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12/8/2013

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Betty B. Bibbins, MD, BSN, CHC, C-CDI, CPEHR, CPHIT

President & Chief Medical Officer

Physician Executive Educator

DocuComp LLC

� Suggest ideas on ways to support non-HIM Compliance Officers

during the transition to ICD-10

� Provide tips on effective training & educational opportunities

� Communicate the positive outcome/WIIFM in understanding ICD-10

implications for Compliance and Administrator stakeholders within

healthcare facilities and systems.

� Explore into how ICD-10 compliance impacts all of the non-clinical

pieces of the revenue cycle.

� Discuss strategies to mitigate loss (i.e. Quality of Care Profile

Reporting, payments, compliance, regulatory agencies, etc).

Session ObjectivesSession ObjectivesSession ObjectivesSession Objectives

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1. Background

2. Benefits/Consequences

3. Project Timelines

4. Budget

5. Estimated System/Implementation Costs

6. Code Comparison

7. Plan of Action

AgendaAgendaAgendaAgenda

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291 DAYS…291 DAYS…291 DAYS…291 DAYS…and counting!!!!and counting!!!!and counting!!!!and counting!!!!

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*Most winning national championship coach, UCLA

* Named NCAA men’s basketball coach of the year six times, John Wooden won ten NCAA national championships in a 12-year period

—seven in a row— as head coach at UCLA, an unprecedented feat. Within this period, his teams won a record 88 consecutive games.

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� January 1, 2011 – began testing HIPPA

compliant 5010 claim form with trading

partners

� October 1, 2011 – ICD-9/10 code freeze

� October 2012 – Stage 2 MU criteria took

effect

� March 1, 2012 – full compliance with 5010

� October 1, 2014 – ICD-10-CM-PCS effective

Dates we need(ed)

to ‘Pencil In’

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Poland

Thailand

United States

Iceland

Denmark

Brazil

New Zealand

Argentina

Austria

Norway

Australia

Finland

Singapore

Canada

Sweden

China

Japan

Venezuela

Germany

Switzerland

ItalySpain

Portugal

Colombia

Belgium

UKIreland

Czech RepublicThe Netherlands

France

Costa Rica

Source: 3M Information Systems, Inc.

Global Use of ICDGlobal Use of ICDGlobal Use of ICDGlobal Use of ICD----10101010

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Source: Deloitte, July 29, 2010

ICDICDICDICD----10 Sits Among the Top 10 Sits Among the Top 10 Sits Among the Top 10 Sits Among the Top

Issues the Industry Has to WeighIssues the Industry Has to WeighIssues the Industry Has to WeighIssues the Industry Has to Weigh

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It’s not just about It’s not just about It’s not just about It’s not just about coding!coding!coding!coding!

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More than Just a Larger Coding Inventory of SystemsAccording to the Healthcare Information Management Systems Society (HIMSS)

RegistrationRegistrationRegistrationRegistrationRegistration and scheduling systemsAdvance Beneficiary softwarePerformance management systemsMedical necessity edits

Clinical SystemsClinical SystemsClinical SystemsClinical SystemsClinical systemsClinical protocolsTest ordering systemsClinical reminder systemsMedical necessity softwareDisease management systemsDecision support systemsPharmacy systems

HIMHIMHIMHIMDRG grouperEncoding softwareAbstract systemsCompliance softwareMedical record abstracting

ReportingReportingReportingReportingProvider profilingQuality measurementUtilization managementDisease management registriesOther registriesState reporting systemsFraud managementAggregate data reporting Clinical systemsPatient assessment data sets (e.g. MDS, RAI, OASIS)

Support SystemsSupport SystemsSupport SystemsSupport SystemsCase Mix systemsUtilization managementQuality managementCase Management

Billing/Financial Billing/Financial Billing/Financial Billing/Financial DRG grouper Conversion of other payment methodologiesNational and local coverage determinationsSystem logic and editsBilling systems Financial systemsClaim submission systemsCompliance checking systems

