shelly guffey preparing for icd-10 implementation 11.16.2012
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Shelly Guffey
PREPARING FOR ICD-10 IMPLEMENTATION
11.16.2012
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OVERVIEW
• Understanding ICD-9 to ICD-10
• Assessment of your business for ICD-10 readiness
• Preparing your systems for ICD-10
• Preparing your staff and physicians
• Current status of industry
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WHY THE CHANGE?• ICD-9-CM is running out of codes. Hundreds of new
diagnosis codes are submitted annually.– 30 year old code set contains outdated terminology & lack of
specificity
• ICD-10-CM will allow for more codes & greater specificity; thus better tracking– This will allow providers to better identify certain patients with
specific conditions
• Enhances quality measures
• Research capabilities will improve patient care
CHANGE FROM ICD-9 TO ICD-10
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UNDERSTANDING ICD-9 VS. ICD-10
• ICD-9 has approximately 13,600 codes that mostly are numeric. 3 to 5 digits
• ICD-10-CM for Diagnosis coding
• ICD-10-CM plans to have approximately 69,000 three to seven digit alphanumeric codes beginning with a letter followed by a mix of numbers and letters
• ICD-10-PCS for in-patient procedure coding
• ICD-10-PCS (facility inpatient coding only - not physicians) will go to 87,000 procedure codes vs. current 8,660 ICD-9 (vol.3) codes
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Characteristic ICD-9 ICD-10 CM
Field Length 3-5 characters 3-7 characters
Available Codes About 13,600 About 69,000
Code Composition Digit 1= alpha or numericDigit 2-5= numeric
Digit 1= alphaDigit 2= numericDigit 3-7= alpha or numeric
Sample Code 813.15- Open fracture of head of radius
S52123C- Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB or IIIC
UNDERSTANDING ICD-9 VS. ICD-10
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Characteristic ICD-9 (Vol.3) ICD-10 PCS
Field Length 3-4 characters 7 Alpha-numeric characters
Available Codes About 8,660 About 87,000
Procedure Description
Lacks description of procedure approach
Has detailed description of procedure approach
Sample Code 3924- Aorta-renal Bypass
04104J3- Bypass Abdominal Aorta to Right Renal Artery with Synthetic Substitute, percutaneous Endoscopic Approach
UNDERSTANDING ICD-9 VS. ICD-10
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• We are the only country that uses coding for reimbursement and one of the last to convert• Some countries use very limited code sets for
some in-patient payments
• We are the only country with a multi-payer system and innumerable payer policies
ICD-10 FACTS
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GETTING YOURSELF READY
• Work Plan
• Analysis
• Budgeting
• Execution
• Post Implementation Auditing
WORK PLAN
IMPLEMENTATION PLAN
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INCLUDE ENTIRE STAFF IN PLAN & FOLLOW A LOGICAL IMPLEMENTATION
• Steering High Level Committee
• Project Committee (in the details)
– Operations
– Systems
– Trainings
– Communications
– Budget
– Contract review
– Future on going
YOU SHOULD HAVE ALREADY BEGAN
WHO SHOULD BE
ON COMMITTEES
?
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• All systems should be inventoried: internal and external
• Review software and hardware• Review EMR impact• Potential system acquisitions• Identify vendors and their readiness• Data conversions• System modifications• Reporting/forms modifications
• Make sure you have the right people reviewing your system
SYSTEMS
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• Define, plan & schedule time for IT changes
• Can system handle ICD-9 and ICD-10?
• Can you do any crosswalks/mapping?• What else?
SYSTEMS
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HIM (HEALTH INFO
MANAGEMENT) * DRG grouper
* Encoding Software
* Abstract systems* Med records
REGISTRATION
SYSTEMS
BILLING/FINANCIAL
SYSTEMS
ALL REPORTING SYSTEMS
CLINICAL SYSTEMS*Protocols
* Test ordering systems*Clinical & Disease systems
* Pharmacy systemsSUPPORT SYSTEMS* Case mix systems
* Utilization management
* Quality management* Case Management
SYSTEMS
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YOU MUST BE READY
• ICD-10 move could range from $84,000 to $2.7 Million depending on practice size
• Education, Process Analysis, Super-bill changes, IT costs, Increased Documentation, Cash Flow Disruption, Over Time, additional staff.
