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Preparing Your Hospital for a Successful Implementation to ICD-10-CM and ICD-10-PCS
Saturday, July 28, 2012 Taiwan Medical and Health Information
Management Association Nelly Leon-Chisen, RHIA
Director Coding and Classification
American Hospital Association
Objectives
• Understand how to build a strategy for implementing ICD-
10-CM/PCS in a hospital environment.
• Describe key elements required in a plan for successful
transition to the ICD-10-CM and ICD-10-PCS systems and
its impact to your facility.
• Make recommendations to organize your ICD-10 transition
team and develop the team’s ―to-do‖ list.
• Understand the role and function of different levels of
hospital staff: executive management, medical staff, health
information management and other departments.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
2
Develop ICD-10 Strategy
• Communicate • Plan • What will it take? - Working on systems
- Time to test internally - Time to test with external
partners - Training • Determine training needs
(different levels) - Documentation improvement
Copyright (c) 2012 by American Hospital Association. All rights reserved
3
Large, Medium or Small
• The level of complexity to implement ICD-10-CM/PCS will
depend on a number of factors
including - hospital size - organization of the hospital - level of automation - the number of electronic databases and
- functional areas affected • But the basic components of the
implementation plan will be the same.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
4
Implementation Phases
Implementation is divided into four phases:
Phase 4
Phase 1
Organizing the Effort
Phase 2 Planning and
Impact Analysis
Phase 3
Implementation
Post- implementation
Evaluation and
Ongoing Efforts
Copyright (c) 2012 by American Hospital Association. All rights reserved.
5
Sample ICD-10 Timeline Developed
Source: American Hospital Association, HIPAA Code Set Rule: ICD-10 Implementation, Executive Briefing
Copyright (c) 2012 by American Hospital Association. All rights reserved.
6
Strategic Planning and Opportunities
• Successful transition requires careful strategic planning and coordination of resources across the entire hospital
• Begin by examining every application where diagnosis or procedure codes are captured, stored, analyzed or reported
• Engage executive leadership • Address challenges across a wide-range of functional areas • Address implications to current and future information
systems • Review current work flow and medical documentation practices
Copyright (c) 2012 by American Hospital Association. All rights reserved.
7
Role of Executive ICD-10 Sponsor
• Organizational Executive ICD-10 Sponsor - Assist in prioritizing ICD-10 activities over other
organization-wide initiatives - Ensure collaboration among departments
- Ensure budgeting issues are considered organization-
wide - Report progress of ICD-10 implementation to CEO and
senior management - Report progress to rest of senior management group
Copyright (c) 2012 by American Hospital Association. All rights reserved.
8
Phase I - Organizing the Implementation Effort
• This phase will involve: - Organizing your cross
functional Steering
Committee - Selecting a Steering
Committee leader - Developing a meeting
schedule - Identifying required tasks
and developing timelines - Assigning tasks and
responsibilities
Copyright (c) 2012 by American Hospital Association. All rights reserved.
9
Communication!
• Organizational awareness • Sharing of information • Communicating and more
communicating
Copyright (c) 2012 by American Hospital Association. All rights reserved.
10
Organizing Your Cross Functional Steering Committee
• Not just a ―coding thing‖
• Who is in charge?
• Collaboration among departments will
be necessary to identify information
systems affected
• Members across clinical, financial and
information systems area
• Get support from executive
management
• Be sure to involve both HIM department
leaders as well as coders
Copyright (c) 2012 by American Hospital Association. All rights reserved.
11
Cross-functional Team
• Convene a cross functional Steering Committee to:
- Identify system applications
affected - Assign tasks and responsibilities to carry-out the necessary
changes • Approach will vary from hospital to
hospital, but cross functional team is a necessity!
Copyright (c) 2012 by American Hospital Association. All rights reserved.