ImpactsImpactsImpactsImpacts

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� ICD-9-CM

◦ Current coding classification system

◦ Introduced 40 years ago

◦ No longer fits with 21st century health system

� ICD-10-CM & ICD-10-PCS

◦ International standard - diagnostic classification for

all general epidemiological and many health

management purposes

◦ Track, report and compare morbidity and mortality

◦ Supports achievement of EHR benefits

◦ Transition to ICD-10 required by federal regulation

ICD-10 Background &

Overview

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ICD-10 Background &

Overview (cont’d)

� On October 1, 2014, the United States will move from the ICD-9 system to ICD-10

� It is the first major change in diagnostic and procedural coding in the U.S. in over 30 years

◦ The “most significant overhaul of the medical coding system since the advent of computers.” –The WEDI Workgroup

◦ Encompasses moving from 5 digit numeric codes to 7 digit alpha numeric codes with embedded logic in the new code structure and a different decision tree

◦ Approximately 9 times more ICD-10 codes than ICD-9 codes (16,000 ICD-9 codes and 155,000 ICD-10 codes)

� A complex, time-consuming and expensive compliance challenge

◦ More complex than HIPAA compliance

◦ Will touch most operational and IT processes and dramatically influence data and financial reporting strategies

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� Comparison of the two systems:

◦ Expansion of codes

� 13,000 diagnosis codes in ICD-9-CM / 69,000 unique diagnosis codes in ICD-10-CM

� ICD-10-CM allows for new code expansion within the code category, ICD-9 does not have that capability

� Example: Adverse Effect and Poisoning codes

� 4,000 procedure codes in ICD-9-CM/ 72,000 procedure codes in ICD-10-PCS

◦ Different code structure, diagnoses for example

� ICD-9-CM: 3 - 5 digits / limited alpha characters

� ICD-10-CM: 3 - 7 digits / additional alpha characters

ICD-10 Background &

Overview (cont’d)

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ICD-9-CM to ICD-10:

BASIC OVERVIEW

ICD-9

• Over 14,000 Diagnoses Codes

• Numeric Codes:

• Max of 5 digits

• 4,000 Procedure Codes

• Numeric Codes:

• Max of 4 digits

ICD-10

• Approximately 69,000 Diagnoses Codes

• Alphanumeric Codes:

• Always Start with a Letter (Exc. U) Max of 7 Char.

• 72,000 Procedure Codes (ICD-10-PCS)

• Alpha/Numeric Codes:

• Start with a Number or Letter (Exc. O or I to avoid confusion with 0/1)

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ICD-10 CODE COMPARISON

EXAMPLES

Tobacco Abuse

ICD-9-CM: 1 Codes

ICD-10-CM: 5 Codes

Diabetes Mellitus

ICD-9-CM: 10 Code

ICD-10-CM: 318 Codes

Fracture of Radius

ICD-9-CM: 33 Codes


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Mechanical complication of other vascular device,

implant or graft

ICD-9-CM: 1 Code


Suture of Artery

ICD-9-CM: 1 Code

ICD-10-PCS: 276 Codes

Angioplasty

ICD-9-CM: 1 Code

ICD-10-PCS: 854 Codes

ICD-10 CODE COMPARISON

EXAMPLES (cont’d)

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� More-accurate payments for new procedures

� Fewer miscoded, rejected, and improper reimbursement claims

� Better understanding of the value of new procedures

� Improved disease management

� Better understanding of health care outcomes

� Higher quality information for measuring healthcare service quality, safety, and efficiency

The Expected Benefits

of ICD-10

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� Increased claims rejections and denials◦ Physician offices need to make sure their diagnosis

codes match up with hospital coding � Increased delays in processing authorizations and

reimbursement claims ◦ Physician offices get pre-auth’s on different dx

codes � Improper claims payment � Coding backlogs � Compliance issues � Decisions based on inaccurate data

Problems can be mitigated with proper advance preparation

Consequences of Consequences of Consequences of Consequences of Poor PlanningPoor PlanningPoor PlanningPoor Planning

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3M Health Information Systems: 2012 Countdown to ICD-10 Calendar

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� Planning◦ Make sure you have the right “people on the bus”

◦ Engage your Project Management Office

◦ Use standard Project Management methodologies

◦ Solid decision-making and escalation process

◦ Don’t reinvent ICD-10 planning activities (many industry resources

available)

