physician office managers association meeting · 2015-06-15 · icd-10 will replace icd-9 on...
TRANSCRIPT
ADVISORS 1
Physician Office Managers Association Meeting
June 17, 2015
TO
Agenda
What’s It All About?
ICD-10 Preparation Tips
Points of ICD-10 Code Contact
Protect Revenue During ICD-10 Transition
Strategies for Physician Engagement
Summary
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What’s It All About?
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What’s It All About?
ICD-10 will replace ICD-9 on October 1, 2015
Move from 3-5 characters to 3-7 characters
There are about 5 times as many ICD-10 codes
Is intensely focused on specificity in coding diagnoses
US is the last country in the world with modern healthcare to adopt
ICD-10 diagnosis codes
Must transition because ICD-9:
Produces limited data about patients’ medical conditions and hospital
inpatient procedures
Is 30 years old, has outdated terms, and is inconsistent with current
medical practice
Structure limits the number of new codes that can be created, and
many categories are full
More than correct billing and reimbursement
Standardizing data to improve interoperability across the care continuum
More accurate diagnosis, improved treatment plans, better outcomes
Ultimately leading to a healthier population
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ICD-10 Preparation Tips
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ICD-10 Preparation Tips
Readiness Assessment
Review equipment placement and access
Reach out to Trading Partners
Check with your billing service, your clearinghouse, and all vendors
Implementation, compliance plans, system updates
If you handle billing internally, involve coding, clinical, IT, and finance
staff in planning of and preparation for your practice’s transition
Coding and Billing
Coding software up to date
Super Bill revisions – 1 page may go to 4 pages
Billing Edits process
Charge Master (for large practices)
Review 5010 and 1500 forms
Referrals and Authorizations
Lab Tests
Imaging
Specialists
Procedures 6
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ICD-10 Preparation Tips – Continued
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Benefits and Coverage
Health Plans coverage changes ICD-10 and the
American Recovery and Reinvestment Act (ARRA)
Coverage verification ICD-10 impact
Compliance
HIPAA
Reporting
National, State, Regional Initiatives, and
don’t forget Meaningful Use
Reimbursement
Pay for performance
Network inclusion
Denials
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ICD-10 Preparation Tips – Continued
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Assess training needs for coding staff and clinicians
Familiarity with code sets for all physicians, nurses, and staff
Refresh of medical terminology and anatomy for billers,
office staff and coders
Cost and Loss of productivity for training – Train the trainer
Metrics – Just the Facts
Determine and baseline for the following:
Days in Accounts Receivable
Percentage of A/R greater than 120 days
Adjusted collection rate
Denial rate
Watch those “unspecified” codes
Monitor metrics post-transition for trend(s) identification
Are there other metrics that your practice monitors?
ICD-10 Preparation Tips – Continued
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Documentation Improvement
Assess workflows, conduct reviews of current practices
Plan for the changes that ICD-10-CM will bring
Documentation Example Hyperlink
Clinician Engagement
Start to educate clinicians
Provide some awareness materials
The more staff understand, the more they can help
and provide suggestions
Points of ICD-10 Code Contact
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Points of ICD-10 Code Contact
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Scheduling Lab / Imaging
Orders
Referrals/Prior
Authorizations
Medical
Record
(EHR)
Coding /
Billing /
Claims
Submission
Remittance /
Denials /
Appeals
Not all areas may be in use or have
impact within your practice
Protect Revenue During ICD-10
Transition
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Protect Revenue During ICD-10 Transition
Training and Education
Thoroughly prepared staff – higher coding productivity
and accuracy
Efficiency – out the door with fewer coding errors,
more revenue return
Most used Diagnoses Analysis
Most risky area for revenue loss
Understand proper ICD-10 code assignment and how
much reimbursements could change
Tighten the Reimbursement Cycle
Clear out reimbursement backlogs NOW to make more money available
before it is needed
Boost Productivity
Strengthen the practice finances and give productivity some room to drop
after October 1st
What are some of the areas you can leverage?
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TO
Protect Revenue During ICD-10 Transition – Cont.
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Test with healthcare payers ASAP
Find out if the ICD-10 upgrades work like they should,
any shift in reimbursement policies?
