ICD-10 Webinar

Dr. Denise W. Hines, PMP, FHIMSSGA-HITREC-Director of Education &

Outreach

Overview

• GA-HITREC

• What is ICD-10?

• What’s the Big Deal? Scope & Costs

• Project Management Steps

• Questions

GA Health Information Technology Regional Extension Center (GA-HITREC)

• MSM-National Center for Primary Care• Grant Funded to work with 4200 PCP & 56 Rural &

CAHs– Provide Education and Outreach (HTH)– Help providers at all phases reach MU– Offer EHR Vendor Selection & Implementation Support– Focus on Workforce Development– Launched Group Purchasing Program

GA-HITREC Online Educationwww.ga-hitrec.org

ONC Workforce Curriculum Available:• ONC Component 1: Introduction to Health Care and Public Health in the U.S.

• ONC Component 3: Terminology in Health Care and Public Health Settings

• ONC Component 8: Installation and Maintenance of Health IT Systems

WEBINARS: • Patient Engagement Strategies

• Medicare/Medicaid Attestation

• Meaningful Use and Value Based Purchasing

• Using Patient Data to Improve Health Outcome

• The Secure Exchange of Health Information

• Planning, Management, Leading for Health IT

• Health Information Management Systems – Coding

• ICD-10

GA-HITREC Group Purchasing Program

• Tax Credit Advisory Services• Document Conversion• Telecom and Data Center Solutions• Halfpenny Lab Hub• HIT Consulting• Privacy & Security Assessments• Online Education and Certification Training• ICD-10 Compliance & Remediation

Contact Us!!

GA-HITRECOnline training center, Resources, & ICD-10 tool

kit and serviceswww.ga-hitrec.org1-877-658-1990

or Contact Sherri Ackerman (Hometown Health)

What is ICD-9?

• International Classification of Diseases (ICD) code set– Published by the World Health Organization – Defines diseases, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury

or disease

• U.S. uses the Ninth Edition (ICD-9) in 2 parts:– ICD-9-CM (Clinical Modification), used in all health care settings/diagnosis coding– ICD-9-PCS (Procedure Coding System), used only in inpatient hospital settings – Originally published in 1977– Been using for over 30 years

• ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) consists of two parts: 1. ICD-10-CM for diagnosis coding

2. ICD-10-PCS for inpatient procedure coding

ICD-9 to ICD-10

• ICD-10– WHO updated in 1990– Other countries adopted in 1994– U.S. only partially adopted in 1999 for mortality reporting– HHS announced the requirement to update from ICD-9-

ICD-10– Original compliance date was October 1, 2013– HHS received push-back from the industry– Proposed compliance date is October 1, 2014– 5010 Compliance required

Who is impacted?

• All “covered entities”—as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)—– Hospitals

– Health care practitioners and institutions

– Health insurers and other third-party payers

– Electronic-transaction clearinghouses

– Hardware and software manufacturers and vendors

– Billing and practice-management service providers

– Health care administrative and oversight agencies

– Public and private health care research institutions

• Does NOT affect Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.

Limitations of ICD-9

• Over 30 years old with outdated terminology and not consistent with current medical practice

• Many ICD-9 categories are full• Codes are not specific and do not provide accurate

anatomical descriptions – Limits the ability to analyze for utilization, costs and

outcomes, resource use and allocation, and performance measurement

– Limits streamlined, automated claims processing– Limits the characters available (3-5) for complexity and

severity

Benefits of ICD-10

• Reflects current medical practice• Provides more detailed data:

– Inform health care providers and health plans of patient incidence and history

– Improve analysis of disease patterns to track public health outbreaks

– Increase opportunities to develop new pricing and reimbursement structures

– Improve detection and investigation of potential fraud & abuse

• Reduces volumes of rejected claims

• Adds flexibility for future updates

Timeline for ICD-10

• June 30, 2012-compliance for 5010 Transaction set

• Original compliance date: Oct 1, 2013

• April 9, 2012-Proposed rule released: Compliance Date to Oct 1, 2014

• Final rule not issued yet.

• NO ICD-9 claims submitted after compliance date!!!