12
ICD-10 Steering Committee Composition
• Leadership - Sponsorship and support from a senior
level manager to ensure coordination
across departments • Core Steering Committee Members
- Health Information Management - Information Systems and Technology - Billing - Finance - Compliance - Revenue Cycle Management
Copyright (c) 2012 by American Hospital Association. All rights reserved.
13
ICD-10 Steering Committee Composition (cont.)
• Ad Hoc Team Members - Quality
- Registration - Nursing - Clinics - Emergency Department - Pharmacy - Medical Staff Affairs - Outpatient Surgery
- Ancillary services such as:
• Imaging • Laboratory Services • Cardiology - Rehabilitation
- Home Health - Urgent Care - Therapies - Utilization Review
14
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Organizing the Implementation Effort
Tasks
Develop implementation goals Develop plan for assessing implementation
impact Develop implementation strategy Develop tools to assess impact on affected
functional areas Identify Steering Committee’s required
tasks Develop timelines Assign responsibility for tasks
Educate IS staff on code sets
Copyright (c) 2012 by American Hospital Association. All rights reserved.
15
ICD-10-CM/PCS Implementation Meeting
• Bring together IT and HIM - leaders • Include other key stakeholders - Develop a contact list
• Agenda to include what the 5010 and ICD-10 initiatives are • IT areas of concern—discuss • IT tasks for next 60-90 days • HIM areas of concern—discuss • HIM tasks for the next 60-90 days • Other areas of concern—discuss • Action to be taken - Develop assessment tool(s)
• Working project plan and timelines • Budget considerations • Next meeting
Copyright (c) 2012 by American Hospital Association. All rights reserved.
16
Large Hospitals May Need Additional Work Groups
• Work Group - Communications • Work Group - HIPAA v5010 • Work Group - Budget and Standardization • Work Group - IT Enterprise Planning - Work Group - IT Integration
• Work Group - ICD-10 Coding • Work Group - ICD-10 Business Process Change • Work Group - Vendor Relations • Work Group - Patient Financial Service/Business Office • Work Group - Managed Care Contracting • Work Group - Clinical
Copyright (c) 2012 by American Hospital Association. All rights reserved.
17
ICD-10-CM/PCS Awareness
• Important to have the
―correct‖ awareness and facts
about ICD-10
• Prepare an ―Executive
Summary‖ (1-2 pages)
- What is ICD-10
- What is the impact
- How do we prepare
- Distribute to Executive
Management
• Prepare a high level overview
for HIM Coding staff
Copyright (c) 2012 by American Hospital Association. All rights reserved.
18
Role of ICD-10 Steering Committee Lead
• ICD-10 Steering Committee Lead - Convene ICD-10 Steering Committee meetings
- Set ICD-10 Steering Committee meeting agendas - Report progress to ICD-10 sponsor - Keep track of implementation progress
Copyright (c) 2012 by American Hospital Association. All rights reserved.
19
Implementation Phases
Implementation is divided into four phases:
Phase 4
Phase 1
Organizing the Effort
Phase 2 Planning and
Impact Analysis
Phase 3
Implementation
Post- implementation
Evaluation and
Ongoing Efforts
20
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Phase II - Planning and Impact Analysis
• This phase will involve performing an organizational assessment and developing an implementation schedule
including: - Conducting an information systems inventory - Assessing vendor readiness and support - Conducting staff awareness sessions - Assessing and planning for staff training needs - Identifying necessary tools - Identifying areas requiring operational and policy changes
- Evaluating health plan contract implications - Budget planning - Identifying gaps in health record documentation
Copyright (c) 2012 by American Hospital Association. All rights reserved.
21
Organize Departmental Assessment
• ICD-10 will impact different departments differently • Each department should conduct internal assessment and report findings back to the ICD-10 Steering Committee
• Develop a detailed ―master to-do list‖ • Departmental assessment to include - Inventory of information systems
- Assessment of training needs - Identification of areas requiring operational and policy changes
- Identification of necessary tools
Copyright (c) 2012 by American Hospital Association. All rights reserved.