Take a financial snapshot
Measure denials, rejections & the time to claim payment
Understand what is going wrong Oct. 1 and how to
prepare for interrupted cash flows
Keep some ICD-9 code books and Electronic files
Federal law that all HIPAA covered entities use ICD-10 codes after Oct. 1st
Non-covered payer(s) may require ICD-9 claims
Be ready to send ICD-9 claims for WC and MVA
Make new friends!
Get friendly with someone at your major health plans before everyone else
wants to be their friend!
Medical practices, hospitals and clearinghouses will be asking for the status
on overdue reimbursements
You’ll want someone to take your calls
Protect Revenue During ICD-10 Transition – Cont.
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TO
Convert Super Bills – Develop Cheat Sheets
May be available electronically in EHR,
Billing Software, or on Paper
GEM software for I-9 to I-10 conversion
Careful – One super bill page may go to many
Identify vendor GEM ability or obtain free resource
Specialty specific – multi-specialty practices
Point of Service – Check Out Billing
Needed billing information
Appointment Schedules
Don’t overload the last week of September, first week of October
Allow time for backlog reduction
Review upcoming referrals, procedures, etc. for conversion to ICD-10
Permit (if needed) “at-the-elbow coding” physician support
Strategies for Physician Engagement
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Leadership & Governance
Process & Change
Management
System Design
Learning & Support
Technology
Metrics
Communication
Provider
Adoption
Main Adoption Indicators
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Do not overwhelm the Physicians, they have:
Strategies for Physician Engagement
Heard of the HUGE numbers of code increases
Concern over the increase in parameters for severity and risk
Find a Physician Champion
Physicians respond better to colleagues with shared or similar
medical practice understanding
Do Make a case for Relevance
Impact on coverage, denials, and authorizations
Impact on the measure of quality and efficiency of services
Value of high quality cross-enterprise data for patient benefit
Future impacts on reimbursement, pay for performance versus
value based payment
Impacts of audits for fraud and abuse by outside parties
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Strategies for Physician Engagement – Cont
Don’t try to turn Physicians into Coders
Physicians should focus on what they are trained to do
Coders should focus on documentation, their knowledge of
codes and the rules related to those codes
Don’t try to make Physicians learn new terminology
ICD-10 procedure codes require a new set of definitions of
medical terms, dramatically different than today’s terminology
Physicians have spent years speaking this language, it will not
change overnight
Coding professionals will have to adhere to definitional
guidelines which conflict with the Physicians documentation
Coders will need to interpret and use judgment, even query the
physician to assure accurate code(s) assignment
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Strategies for Physician Engagement – Cont
Provide Feedback
Physician behavior will NOT change without ongoing feedback
Revisit educational programs
Specific analysis of their documentation and coding patterns
Physicians will give more attention to comparative data that
is specific to them
To their reputation, reimbursement, and the best care for their
patients
Informational documentation of coding examples
Post and make available to your medical staff
Remind them ICD-10 is an extension of ICD-9 with added
specificity, laterality and other relevant clinical details
Don’t forget “specialties”
Always be open to suggestions
Be responsive and available
Summary
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Summary
Clinical documentation is not just about coding, and coding is
not just about payment
Accurate coding is a requirement for good healthcare data
Good healthcare data are critical to improving the quality of
care, effectiveness of care, and ensuring patient safety
Complete and accurate documentation of important clinical
concepts of the patient condition is a requirement for good
patient care
The requirements for documentation to support ICD-10 are
consistent with documentation to support good patient care
and improve healthcare data
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Questions
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Lab / Imaging
Orders
Referrals/Prior
Authorizations
Medical
Record
(EHR)
Coding /
Billing /
Claims
Submission
Remittance /
Denials /
Appeals
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Scheduling Hexagon
Scheduling
If you have a Scheduling Module or capability within your EHR/
EMR, check to see if it has a Pre-Visit diagnosis code
Schedulers will require ICD-10 training if this capability is present,
and particularly if the field is required
Pre-transition updating of the patient problem list (if available)
may ease the scheduling transition
Scheduling
Referrals/Prior
Authorizations
Medical
Record
(EHR)
Coding /
Billing /
Claims
Submission
Remittance /
Denials /
Appeals
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Lab/Imaging Hexagon
Lab / Imaging
Orders
Do you have a pre-defined list of
lab diagnosis codes that will need
to be updated for ICD-10?