What’s the Big Deal?

•

ICD-9 ICD-10

13,000 codes 68,000+ codes

Mostly numeric Digit 1 = alpha or numeric Digits 2-5 = numeric

Alpha or numeric Digit 1 = alpha Digit 2 = numeric Digits 3-7 = alpha or numeric

3-5 digits 3-7 characters

Does not identify left versus right Identifies left versus right

Incorporates anatomical location & surgical technique

Pressure Ulcers-9 codes to broad body locations & wound depth

125 codes-includes anatomical coordinates and wound depth

Angioplasty-1 code Angioplasty-854 different codes including body part, method, instrumentation

ICD-10 Readiness and Costs

• HHS cites a CMS survey finding that one quarter of providers do not believe they will be ready by October 1, 2013, and a recent WEDI readiness survey in which nearly 50 percent of the 2,140 providers responding did not know when they would complete their impact assessment.

• HHS projects that ICD-10 will cost commercial and government health organizations between $650 million and $1.3 billion

Costs to Delay Compliance to 2014

• Savings would come from the avoidance of costs that would occur as a consequence of significant numbers of providers being unprepared for the transition to ICD-10.

• HHS determined a cost avoidance of between $3.6 billion and $8 billion – but acknowledged that “a 1-year delay of the ICD-10 compliance date would add 10 to 30 percent to the total cost that these entities have already spent or budgeted for the transition.”

• HHS demonstrated that a 1-year delay in the compliance date of ICD-10 would cost the entire health care industry approximately $1 billion to $6.5 billion.

Reactions to the Delay (10/1/13 to 10/1/14)

• American Medical Association-Applauded the delay

• College of Health Information Management Executives-(CHIME)-Appreciates the extra breathing room but doesn’t want to lose focus.

• Medical Group Management Association (MGMA)-wants ICD-10 certification of practice management system vendors,

• American Hospital Association-"welcome news, particularly for smaller hospitals”

• American Health Information Management Association (AHIMA)-preferred no extension and supports the shortest extension period; continued delay is in no one’s best interest

Impacted Hospital Functions

• Patient intake /registration

• Eligibility

• Authorization

• Certification

• Scheduling

• Care management/disease management (including clinical documentation)

• Coding and supporting clinical documentation requirements

• Billing and reimbursement

• Contracts and fees

• Payment reconciliation (including denial management)

• Regulatory and compliance reporting

• Quality assessment and management

• Case mix and population risk assessment

$Costs to Consider

• Training Costs

• System Upgrades

• Contract Re-negotiations

• Coding Tools

• Coder (staff) support

• Productivity Losses

• Underpayments & Denials

ICD-10 Project Management Steps

• Designate a PM, Team, Ex.Committee

• Develop Communication & Work Plans – Health Information Management – Clinical Departments– Information Technology/Systems– Revenue Cycle/Finance– Application Assessment & Readiness

• Plan for Physician and Staff Training

ICD-10 Project Management Tasks

• Assess Internal & External Impact• Assess Education• Form Budget• Upgrade/Change Systems & Business

Processes• Internal Testing & Validation• External Testing & Validation• Go-live• Follow-up & Evaluation

Project Management Tips

• Gain buy-In from Administration/Executive Team• Identify a physician champion• Use a Steering Committee• Provide On-going education about the importance of

the project and the status• Offer a variety of training methods and tools:

– One-on-one– Off-site training sessions– Rounding – Departmental/Medical Staff Meeting

Summary/Take-Away Points

•Transitioning from ICD-9 to ICD-10 will be challenging –Requires more complete and accurate documentation by physicians–Thorough knowledge of anatomy and physiology by nurses, clinical staff, and coders

•Benefits include more complete patient information (severity of illness, medical necessity) and improved reimbursement•Don’t be afraid to ask for help! •Use a project management methodology

Resources

GA-HITRECOnline training center, Resources, & ICD-10 tool kit and

serviceswww.ga-hitrec.org1-877-658-1990

www.cms.gov/ICD10/

www.himss.org

www.ahima.org

www.dch.ga.gov

QUESTIONS ????