◦ Conduct a Stakeholder Analysis

◦ Use existing modes of communication

◦ Have an action plan before people start working

◦ Start outlining your ICD-10 Training Plan

Phases of ICDPhases of ICDPhases of ICDPhases of ICD----10 10 10 10 Implementation Implementation Implementation Implementation ---- 1111

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� Assessment◦ Carefully select your assessment team

◦ Define ICD-10 stakeholders and align expectations

◦ Awareness education is needed prior to Assessment

◦ Spend time outlining scope and vet with process owners

◦ Approach the assessment from a business process workflow perspective

◦ Streamline your reporting, create document repository such as Microsoft SharePoint

◦ Conduct feasibility studies on opportunities that are strategic to determine if “nice to have”, process improvement for later, or required for compliance

◦ Ensure stakeholders are thinking holistically in developing recommendations


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� Operational Implementation◦ “It’s better to measure twice and cut once”

◦ Ensure an integrated project schedule is developed and approved

◦ Be persistent in contacting vendors for readiness preparedness

◦ Monitor Subcommittee progress

◦ Don’t be afraid to escalate issues


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� Testing� Identify existing testing plans that can be built upon for ICD-10 testing

◦ Engage stakeholders across functional areas in developing test plans

◦ Approach end-to-end testing plans by business process workflows

◦ Specifically for IS system changes, vendors are making more than just

ICD-10 change and as these changes ripple through the organization the

desire is to be proactive instead of reactive


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� Transition◦ Engage your Audit Committee to perform project health checks

◦ Foster collaboration among all stakeholders

◦ Joint Ventures – awareness training, meetings, check status of

remediation, offer guidance/support

◦ Some vendors already have ICD-10 compliant software (start testing

now if you can)


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TheRevenueCycle

PatientRegistration

Clinical Service

SchedulingPre-Registration

Insurance

Denial Management

Charge Capture

BillingCash

Management

Chart Processing & Coding

AR Follow-Up

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� A failure modes and effects analysis (FMEA) is an inductive failure analysis used in operations management for analysis of failure modes within a system for classification by the severity and likelihood of the failures.

� A successful FMEA activity helps a team to identify potential failure modes based on past experience with similar products or processes or based on common failure mechanism logic, enabling the team to design those failures out of the system with the minimum of effort and resource expenditure, thereby reducing development time and costs. It serves as a form of design review to erase weakness out of the design or process. It is widely used in development and manufacturing industries in various phases of the product life cycle. Effects analysis refers to studying the consequences of those failures on different system levels.

� The outcomes of an FMEA development are actions to prevent or reduce the severity or likelihood of failures, starting with the highest-priority ones. It may be used to evaluate risk management priorities for mitigating known threat vulnerabilities. FMEA helps select remedial actions that reduce cumulative impacts of life-cycle consequences (risks) from a systems failure (fault).

Failure Mode &

Effect Analysis (FMEA)

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� Identify each process step� Identify potential failure modes – all the manners in which the

process could fail

� Identify any potential effect(s) of failure – consequences on other systems, parts or people

� Rank Severity of the effect(s) of failure� Identify potential cause(s)� Rank the possibility of occurrence� List your current controls that would detect these occurrences� Rank your ability to detect a failure using these controls� Calculate the risk priority number (RPN =

severity*occurrence*detection)

� Design recommended improvement actions� Assign responsibility and target completion date� Monitor actions and effects on RPN

FMEA Process StepsFMEA Process StepsFMEA Process StepsFMEA Process Steps

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� Budget $$’s

◦People

◦Process

◦Technology

◦Other…

The ‘B’ Word The ‘B’ Word The ‘B’ Word The ‘B’ Word ☺☺☺☺

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POTENTIAL BUDGETING CATEGORIES

2010 2011 2012 2013 2014

PEOPLE (HUMAN RESOURCE)

# FTEs/ Contract Workers

Program Manager w/ Admin Support x x x x x

Staff to review payer contracts/ renegotiate

x x x

HIM temporary during cross over period

x x

PFS temporary during transition x x

PROCESSES (not including potential process improvement gains)

Assessment/ Gap Analysis (internal +/or external )

x x

Documentation Improvement x x x x

Dual Systems? X X

Decision Support /Home Grown System Remediation (and/or Translation Software)

X

Payer Integration and/or Readiness (mitigation)

x x x x

Communications to internal/ external constituents

X X X X

TECHNOLOGY X X X X

Vendor Systems (ICD-10fees? x x x

Vendor Interface charges? X X X

New Vendors? x

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Sullivan, Tori. "Budgeting for ICD-10: Hardware Costs Should be Peaking Next Year, Contract Support Rising." Journal of AHIMA 81, no.9 (September 2010): 30-33.