22
Sample ICD-10 Implementation Department Assessment
Department: Health Information Management
Application Name
Vendor
Application
Frequency of
Under
Diagnosis or
Codes Entered
Lead Person Maintainer
Regular Updates
Maintenance
Procedure
Directly Into Contract
Codes, or Both
Application or Downloaded from Other Systems?
Encoder
ABC, Inc.
ABC, Inc.
Quarterly
Yes
Both
Entered directly
K. Jackson
Abstracting
DEF
DEF
Quarterly
Yes
Both
Downloaded from System
encoder
DRG Grouper
GHI
GHI
Annual
Yes
Both
Downloaded from encoder
Outpatient Code
Quarterly
Yes
Diagnosis
Entered directly Editor
Present on
In-house
IS&T
Annual
No
Diagnosis
Downloaded from Admission
abstracting Database
system
Birth Registrations
State
State
Annual
Yes
Diagnosis
Entered directly
Trauma Registry
State
State
Annual
Yes
Diagnosis
Entered directly
Copyright (c) 2012 by American Hospital Association. All rights reserved.
23
Public Reporting Across the Continuum-
Where are ICD-9 and ICD-10 Codes?
AHRQ Publication: 07 0033 EF March 2007
24
Conducting Information Systems Inventory
• Survey all departments to conduct an inventory of the applications used.
• Commercial vs. in-house application - Diagnosis vs. procedure codes or both
- Codes entered directly into application or transferred
from another application - Interfaces - Frequency of updates - Updates included as part of maintenance contract • Storage capability
• Field size changes
Copyright (c) 2011 by American Hospital Association. All rights reserved.
25
Systems Likely To Be Affected
• Accounting systems • Advanced Beneficiary Software
• Birth defect registries • Billing • Case management system • Claims submission • Clinical data reporting • Clinical department systems • Clinical protocols • Clinical reminder systems • Compliance checking systems
• Databases • Decision support systems • Disease management • DRG grouper • Electronic processing systems • Encoder software • E-prescribing • Financial systems • Hospital information system • Interface engines • Inpatient rehab facility patient assessment instrument data
collection
26
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Systems Likely To Be Affected (cont.)
• Managed care (HEDIS) reporting system
• Medical abstracting system
• Medical necessity • Minimum data set collection system
• OASIS system • Outpatient Code Editor • Pharmacy systems • POA systems • Provider profiling
• Quality management • Reports • Registration and scheduling
• Research databases • State birth registration systems
• State reporting systems • Test ordering systems • Utilization management
27
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Assessing Legacy Systems
• Currently in use? • What is it used for? • Is the system still currently in use? • What is the system used for? • Does the system work satisfactorily? • Is there another application currently available that can
perform a similar function as the current system? • Is there current staff capable of redesigning the system? • Is the system documented fully enough to allow another designer to update the system?
• On what hardware does the system run? • On what software platform does the system run?
Copyright (c) 2011 by American Hospital Association. All rights reserved.
28
Assessing Legacy Systems
• Is the system difficult to maintain or improve? • Can the system be integrated with newer systems? • What is the cost of updating the system? • What is the cost of replacing the system with a new
application? • With what other systems or programs does the legacy
system interface? • What impact would a change in the legacy system have on these other systems or programs?
• With how many legacy systems is your organization
contending? • If multiple systems, what is the priority among the legacy systems?
Copyright (c) 2011 by American Hospital Association. All rights reserved.
29
Assessing Legacy Systems
Question
Answer/Comments
Is the system still currently in use?
What is the system used for?
Does the system work satisfactorily?
Is there another application currently available that can perform a similar function as the current
system? Is there current staff capable of redesigning the system? Is the system documented fully enough to allow another designer to update the system?
On what hardware does the system run?
On what software platform does the system run? Is the system difficult to maintain or improve? Can the system be integrated with newer systems?
What is the cost of updating the system?
