icd 10: celebrating success? a conversation with himss icd ... · icd 10: celebrating success? a...

ICD 10: Celebrating Success? A Conversation with

HIMSS ICD-10 Task Force

Moderator: Bonnie Sunday, MD, Medical Director, Health Care Services Elaine T. Lips, RHIA, President & CEO, ELIPSe, Inc. Betty Gomez, Compliance Manager/Director, Xerox Healthcare, LLC

Long Beach Memorial

Orange Coast Memorial

Miller Children’s & Women’s Hospital Long Beach

Saddleback Memorial San Clemente

Saddleback Memorial Laguna Hills

Community Hospital Long Beach

MemorialCare Health System Six Nationally-Recognized Hospitals

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MemorialCare’s ICD10 Journey • ICD-10 Program began 2011; minimum slow down; successful go-live • EMR: EPIC • Coding Tools: 3M Encoder and CAC (Computer-Assisted Coding) • Mapping Tool: Wolters Kluwer • Developed Specific ICD10 templates for physicians including CDI queries • Education & Training

• eLearning tool for coders and physicians • Onsite advanced PCS and OP/ER classes for coders • QA and Weekly education calls with coders

• Early Adoption for coders started April 2015 – 100% ICD10 coding • Stretched 2014 budget through 2015 • Go Live and post Go Live – Command Center shut down early • Transition to ICD-10 determined to be successful • Daily Claims (now 3x/week) and weekly PFS meetings (now bi-weekly)

• Only 188 denials related to ICD10

Q & A - MemorialCare

• If you had to do this all over again, what would you do differently?

– Would not have implemented CAC during this time due to prolonged implementation and unplanned technical issues causing loss of confidence with software amongst the coders.

• How can you use ICD-10 to improve revenue and reporting?

– Maintaining dual reporting and tracking of the code transition on adjudicated claims allows for monitoring to make sure ICD-10 codes are being reimbursed based on payer contract. Payer contract reviews of ICD-9 to ICD-10 to identify potential changes in revenue could create significant improvement in contract negotiations.

Good Samaritan Hospital

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Good Samaritan’s Journey

• Program started 2013; minimum slow down; successful go-live • EMR: Meditech • Coding Tools: 3M encoder; Dolbey CAC (Computer-Assisted Coding) • Mapping Tool: None; used consultant to do mapping projects • CDI Queries manual due to:

– Pdoc go live Jan 2016 – Dolbey CDI implementation scheduled 2016

• Education & Training – On site introduction and advanced CM and PCS classes – QA and weekly education calls with coders – Presentations to physicians; lunch & learn

• Early adoption for coders started June 2015 • Stretched 2014 budget through 2015 • Transition to ICD-10 determined to be successful • Daily PFS (now x/week) meetings

Q & A - Good Samaritan • If you had to do this all over again, what would you do differently?

– Would not have changed anything; addressed it early & did not quit; made best choice for CAC vendor based on all factors and it was a big success

• How can you use ICD10 to improve revenue and reporting?

– With the increased specificity, it is a stats/reporting person’s dream they can now pull out more specific diagnoses & procedures and analyze the effects on reimbursement

• How should organizations be preparing now for upcoming programs that

will require reporting periods where the two code sets overlap?

– Need to be able to report on both sets of codes. Have tackled this with many of current vendors by modifying existing program to report both. Code sets are in different fields for reporting.

Cooperative Exchange Metrics Metrics October November Claim Volume 203,364,944 220,254,548 % ICD-10 Claims Received 62 88 % of ICD Rejections 999/277 level

1.5 1.1

% ICD Denial Rate 2.8 2.2 Payer Reimbursement trending

Up Down

% Unspecified codes Slight increase

Starting to decrease

• As of December the % of ICD-10 claims received had surpassed 93% and now is nearly 100%.

• CE members have processed millions of claims with minimal ICD-10 issues. • There is little to no variance in numbers set by benchmarks, pre-ICD-10 to post-ICD-10. • Denial rates ranged from insignificant changes to less than baseline average.

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Lessons Learned

Can we apply them to future efforts? • Early industry engagement is important • Industry resources help • Testing is critical

– Value in internal AND external testing – Testing of processes is necessary – Simplifying testing would be helpful

• Don’t forget ‘other’ types of entities • Assure messaging is clear • More time doesn’t necessarily result in more effort • Collaboration works!

• Address any issues

• Monitor - Analyze key metrics

• Accommodate fiscal year changes

• Identify other key dates

• Prepare for new ICD-10 codes / updates

• Enhance clinical documentation

• Enhance internal processes

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What’s Next – Short Term

• Continued monitoring

• Ongoing code set updates

• Informatics

• Medical policy changes

• Payment models / quality

• Enhance process for testing and implementing mandates

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What’s Next – Longer Term

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ICD-10 Usage

• Supports new technology and diseases

• Specificity supports new payment models

• Increased specificity facilitates: • Better reflection of condition, severity, complications, location LEADING TO:

• Better quality of care • Better tracking of outcomes

LEADING TO: • Better quality measures • Better data for research and clinical trials

• Long term population health benefits

• Better understanding • Better treatments

What’s Next – Long Term

Questions?

Elaine Lips President & CEO ELIPSe, Inc. elaine.lips@elipeshealth.com 310-820-3592

Moderator: Bonnie Sunday, MD Medical Director, Health Care Services HealthNow New York, Inc. Sunday.bonnie@healthnow.org 716-887-8686

Betty Gomez Compliance Manager/Director Xerox Healthcare, LLC betty.lengyel-gomez@xerox.com 502-565-9950