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diagnosis codes are submitted annually.– 30 year old code set contains outdated terminology & lack of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