Will Physicians, Nurses and
Medical Assistants require
training to assure proper codes
and terms are obtained?
Lab and Imaging are reliant on the provision of accurate
diagnosis code and diagnosis terms
How will you handle pre-authorizations and ICD-9 codes on
recurring orders?
Impact on prescriptions requiring ICD codes?
Scheduling Lab / Imaging
Orders
Medical
Record
(EHR)
Coding /
Billing /
Claims
Submission
Remittance /
Denials /
Appeals
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Referrals/Authorizations Hexagon
Referrals/Prior
Authorizations
Referrals to Specialists and prior authorizations for procedures/services
and/or drugs require accurate diagnostic information
Support other physicians and specialists with accurate documentation to
support medical necessity = improved relationships
Will there be new
requirements from payers
when submitting information
for future services
authorization?
Scheduling Lab / Imaging
Orders
Referrals/Prior
Authorizations
Coding /
Billing /
Claims
Submission
Remittance /
Denials /
Appeals
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Medical Record Hexagon
Medical
Record
(EHR)
Diagnostic information must always be included in
the medical record
It is the source for the assignment of diagnosis
codes which are submitted via claims as the source
of reimbursement
Coding can only be based on documentation
Physician documentation failures to provide
required ICD-10 specificity will result in “queries”
which will delay final claim submission and
reimbursement
Nursing and Medical Assistant staff can be a source
of documentation specificity if adequately trained
and the physician reviews the documentation
Scheduling Lab / Imaging
Orders
Referrals/Prior
Authorizations
Medical
Record
(EHR)
Remittance /
Denials /
Appeals
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Coding/Billing/Claims Hexagon
Coding /
Billing /
Claims
Submission
All IT systems should be remediated and workflows analyzed for impact
Don’t underestimate the power of internal and external audits on
current state documentation practices
Documentation audits will identify deficiencies and permit development
of a priority list of diagnoses requiring more detailed documentation
Audits will also help identify Physicians who will benefit from focused
training on ICD-10
Scheduling Lab / Imaging
Orders
Referrals/Prior
Authorizations
Medical
Record
(EHR)
Coding /
Billing /
Claims
Submission
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Remit/Denials/Appeals Hexagon
Remittance /
Denials /
Appeals
Inaccurate coding will result in claims denials and appeals
Adequate attention to the precursors for claims submission will reduce
denials, appeals and the impact on cash flow post-transition
Leadership/Governance
Establish a Physician Champion educated and supportive of
the ICD-10 transition
Develop an Office ICD-10 Knowledge expert as point of
contact for all ICD-10 related questions and concerns
Leadership & Governance
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Process & Change
Management
Process/Chg Mgt
Provide awareness of needed changes
and rationale as they relate to improved
patient care and outcomes
Think through and encourage
involvement in the development of
needed workflow changes
Try to present workflow changes in a
sequenced “day in the life of” format
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System Design
System Design
Encourage Physician comments, feed
back and positive suggestions
Follow through with a Change Request to
Information Technology
Monitor Information Technology
responses and provide status of
suggestions to the requestor
If the response(s) are not approved,
provide rationale to the requestor
Start thinking about the development of
documentation templates that allow ICD
diagnosis entry or choices
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Communication
Communication
Critical success factor – Project failures are almost always due to a lack
of communication
What established current means and formats for communication already
exist within the practice – can these be leveraged?
What is the best and preferred method of communicating with your
Physician(s)
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Learning & Support
Learning/Support
Perceived excessive time commitment for ICD education is a dissatisfier
Education should be tailored to provide maximum impact with minimal
disruption to patient care
Consider WEB based education, in-office FAQ and informational sheets
Plan and communicate Physician support plan – You are not alone!
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Technology
Technology
Evaluate the number of available devices
and their location
Understand your individual Physician
documentation location preferences
With rare exceptions, most Physicians
are not technology Guru’s and require
technology support – instantly!
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Metrics
Metrics
Physicians are scientifically trained and understand statistics
and metrics
Keep them informed of the metrics that make sense to them
and have an impact on patient care and business performance
New Concepts
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