•Internal communication

•External communication

•Printing and postage

•Survey or data gathering

Communication and marketing

•Software modifications that require hardware changes

•Production server

•Test server(s)

•Workstations

•Testing workstations

hardware

•Vendor contractual fees (software upgrade)

•New software

•Interfaces

•Software programming

•Testing application

•Supporting applications (e.g., project management,

quality control, or budget management software

products)

Software

•Program management

•Overall program management

•Project management

•Assessment/gap analysis activities

•Technology upgrades, implementation, and testing

Supportive resources

Subject matter expertise

•Regulation awareness and understanding

•Coding format, anatomy and physiology

•Classes, software, books, materials, travel expenses,

etc.

•Procedural changes

Training

•Lowered coding productivity

•Slow adjudication, slower turn-around for payment

•Increased claim rejections

Revenue Loss

Contingency reserve

Implementation

Project Expenses

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Bed Size Cost

400 + $1.5 Million - $5 Million

100 – 400 $500, 000 - $1.5 Million

<100 $100,000 - $250,000

Carmichael, Angela. “ICDJ10JCM/PCS: What Every Hospital Needs to Know Now.” PowerPoint presentation. Georgia Hospital Association Audio Conference, Telnet 2673. 12 May 2011

Estimated Organizational Cost by Bed Size

ICD-10 Organizational

Costs

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An example of structural change

ICD-9

X X X XX.Category Etiology, anatomic site,

manifestation

X X X XX.Category Etiology, anatomic site,

manifestation

ICD-10

X X.Extension

An example of (1) ICD-9 code being represented by multiple ICD-10 codes

2 5 0 16.Diabetes mellitus with neurological Manifestations type I not stated as uncontrolled

E 1 0 04

E 1 0 14

E 1 0 44

E 1 0 94

.

.

.

. Type I diabetes mellitus with

diabetic neuropathy, unspecified

Type I diabetes mellitus with

diabetic mononeuropathy

Type I diabetes mellitus with

diabetic amyotrophy

Type I diabetes mellitus with other

diabetic neurological complication

The Basics of the The Basics of the The Basics of the The Basics of the ICDICDICDICD----10 Change10 Change10 Change10 Change

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ICDICDICDICD----9999----CMCMCMCM821.01 Fracture of femur, shaft, closed

ICDICDICDICD----10101010----CMCMCMCMS72301A Unspecified fracture of shaft of right femur, initial encounter for closed fracture

