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TRANSCRIPT
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ICD10 Implementation
Kathy Sain, MBA, RHIA, CCS, CCS-P
Mary Gregory, RHIT, CCS, CDIP, CPC, NCHIMA Coding Roundtable
11-06-2013
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Agenda
• Planning for ICD10• Phases of ICD10 Implementation for Providers
(CMS)• Training (identifying key teams) • Planning for ICD10 specific to Coding • Minimizing loss and maximizing training
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ICD10 Implementation
• Planning Q1-2013• Communications Q1-2013-Q2-2014• Testing Q2-2013-Q3-2014• Training Q1-2014-Q4-2014
• Source: http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10
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Planning Jan-Mar 2013
• Planning (outline of how to tackle ICD10)
• Identify Resources (what will be needed to accomplish this change)
• Create Project Team (who can help lead the change)
• Create Project Plan (when- set goals/deadlines to carry out the plan)
• Secure Budget (employee time and materials needed to carry out the plan)
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Communications Jan 2013– June 2014
• Inform Staff-– communication plan for team members who are affected- keep them
informed / aware of progress and timing of key milestones• Contact Vendors-
– find out progress with key vendors that impact your business (IT Applications, Electronic Records, Claims Submissions/Clearing Houses, Editing Applications, etc.)
• Contact Payers-– find out what your top payers are doing to prepare/proceed with
implementation, ask how they are planning to process I-10 claims data (use of GEMS?), consider reimbursement contracts- do these need to be updated to include timeliness of processing or limit on number of times claim can be denied or escalation processes for unresolved claims issues, or even a contact person to help get claims adjudicated if having problems. (think about CPT world for unlisted procedures- paper claim/record submission to get claim paid)
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Testing Mar 2013– Sept 2014
• High Level Training for test team– Make sure the team testing IT applications have enough understanding
of the ICD10 Code set changes to understand the impact of nuances when testing. (ie. I10 codes can be 3 to 7 digits and have alpha characters, therefore programming needs to include enough character spaces to accommodate the maximum number of digits for a code)
• Level 1 internal-– (report programming, data retrieval / analytics of codes, testing of edit
applications, release of information- don’t forget patients need to understand this change as well)
• Level 2 external-– testing with claims data exchange from facility/office to clearing house
to payer and then remittance advice back to provider
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Comprehensive TrainingJanuary – September 2014
• Documentation (CDI & Physicians)• Coding (Coders)• Ancillary Team Members
– Anyone who uses Coded data• Quality Departments, Finance, etc..
– Lab/Xray/Patient Registration who may verify medically necessity and issue ABNs
– Case Managers reviewing for utilization review and medical necessity
– OthersConsider role based training
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Coding Specific• Training Considerations
– Detailed Training for Coders– Who, What, When, Where, How (similar to overall plan)
– What to focus on for training• Guidelines (similar but different) CM and PCS• Analyze past year’s data, focus on top volume and top
revenue procedures and diagnoses and create tools to help team members have a reference guide as an aid until familiar with the code sets
• Encoder – have a couple of coders help create the reference tools and make notes of your encoder logic trees- this is different for I10 than I9
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Coding Training continued
• Who to deliver training– Outside Vendors (several excellent companies- search web)– Develop Inside Experts- many coders do not want the chore of
being a pioneer to lead their peers into I10 because it is uncharted and uncertain territory– it’s okay– there are still mistakes with the draft code set and still things that are not easily understood.
– Expect to see many changes to what initial training experts indicated after implementation--- this is just part of the code set change process---no one is an expert
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Coder Training continued
– Online learning vs. Face to Face/Team training• If online, need assurance coders getting what is needed and
understanding is occurring (remote mgt is tough!) • If face to face, consider where to do this and scheduling and impact to
DNFB/Coding productivity
– Budget items• Books (ICD10CM and PCS books for training/notes)• Employee Time for training (do not allocate as regular worked hours,
instead I10 Training hours)
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Dual Coding• Dual Coding- coders need to first learn the code set
and changes, then begin to practice• Dual Coding has many definitions and purposes and
also require many IT configurations to allow this to happen– Dual coding to capture I10 data for future
analytics/reimbursement impact– requires large volumes of accounts to be useful
– Dual coding for coder practice– Dual coding for testing
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Dual Coding
• Feedback from coders:– It is difficult to code a single account twice (I9 and then I10)
because like outpatient and inpatient, the guidelines are different and it is difficult to recall the differences.