What is the cost of replacing the system with a new application?
Copyright (c) 2012 by American Hospital Association. All rights reserved.
30
Assessing Vendor Readiness and Support
Identify which vendor systems
are affected Develop a master list of all
vendors affected Contact vendors to determine
whether changes to existing systems are forthcoming and
when they plan to have available upgrades to support
ICD-10
Determine whether the
upgrade to ICD-10 is included with your maintenance
agreement
Ask vendor to share their
plans for readiness Make certain that the vendor
intends to continue to provide support for the application
Determine whether the
application requires any
special or custom developed
edits
Identify special terms in
contracts to cover custom edits, if any
31
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Commercial vs. Homegrown Software
• Work with major commercial vendors to ensure they are aware
- Technical issues - Contractual issues - Costs - Timelines • Homegrown Systems
- Technical issues - Costs
Copyright (c) 2012 by American Hospital Association. All rights reserve
32
Data Conversion
• Decisions, decisions, decisions - Cost/benefit analysis
regarding database uses - Convert?
- Cross-walk? - Dual systems?
Copyright (c) 2012 by American Hospital Association. All rights reserve
33
IT Implementation Issues
• Interact with all vendors to ensure each one provides an ICD-10-CM/PCS
update for current system—
assessments and readiness • Evaluate interfaces that lie between
code entry in HIM and electronic billing • Inventory department databases and
decision support systems - Patient Financial Services
• Determine retention needs for ICD-9-CM
Copyright (c) 2012 by American Hospital Association. All rights reserved.
34
Consider Storage Capabilities
• Consider storage capabilities of all
systems and plans for
maintaining both code
sets for a period of time • Determine need to store
historical data • Consider expanded
number of available codes for ICD-9-CM vs.
ICD-10-CM/PCS.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
35
Field Size Changes
• Field size changes associated with ICD-10-CM/PCS codes will also impact storage capabilities.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
36
Evaluate Health Plan Contract Implications
• Prepare list of largest health plans • Review existing health plan contracts - Diagnosis or procedure based?
- DRG based? - Other basis? • Contact health plans and schedule meetings (can be done
collectively with other providers; if possible work with state
associations to schedule meetings) • Share hospital plans for readiness and dates when hospital will be ready to begin external testing
• Host periodic follow-up meetings to share implementation
progress and to validate plans for future testing
Copyright (c) 2012 by American Hospital Association. All rights reserved.
37
Budget Requirements
• Consider multi-year budgeting and reassess financial support that is needed on an annual basis.
• Budgeting requirements should include consideration for the following areas:
- Training and education - System changes - Staffing for internal changes - Updating of existing commercial software applications - Purchasing replacement applications that will not be upgraded internally
- Data conversion - Purchasing of electronic tools to assist in mapping or
conversions
Copyright (c) 2012 by American Hospital Association. All rights reserved.
38
Budgetary Impact
• Operational - Education, staffing
• Capital - System/interface modifications
- Replacement/new systems • MS-DRG reimbursement
- Potential effect of delays, decrease in coder productivity - Lack of specificity in documentation - Payer not ready to process - Contingency planning
Copyright (c) 2012 by American Hospital Association. All rights reserved.
39
Provider Costs
• Personnel costs -- lost productivity, training - Dual coding?
• Hardware and software changes - Commercial vs. homegrown systems
- Vendor awareness - Technical issues - Contractual issues - Costs • Data conversion
- Cost/benefit analysis regarding database uses • Convert?
• Cross-walk? • Dual systems?
Copyright (c) 2012 by American Hospital Association. All rights reserved.
40
Assessing and Planning for Staff Training Needs
Accounting
Ancillary departments
Auditors
Performance improvement
Business office
Claims analysts
Clinicians
Coders
Clinical department managers
Compliance
Patient access & registration
Data analysts
Infection control
Medical staff
Other HIM department employees
Information systems
Billing
Quality management
Senior management
Utilization review
Copyright (c) 2012 by American Hospital Association. All rights reserved.