S72322A Displaced transverse fracture of shaft

of left femur, initial encounter for closed fracture

S72326A Nondisplaced transverse fracture of shaft of

unspecified femur, initial encounter for closed fracture

S72301G Unspecified fracture of shaft of right

femur, subsequent encounter for closed fracture

with delayed healing

S72322G Displaced transverse fracture of shaft

of left femur, subsequent encounter for closed

fracture with delayed healing

S72326G Nondisplaced transverse fracture of shaft of

unspecified femur, subsequent encounter for closed fracture


S72302A Unspecified fracture of shaft of left

femur, initial encounter for closed fracture

S72323A Displaced transverse fracture of shaft

of unspecified femur, initial encounter for closed

fracture

S72331A Displaced oblique fracture of shaft of right femur,

initial encounter for closed fracture

S72302G Unspecified fracture of shaft of left

femur, subsequent encounter for closed fracture


S72323G Displaced transverse fracture of shaft

of unspecified femur, subsequent encounter for

closed fracture with delayed healing

S72331G Displaced oblique fracture of shaft of right femur,

subsequent encounter for closed fracture with delayed

healing

S72309A Unspecified fracture of shaft of

unspecified femur, initial encounter for closed

fracture

S72324A Nondisplaced transverse fracture of

shaft of right femur, initial encounter for closed

fracture

S72332A Displaced oblique fracture of shaft of left femur,

initial encounter for closed fracture

S72309G Unspecified fracture of shaft of

unspecified femur, subsequent encounter for


S72324G Nondisplaced transverse fracture of

shaft of right femur, subsequent encounter for


S72332G Displaced oblique fracture of shaft of left femur,

subsequent encounter for closed fracture with delayed

healing

S72325A Nondisplaced transverse fracture of

shaft of left femur, initial encounter for closed

fracture

S72333A Displaced oblique fracture of shaft of

unspecified femur, initial encounter for closed

fracture

S72321A Displaced transverse fracture of shaft of right

femur, initial encounter for closed fracture

S72325G Nondisplaced transverse fracture of

shaft of left femur, subsequent encounter for


S72333G Displaced oblique fracture of shaft of

unspecified femur, subsequent encounter for


S72321G Displaced transverse fracture of shaft of right

femur, subsequent encounter for closed fracture with delayed

healing

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Character 1

Section

Character 2

Body System

Character 3

Root Operation

Character 4

Body Part

Character 5

Approach

Character 6

Device

Character 7

Qualifier

MEDICAL AND

SURGICAL

RESPIRATORY EXCISION LOWER LOBE BRONCHUS,

RT

OPEN NO DEVICE

DIAGNOSTIC

0(zero) B B 6 0(zero) Z X

ICD-10-PCS

A glimpse at ‘specificity’

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• Greater specificity

• Clinical data documented

• Information relevant to patient care encounters

• Makes it possible to document risk factors

• Physician peer-to-peer education most effective

• Recruit physician champions

ICD-10 Incorporates:

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WIN – WIN SITUATION?

YES!

Better Documentation

Clearer Picture of Patient’s Severity of Illness

Better Coding for Facilities & Physicians

Improved Reimbursement &

Quality representing TRUE acuity

& resources utilized per case37

COMMON ICD-10 CLINICAL

EXAMPLES: RESP. FAILURE - 1

• RESPIRATORY FAILURE

• - 518.81 Acute

• - 518.83 Chronic

• - 518.84- Acute-on-Chronic

ICD-9

• J96.00- Acute respiratory failure, unspecified with hypoxia or hypercapnia

• J96.01- Acute respiratory failure with hypoxia

• J96.02- Acute respiratory failure with hypercapnia

ICD-10

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• J96.10- Chronic respiratory failure, unspecified with hypercapnia or hypoxia

• J96.11- Chronic respiratory failure with hypoxia

• J96.12- Chronic respiratory failure with hypercapnia

ICD-10

• J96.20- Acute & Chronic respiratory failure, unspecified

• J96.21- Acute and chronic respiratory failure with hypoxia

• J96.22- Acute and chronic with hypercapnia

ICD-10


EXAMPLES: RESP. FAILURE - 2

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• 599.7 Hematuria

ICD-9

• R31.9-Hematuria, unspecified

• N30.01- Acute cystitis with hematuria

• N02.0- Recurrent and persistent hematuria with minor glomerular abnormality

ICD-10


EXAMPLES: HEMATURIA - 1

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• N02.5- Recurrent and persistent hematuria with diffuse mesangiocapillary glomerulonephritis

• N02.6- Recurrent and persistent hematuria with dense deposit disease

ICD-10

• N02.7- Recurrent and persistent hematuria with diffuse crescentic glomerulonephritis

• N3N02.8- Recurrent and persistent hematuria with other morphologic changes

• N02.9- Recurrent and persistent hematuria with unspecified morphologic changes

ICD-10


EXAMPLES: HEMATURIA - 2

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Only the Physician can document and treat a clinical

diagnosis.

What seems like common clinical diagnosis to

Physicians is not explicit in the medical record unless

specifically worded.

(coders cannot make diagnoses from assumptions or

implicit wording)

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means that the provider did not include pertinent

patient facts (e.g., the patient’s overall condition,

diagnosis, and extent of services performed) in

the medical record documentation submitted.