– Coders suggest perform all I10 coding at once (four hours per week- use previously coded accounts as a practice account, assign I10 codes for practice only) With this, coders can get a feel for the difference in encoder logic and the differences in the I10 code set descriptions.
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ICD10 Implementation Summary • All entities should have a plan • The plan should address all facets of your organization that are
impacted (at any level) by the I10 code set change• The plan should consider all anticipated budget needs and
understand that there will be some unexpected expenses that cannot be forecasted.
• Plan should include communication to all team members, including patients
• Plan should address training needs/plans• Plan should address goals/timelines for each phase of the plan• Be sure to communicate to executives regarding the needs of
resources (people and financial)
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Coder Training – Minimize
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Coder Training• Communicate to your coders that they will get
through and come out shining with ICD-10.• Meet with your coders and get their ideas and
feedback. • Find out their fears and weaknesses – then help
them to overcome• Give each coder charts to code only in ICD-10-
CM, keeping up with time. Get an average of time using your best coder, your mid-level coder and your novice coder.
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Coder Training
• Your organization must make a commitment to the training and be willing to pay the price.
• Remember you can pay now by getting your coders prepared or you will pay later with loss of revenue, loss of data integrity, a change in your quality reporting, etc.
• You must be committed to training
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Coder Training• What resources will you need to support the staff
after training?− Manuals, system prompts, troubleshooting guides, or
FAQ lists.• How will your staff maintain operations and
reduce productivity loss during training?– Is there a need for additional coding staff to support
during the ICD-10 transition?– Do you need to outsource some operations?
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Coder Training• Stop selling fear to your coders • Perform coder assessments• Find and begin to develop your Super User• Determine the training modalities:
Example - use a mixture of lecture, videos, online, live classes.
• Set training days. Training is not optional.• What is your internal training deadline?
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Clinical Documentation Improvement
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Clinical Documentation Improvement
Training Begins
Coders, Physicians, Ancillary staff
Review Documentation
What clinicians or departments documentation impacts those cases?
Top 50
Diagnoses and Procedures
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Clinical Documentation Improvement
• Determine what diagnoses and procedures will need documentation improvement. Remember that you may have more documentation than you are aware of.
• Identify new documentation concepts that will be required to support ICD-10; with a focus on the most common conditions seen in your facility or falls with in your top diagnoses and procedures
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Clinical Documentation Improvement
• Meet with the department(s) that documentation impacts coding; such as dietary, nursing, emergency department, wound care, etc.
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Clinical Documentation Improvement
Examples• Meet with radiology to do determine the types of
contrast materials and the used most frequently• Review nursing documentation for protocols;
such as blood transfusion, placement of central venous access devices
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Clinical Documentation Improvement
Examples – Risk and Preventative Actions• Identify the potential for creating incentives for
high quality documentation and potential disincentives for inappropriate levels of documentation
• Create templates within EHR systems or paper based templates that will help guide required documentation in common clinical areas
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Clinicians
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Clinicians
Train Quietly• Train on what is most important to their specialty• Do not try to train on everything in ICD-10, just
what they need to know• Stop Selling Fear
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Clinicians
• Give small, bite-size pieces of ICD-10 • Meet with the office manager, coder or biller and
begin educating on what is needed and enlist their help
• Offer to help review the office superbill and see how you can help with the changes or make suggestions
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Clinicians
• Review documentation and coding guidelines to determine what you can code from without asking more from the clinician
• Make sure you know the guidelines and do not ask for insignificant documentation that is answered with a coding guideline
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Revenue Cycle/Patient Financial Services• Determine your top 50 denials• Determine if denials are due to medical necessity
versus documentation• What will need to change in documentation • What are your biggest RAC denials• How will ICD-10 affect the charge master
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