sharp healthcare icd-10 momentum continues! · pdf filesharp healthcare icd-10 momentum...

Sharp Healthcare ICD-10 Momentum

Continues!

CAHP Annual Conference

October 2012

Huntington Beach, CA

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AGENDA

Reflection

Sharp Introduction

The Teams

The Stats

The Schedule

Upcoming Events

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Reflection

“People who work together will win,

whether it be against complex football

defenses, or the problems of modern society.” ~Vince Lombardi

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Sharp HealthCare Largest health care system in San Diego

2 affiliated medical groups, 7 hospitals, 3

skilled nursing facilities, a health plan, 21

outpatient clinics, 5 urgent care centers,

home health, hospice, and home infusion

programs

Market share leader and only health care

system that increased market share each of

the past 11 years

Largest private employer in San Diego o 15,000 employees, 2,600 affiliated physicians,

2,300 volunteers

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Sharp HealthCare Grew from one hospital in 1955

to an integrated health care delivery system Aligned physician partners

Fully integrated information technology systems and infrastructure

Centralized system support services

Over 25 years experience in managing care under population-based payment structures

Sharp Health Plan, a 65,000 member, Knox Keene licensed commercial health plan

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The Teams

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Transcription, Documentation and Coding

Develop an enterprise strategy for transcription,

clinical documentation and coding that…

• Re-evaluates transcription for service improvements

and as part of a comprehensive strategy

• Consolidates the various transcription vendors,

services and related products that currently exist

within the organization.

• Assesses complementary technologies such as

voice recognition, natural language processing and

computer assisted coding.

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RFP Project

Coding, Documentation and Education Workgroup

• Create the education and training materials

needed for all levels of employees and health care

providers affiliated with Sharp to support accurate

and compliant ICD-10 coding for all services

provided.

• Education for:

- Environment: Hospital-based Services:

- Audience: Coders (HIM), Auditors, Billers, and Lab

Imaging Ancillary

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The Stats

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Key Performance Indicators

• Determine baseline before go live

• Measure after go live

• Determine frequency of measure and reporting

• Measurement at 30, 60 and 90 day

Area Description

Hospital • Days in AR (number of days from bill date to pay date by payer) • Aged inventory over 90 • DNFB – coding (Discharged Not Final Billed) • % Denied by payer for ICD 10 • Medicare net rev/claim for Inpatient (IP) and Outpatient (OP) • MS-DRG coding accuracy

Clinic

• Days in AR • # Edits • % Denied by payer for ICD-10 • Sr HMO rev/claim • Physician document audit

Claims • Claim inventory • 95% paid claims timely

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The Stats

Area Description

Training • Hospital Total number people trained/total people to train • Clinic Total number people trained/total people to train • Hospital: Total coders passing certification test/total

number of coders that need to pass • Clinic: Total coders passing certification test/total number of

coders that need to pass

Budgets • Tracking of operating cost associated with ICD-10 implementation

• Tracking of capital cost associated with ICD-10 implementation

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The Stats

Area Description

IT Systems

• The total number of high priority applications upgraded on or before October 1, 2013 is 100%.

• The percentage of the total number of applications delivered into the Production environment with ICD-10 version upgrades completed by 10/1/2013 is 90 %.

• The percentage of the total number of applications obtaining approval/signoff from the testing process by 9/1/2013 is 90%

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The Stats

The Stats - IT Systems Tracking

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Reven

ue M

an

ag

em

en

t

Sys

tem

s (

RM

S)

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The Stats - IT Systems Tracking

RMS Programmers - GECB

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The Stats - IT Systems Tracking

RMS Analysts - GECB

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The Schedule

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The Schedule

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The Schedule

Systems are

ready!

Upcoming Events

FY 13 Priorities

• Hire/train new CDI RN staff

• Complete physician documentation education

• Implement CAC software

• Create electronic physician query process

• Develop key analytical reports

• All IT systems ICD-10 ready and in production by 10/1/13

o CACHE 2011 Upgrade

o GECB v5.1 Upgrade

o Claims Manager v4.9 Upgrade (TBD)

o CodeRyte Upgrade (TBD)

• Implementation of eScription, FES, and CAC/CDIS.

• APR-DRG’s implemented by 7/1/13 – needed for Medi-Cal billing.

• Coders ICD-10 certified. Coders trained and utilizing CAC .

• System-wide ICD-10 readiness one year in advance of 10/1/14.

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Thank You!

Carol Wanke

Vice President, Managed Care Operations

Carol.wanke@sharp.com

858-499-4217

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