41
Determine Need for Level of Understanding
Source: AHA
Copyright (c) 2012 by American Hospital Association. All rights reserved.
42
Don’t Forget the Medical Staff
• Collaboration is key
- Training
- Documentation changes
- ICD-10 requires more
detailed documentation to
specify aspects of diagnoses
and procedures required for more detailed codes
• Partnering
- Help them understand the
impact
- Include their office staff in training
- Assist them to convert their ―super bills‖
43
Copyright (c) 2012 by American Hospital Association. All rights reserved
Case of the Missing Documentation
• Paper vs. electronic • Hybrid • Documentation in multiple
locations - Difficult to find
- Coders may need to log into multiple
systems or paper - Easy to miss important
information - Coders are too
valuable to spend time
playing detectives
• Centralized records
- Scanning
- Electronic health
records • Technology can be a
coder’s best friend (if done right) • Enable remote chart
reviews and audits • Dealing with shortage of qualified coders
Copyright (c) 2012 by American Hospital Association. All rights reserved 44
ICD-10 MS-DRG Conversion
• Conversion goals: - Coded in ICD-9-CM or ICD-10, the same patient is
assigned to the same MS-DRG - Clinically equivalent - Definitions manual has familiar look and feel • Over time DRGs could be refined to take advantage of
additional specificity. • Version 28.0 (FY 2012) of the ICD-10 MS-DRGs is posted
on CMS web site. • Final version of ICD-10 MS-DRGs to be implemented will be subject to rulemaking.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
45
Implementation Phases
Implementation is divided into four phases:
Phase 4
Phase 1
Organizing the Effort
Phase 2 Planning and
Impact Analysis
Phase 3
Implementation
Post- implementation
Evaluation and
Ongoing Efforts
46
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Phase 3: Implementation
• This phase will involve executing, monitoring and overseeing the implementation schedule including:
- Outlining specific tasks and monitoring timeline for
completion - Reviewing budget requirements - Developing metrics and monitoring progress - Routine reporting of progress towards completion - Implementing changes to system design and development
- Testing and validation of system changes - Conducting the staff training - Conducting physician training to address documentation
gaps
Copyright (c) 2012 by American Hospital Association. All rights reserved.
47
Phase 3 - Implementation (cont.)
- Conducting physician training to address documentation gaps
- Monitoring current work flow volumes during the training
period so backlogs are a minimum prior to go live. This will result in less time needed to maintain dual
coding systems if old accounts
are processed prior to implementation.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
48
Operational and Policy Changes
• As you make your plans for ICD-10- CM/PCS implementation also
review existing operations and policies. There may be a need to
change these - especially those dealing with coding and documentation instructions.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
49
Useful Tools
• Commercial tools - Translation tools
- Conversion tools - Comparative assessment tools - Compliance tools • Free tools currently available
- General Equivalence Mappings (GEMs) - Reimbursement mappings • Designed to be used by all providers, payers, and
data users • Tools to assist in converting data
• Publicly available on the CMS & CDC websites
Copyright (c) 2012 by American Hospital Association. All rights reserved.
50
Other Tools
• Data analysis and decision review tools - For example, a translation tool may be used to evaluate
revised health plan contracts (decision support, revenue
cycle, claims adjudication applications) and the
translation tool may convert the vast majority of the codes. - There are, however, a small number of codes that
will still require manual evaluation and expert
decision making about code list relationships to determine the most accurate mapping.
- The manual evaluation may require data analysis support and other tools that can look at the provider’s
patient population, past contracts, or other pertinent
information.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
51
Execute Implementation Schedule • Outline of the specific tasks to work on.
• Develop a master ―to-do‖ list with specific timelines for
completion.
- Identify responsible individuals
- Identify required tools
- Appoint project manager to ensure timing and
interdependent milestones are flawless for ―on time‖
implementation.