• Key is to have strategic Planning
ESTIMATE BUDGET
ESTIMATES
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CASH FLOW ANALYSIS / REPORTING
BUDGET
• Line of Credit ready
• Minimum of 6 months of cash reserves
• Contact payers, are they going to offer contingency plans?
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• Understand and review payer contracts
• Identify high volume diagnosis/procedure codes and focus on these key revenue drivers
• Talk to other groups, peers, networks to do combined effects to save in costs
• Consulting and audit costs
• Labor will go up
BUDGET
MORE TO THINK ABOUT
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PREPARE TO SEE:
• Post Implementation education/training costs
• Decreased productivity/accuracy
• Delays in processing claims
• Increased denial/claims rejections
WHAT TO EXPECT
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STAFF AND PHYSICIAN TRAINING
• Audience – physicians, providers, staff, etc.
• Identify training sources
• Define time requirements & resources
• Set timeframes for training
• Determine coverage during training
• Ongoing support/training
• Dual ICD-9 and ICD-10
TRAIN EVERYONE
DEVELOP TRAINING
PLAN
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MAKE SUGGESTIONS TO IMPROVE CLINICAL DOCUMENTATION & PROCESSES
• Will you have the detail needed to generate correct ICD-10 Codes?
• Completing up-front documentation is your key to saving wasted time and dollars
• Work flows must be reviewed and revised
• Identify and rank risks
TRAINING
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PERFORM GAP ANALYSIS• Plan MD Education to close gaps in
documentation for both diagnosis and procedural coding
• Start with your top diagnosis codes for training
• Identify areas of weakness in coding staff and target more education there
• Canada’s implementation: 50% productivity slowdown in 1st six months, 18-20% never regained. (Didn’t implement ICD-10 PCS)
TRAINING
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ICD-10 IMPLEMENTATION PLAN WORKSHEET
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GO-LIVE PLANGET READY – SET – GO !!
• Are you ready to run parallel systems for three months prior to go-live? (Internal)
• Check lists all updated
EXECUTION
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DOESN’T STOP
AUDITING
Compliance
Risk Managem
ent
Audits &Documen
tation
Continued Training
Communication
&Awarenes
s
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ICD-10 WILL HAPPEN
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• October 1, 2014
• Continue with your efforts, or start NOW if you haven’t started yet
• Use the extra time to better prepare
NEW ICD-10 COMPLIANCE DEADLINE
WILL YOU BE READY?
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Q + A
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SHELLY GUFFEYMANAGER, PREMIER ACCOUNTS AND VENDOR PARTNERSGATEWAY EDI
SGUFFEY@GATEWAYEDI.COMINDUSTRYINFO@GATEWAYEDI.COMWWW.GATEWAYEDI.COM/ICD10
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GENERAL ICD-10 INFORMATIONHTTP://WWW.CMS.GOV/ICD10 AAPCHTTP://WWW.AAPC.COM/ICD-10 TRANSACTIONS AND CODE SETS REGULATIONSHTTP://WWW.CMS.GOV/TRANSACTIONCODESETSSTANDS/02_TRANSACTIONSANDCODESETSREGULATIONS.ASP WEDI- WORKGROUP FOR ELECTRONIC DATA INTERCHANGEHTTP://WWW.WEDI.ORG/PUBLIC/ARTICLES/
AHIMA- THE AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION HTTP://WWW.AHIMA.ORG/ICD10
SOURCE AND RESOURCES
THANK YOU.
PREPARING FOR ICD-10 IMPLEMENTATION
11.16.2012
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