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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
858-499-4217
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