• The ICD-10-CM/PCS Steering Committee can assist with
prioritization of tasks in collaboration with the affected
departments.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
52
Metrics and Monitoring Progress
• Establish and monitor timelines and progress. Report findings to the ICD-10-CM/PCS Steering Committee on a
monthly basis. Timelines may need to be adjusted as
necessary.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
53
Routine Reporting
• Routine reporting on implementation progress - Integral component of the ICD-10-CM/PCS Steering
Committee meetings. - Report progress at organization-wide meetings
- Share among departments to ensure staff is apprised of
progress. • Manager and Department Involvement
- Specific tasks for individual departments will be completed by department managers and their staff.
- Whenever possible, activities should be incorporated
into individual performance evaluations.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
54
System Design Development - Internal Testing Process
• Populate files used for testing purposes. • Examine whether all of the format configuration changes have been properly modified.
• Validate whether these changes are properly recorded in
the specific section of the HIPAA transaction standard. • Test the accuracy of the changes by creating edits that specifically focus on these changes and how and when they
should occur as information flows during the population of
data into the files.
55
Copyright (c) 2012 by American Hospital Association. All rights reserved.
System Design Development - Internal Validation Process
• Examine whether supporting documentation is gathered and is available to support the coded information.
• Monitor whether appropriate security methods are used,
including log-in and tracking of individuals. • Ensure that the appropriate communication protocols are being utilized during the transmission of data.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
56
System Design Development - External Testing Process
• Prepare for external testing by communicating
with the health plans. • Register with the health plans for testing. • Establish dates for conducting testing • Identify the various production scenarios that should be used during the testing period.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
57
System Design Development - External Validation Process
• Consider the results that should be achieved from a reimbursement perspective.
• Validate that the results should yield similar reimbursement
results to that of using ICD-9-CM. • Ensure health plans demonstrate that they are processing
the claim using the ICD-10-CM/PCS information rather than
relying on the GEMS to convert an ICD-10-CM/PCS code
back to an ICD-9-CM and then process the claim for
payment. • Verify that the health plan has not redone their edit logic for reimbursement using ICD-10-CM/PCS as their basis to drive
the reimbursement formula. This is important because the
GEMS will not be maintained indefinitely and at some point
in the near future the maintenance for these GEMS will
cease. •
Copyright (c) 2012 by American Hospital Association. All rights reserved.
58
System Design Development - External Validation Process
• Ensure the production scenarios reflect real-world situations - typical billing scenarios reflecting the most common type
of claims. • Generate reports on the results of the external testing
process. • Review the security and connectivity profiles as well as any additional resulting transaction that is generated from the
submitted transaction. That includes the acknowledgment
transaction as well as other transactions. For instance if the claim is submitted it then is processed using the ICD-10- CM/PCS codes, once processed it produces the remittance
transaction to describe how reimbursement occurred. This
end-to-end testing is needed to ensure appropriate changes have been made.
Copyright (c) 2012 by American Hospital Association. All rights reserved.
59
Implementation Phases
Implementation is divided into four phases:
Phase 4
Phase 1
Organizing the Effort
Phase 2 Planning and
Impact Analysis
Phase 3
Implementation
Post- implementation
Evaluation and
Ongoing Efforts
60
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Phase 4: Post Implementation Evaluation and Ongoing Efforts
• This phase will involve an evaluation to determine the success of the implementation, as well as fine-tuning any
additional changes required including: - Evaluating software upgrades - Reviewing quality of coded data - Conducting additional staff training - Reinforcing physician documentation training - Assessing case mix impact
Copyright (c) 2012 by American Hospital Association. All rights reserved.
61
Phase 4 - Post-implementation Evaluation and Ongoing Efforts • Software Upgrades
- Evaluate software applications to ensure applications
are working appropriately.
• If necessary, software upgrades or enhancements
may be needed to correct any post implementation
―glitches‖ or system errors.