“Insufficient Documentation”

It’s not so much that we’re afraid of change or so in

love with the old ways, but it’s the place in between

that we fear…. It’s like being between trapezes. It’s

like Linus when his blanket is in the dryer. There’s

nothing to hold on to.”

Marilyn Ferguson, American Futurist

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MANAGING CHANGE

� Change is:

�Situational

�Psychological

� isn’t optional, and

� isn’t easy

� Human behavior is the pivotal factor

resulting an outcome of success or failure

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COMMUNICATION

DURING TRANSITION

� Communications help people to feel connected

� Without communication---worry, rumors, anxiety, &

apathy

� Protect

� Encourage

� Provide structure

� Consider developing a Transition Monitoring Team

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You must first know and understand what the

rules, regulations and requirements are

regarding clinical documentation:

Only then can you truly become the change

agent that you organization needs for

success.

Remember...

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Documentation Compliance

Quality Care =

“The Right Care →

At The Right Place →

At The Right Time”.

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Compliance Action Plan:

Merge the Practice of Medicine, the

Medical Necessity and the

appropriate Documentation of both

=

Compliance to the communications of

appropriate Severity-of-Illness and

Medical Necessity.

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Key Strategies for

Compliant Documentation

• Helping the provider understand what is necessary.

• Keeping the lines of communication open between providers and relevant staff.

• Ensure that providers/staff have access to current documentation education and materials.

• Encourage networking between peers.

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Practice of Medicine + Language of Coding( the actual diagnosis that stays with the chart)

=

Full Documentation of Medical Necessity regarding severity

of illness, mortality risk, and resource consumption

=

Compliance and fiscal responsibility

=

Stronger viability of your facility

IN A NUTSHELL

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Early Preparation

� A well-planned, well-managed implementation process will increase the chances of a smooth, successful transition.

� Experience in other countries has shown that early preparation is the key to success.

� An early start allows for resource allocation, such as costs for systems changes and education, process evaluation and change, as well as staff time devoted to implementation processes, to be spread over several years.

Supporting Continued Urgency

� Switch focus to Clinical Documentation Improvement

� Engage Non-HIM Stakeholders

◦ WIIFT

◦ Report Readiness

◦ Process Flows

◦ Vendor Awareness/Preparation

� Use this time wisely!!

◦ …keep your foot ‘on the gas’!!

Preparation is Key

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� Assess Readiness – What is your ‘Current State’?

� Identify Barriers/Challenges/

Expectations/Needs

� Introduce end-users to change (Buy-In)

� Milestone ReCap – How do you know you were successful?

Plan of Action

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Audience Topic

HIM/Coding/CDI Coding structure and rules; A&P*

Information Technology Interface, internal systems, & database impact

Finance/Auditors/Compliance/Consultants Impact on reporting, cost accounting, grouping & payment

Clinicians Proper documentation to capture specificity of ICD-10

Quality Impact on reporting, databases & cost accounting

Utilization Review Proper documentation to capture specificity of ICD-10; impact on reporting & databases

PFS ICD-10 Basics, Impact on grouping and payment

C-Suite Awareness Training…..

Patient Registration Proper documentation, impact on medical necessity & POA

Ancillary Departments/Staff Proper documentation to capture specificity of ICD-10

Tra

inin

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ug

ge

stio

ns

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Basic AwarenessBasic AwarenessBasic AwarenessBasic AwarenessLevel 1Level 1Level 1Level 1

IntermediateIntermediateIntermediateIntermediateLevel 2Level 2Level 2Level 2

IntermediateIntermediateIntermediateIntermediateLevel 2Level 2Level 2Level 2----PPPP

AdvancedAdvancedAdvancedAdvancedLevel 3Level 3Level 3Level 3

Recommended that everyone be exposed to this level, some will need to go on to next level training.

Minimum for all associates.Minimum for all associates.Minimum for all associates.Minimum for all associates.

The curriculum is an overview, expected to deliver a high level understanding of ICD-9-CM and ICD-10 .

Expected Total Hours: 1Expected Total Hours: 1Expected Total Hours: 1Expected Total Hours: 1----1½ 1½ 1½ 1½ hourshourshourshours

People who may occasionally document in the chart but not much clinical documentation of patient’s condition – i.e. phone messages, but not patient encounters ,etc.

