 401Claim submission systems 2 3 2 70 2 3 5 90 3 2 1 3 48 4 3 49 281Registration and scheduling systems 1 2 1 40 3 2 1 54 3 1 1 3 40 3 2 35 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 90 4 3 2 81 5 4 3 1 64 4 2 42 317Pharmacy systems 3 4 2 90 3 4 5 108 3 5 5 5 120 5 5 70 412Registries 2 2 1 50 4 5 4 117 1 3 4 5 96 3 2 35 306Patient assessment data sets (PAI, OASIS) 1 1 1 30 1 1 1 27 1 1 1 1 24 1 1 14 103
10 9
Regulatory Revenue CycleOperational Efficiency
Performance Management
8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
6. Review/ discuss priorities and
communicate to organization executives
32
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 17
Notes/Comments/Questions
Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization
Create a One Page Dashboard for Key Stakeholder:• Examples:
• All Executives- Overall Summary with Sub-summaries by key areas
• Revenue Cycle- Sort by this key category to enable specific discussions
33
Polling Question #3
Do you think a tool like this could assist in prioritizing your organization’s ICD-10 Planning when the timing is right?
a) Yesb) Noc) Not Sure
34
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 18
Notes/Comments/Questions
Next Steps –Getting Started…and Realize Results
Communicate opportunity to key executives and stakeholdersProvide knowledge transfer re: opportunityObtain executive decision re: organizational priorities/strategic objectivesPrioritize data/functional translations accordingly with interdisciplinary teamInitiate processImplement PlanRealize Results!
35
ICD-10 Implementation Summary
Goal Timing1. Provide Organization Education/Awareness NOW!2. Appoint Interdisciplinary Steering Committee
3. Develop ICD-10 Strategy and Plan
4. Determine Functional Area Opportunities and Gap
5. Initiate Interdisciplinary Project Management
6. Partner with Vendors and stakeholders
7. Ensure Payer Implementation Plan in Place
8. Provide Detailed Training According to Program Plan
9. Simulate and Manage Change
10. Successful Implementation!36
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 19
Notes/Comments/Questions
Discussion & Recommendations
Debrief• Positive• Recommendations
How might you use this approach in your organization?References:• AHIMA http://www.ahima.org/ICD10/• 3M HIS ICD-10
http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/Resources/ICD-10/
• CMS Educational resources http://www.cms.hhs.gov/ICD10/05_Educational_Resources.asp#TopOfPage
37
Audience Questions
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 20
Notes/Comments/Questions
Audio Seminar Discussion
Following today’s live seminarAvailable to AHIMA members at
www.AHIMA.org“Members Only” Communities of Practice (CoP)
AHIMA Member ID number and password required
Join the e-HIM Community from your Personal Page. Look under Community Discussions for the Audio Seminar Forum
You will be able to:• discuss seminar topics • network with other AHIMA members • enhance your learning experience
Become an AHIMA Member Today!
To learn more about
becoming a member
of AHIMA, please visit our website
at www.ahima.org/membership
to join now!
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 21
Notes/Comments/Questions
AHIMA Audio Seminars and Webinars
Visit our Web site http://campus.AHIMA.orgfor information on the 2009 seminar schedule. While online, you can also register for seminars and webinars or order CDs, MP3s, and webcasts of past seminars.
Upcoming Webinars
The Intersections between E-Prescribing and HIMMay 19, 2009The Legal Health Record and E-Discovery: Where You Need to Be June 9, 2009Auditing for Privacy and Security Compliance June 23, 2009
ICD-10-CM/PCS Impact Assessment
AHIMA 2009 HIM Webinar Series 22
Notes/Comments/Questions
AHIMA Distance Education
Anyone interested in learning more about e-HIM® should consider one of AHIMA’s web-based training courses.
For more information visit http://campus.ahima.org
Thank you for joining us today!
Remember − visit the AHIMA Audio Seminars/Webinars Web site
to complete your evaluation form and receive your CE Certificate online at:
http://campus.ahima.org/audio/2009seminars.html
Each person seeking CE credit must complete the sign-in form and evaluation in order
to view and print their CE certificate.
Certificates will be awarded for AHIMA CEUs.
Appendix
AHIMA 2009 HIM Webinar Series 23
Resource/Reference List ....................................................................................... 24 CE Certificate Instructions
Appendix
AHIMA 2009 HIM Webinar Series 24
Resource/Reference List http://www.ahima.org/ICD10/
http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/Resources/ICD-10/
http://www.cms.hhs.gov/ICD10/05_Educational_Resources.asp#TopOfPage
To receive your
CE Certificate
Please go to the AHIMA Web site
http://campus.ahima.org/audio/2009seminars.html click on the link to
“Sign In and Complete Online Evaluation” listed for this webinar.
You will be automatically linked to the
CE certificate for this webinar after completing the evaluation.
Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the webinar, in order to view
and print the CE certificate.
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