•
Training
- Conduct additional training based on findings of quality
coding audits.
- Conduct physician training based on coding staff
identification of high volume areas requiring additional
physician queries.
62
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Phase 4 - Post-implementation Evaluation and Ongoing Efforts (cont.)
• Quality Improvements - Conduct an audit of coded data post implementation to
identify any potential coding errors or areas. - Work with coding staff to determine the high volume
areas requiring additional physician queries and develop
physician documentation training accordingly. • Comparative Assessments
- Review coded data to ensure that cases continue to be reimbursed at the same rate or grouped to the same
MS-DRG they would have been with ICD-9-CM. - Monitor reimbursements to avoid any unintended
consequences of coding change.
63
Copyright (c) 2012 by American Hospital Association. All rights reserved.
Roles by Function
• HIM/Coding - Participate as a member of ICD-10 Steering Committee
- Conduct ICD-10 awareness training throughout
organization - Complete information systems assessment inventory - Identify training and budgeting issues for department - Determine physician documentation areas requiring
improvement - Identify areas in coding and documentation requiring operational and policy changes
- Identify gaps in health record documentation
Copyright (c) 2012 by American Hospital Association. All rights reserved.
64
Roles by Function
• Billing - Participate as a member of ICD-10-CM/PCS Steering
Committee - Attend ICD-10-CM/PCS awareness training sessions
- Complete information systems assessment inventory - Identify training and budgeting issues for department - Identify areas requiring operational and policy changes
Copyright (c) 2012 by American Hospital Association. All rights reserved.
65
Roles by Function
• Finance - Participate as a member of ICD-10-CM/PCS Steering
Committee - Attend ICD-10-CM/PCS awareness training sessions
- Complete information systems assessment inventory - Identify training and budgeting issues for department - Identify areas requiring operational and policy changes - Review current contractual agreements with health plans - Analyze impact of ICD-10-CM/PCS on health plan agreements
Copyright (c) 2012 by American Hospital Association. All rights reserved.
66
Roles by Function
• Information Systems - Participate as a member of ICD-10-CM/PCS Steering
Committee - Attend ICD-10-CM/PCS awareness training sessions
- Complete information systems assessment inventory - Assess vendor readiness and support - Review contractual agreements with software vendors - Ensure ICD-10-CM/PCS implementation is considered in all future software application purchases
- Identify training and budgeting issues for department - Identify areas requiring operational and policy changes
Copyright (c) 2012 by American Hospital Association. All rights reserved.
67
Roles by Function
• Quality - Participate as a member of ICD-10-CM/PCS Steering
Committee - Attend ICD-10-CM/PCS awareness training sessions
- Complete information systems assessment inventory - Identify training and budgeting issues for department - Identify areas requiring operational and policy changes - Identify areas where physician documentation improvement may be necessary
- Assess opportunities with availability of granular data for
quality improvement
Copyright (c) 2012 by American Hospital Association. All rights reserved.
68
Roles by Function
• Medical Staff Liaison - Participate as a member of ICD-10-CM/PCS Steering
Committee - Attend ICD-10-CM/PCS awareness training sessions
- Complete information systems assessment inventory - Identify training and budgeting issues - Participate in documentation improvement training
Copyright (c) 2012 by American Hospital Association. All rights reserved.
69
AHA Member Benefit Executive Briefing and Advisories
Available on www.aha.org and www.ahacentraloffice.org
70
Resources and References
• Centers for Medicare and Medicaid Services
ICD-10-PCS
www.cms.hhs.gov/ICD10
• National Center for Health Statistics - CDC ICD-10-CM
http://www.cdc.gov/nchs/icd/icd10cm.htm
• AHIMA www.ahima.org/icd10
• AHA
http://www.ahacentraloffice.org/ICD-10
Copyright (c) 2012 by American Hospital Association. All rights reserved.
71
Questions?
Copyright (c) 2012 by American Hospital Association. All rights reserved.
72
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