Any associate who currently Any associate who currently Any associate who currently Any associate who currently works with ICDworks with ICDworks with ICDworks with ICD----9 codes as a 9 codes as a 9 codes as a 9 codes as a job requirement for nonjob requirement for nonjob requirement for nonjob requirement for non----coding purposes.coding purposes.coding purposes.coding purposes.

General plus info necessary for clinical documentation.

Moderate level of understanding – structure, mapping, LCD, job related .

Expected Total Hours: up to 4 Expected Total Hours: up to 4 Expected Total Hours: up to 4 Expected Total Hours: up to 4 hourshourshourshours

Physicians and all other who document the patient’s clinical condition and or portions of their encounter, order sets, assign conditions to tests, etc.

Physicians, MLP, RN, Physicians, MLP, RN, Physicians, MLP, RN, Physicians, MLP, RN, LPN, Techs, Social LPN, Techs, Social LPN, Techs, Social LPN, Techs, Social workers, Perfusionists, workers, Perfusionists, workers, Perfusionists, workers, Perfusionists, Dietician, Counselor, Dietician, Counselor, Dietician, Counselor, Dietician, Counselor, Nurse Anesth, Midwife, Nurse Anesth, Midwife, Nurse Anesth, Midwife, Nurse Anesth, Midwife, Opticians, etc.Opticians, etc.Opticians, etc.Opticians, etc.

All will have clinical foundation – will need more condition specific information geared towards documentation needs versus ICD-10 structure and format.

Faster paced clinical focused.

Expected Total Hours: Expected Total Hours: Expected Total Hours: Expected Total Hours: TBDTBDTBDTBD

Recommended for anyone assigning the actual code who is not also documenting services and not a clinician .

All HIM/Coding All HIM/Coding All HIM/Coding All HIM/Coding professionals and any professionals and any professionals and any professionals and any associate responsible associate responsible associate responsible associate responsible for applying and/or for applying and/or for applying and/or for applying and/or reviewing reviewing reviewing reviewing appropriateness of ICD appropriateness of ICD appropriateness of ICD appropriateness of ICD codes/auditing.codes/auditing.codes/auditing.codes/auditing.

Will need to understand current methods and tools and access for the need to increase current baseline clinical knowledge of medical terminology, anatomy, physiology, pathophysiology, and pharma.

Expected Total Hours: Expected Total Hours: Expected Total Hours: Expected Total Hours: 20+ hours20+ hours20+ hours20+ hours

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1. Important to maintain urgency of implementation2. Everyone will be affected3. Private and public health plans will not accept and

pay based on ICD-9 codes4. Automated conversions are not possible (forward &

backward mapping of codes)5. ICD-10 cannot wait for Electronic Health Records &

other health IT initiatives6. Must implement both 5010 and ICD-107. ICD-10 is more than a compliance activity8. Planning and implementation must begin now9. The first step is a comprehensive Risk Readiness

Assessment followed by an Impact Analysis10. There is still plenty of work to do!

Top Ten Things You Need to

Know (to Prepare for ICD-10)

56

� ICD-10 Steering Committee

� Comprehensive assessment (including gap

analysis and System Inventory)

� Roadmap to guide implementation planning

� Clinical Documentation Assessment

� Claims analysis to identify top impacted

specialties

� Educational Needs within Organization

� Identify top specialties and education to

physicians

� Implement education/documentation

improvement plan for ICD-10 (“ICD-9

improvement”)

� Open communication channels with system

vendors and payers

� Collaborate/combine efforts to maximize

resource utilization

� Keep yourself educated and in tune with the

latest ICD-10 news

� Attend industry conferences to collaborate

with providers, payers, and vendors

� Buy-in from the top-level down throughout

the organization

� ICD-10 cannot wait for Electronic Health

Records & other health IT initiatives to be

completed

� Start early enough so that thorough testing

can be performed

� Continued urgency is a must!

� There is still plenty of work to do!

What I Know for Sure

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� Do you fully understand the outcome of the impact assessment and are

able to initiate resolutions?

� Do you continue to evaluate effect on data analysis?

� Are you monitoring Trading Partner readiness?

� Have you implemented your Training and Education Plan (Awareness)?

� Do you update and reassess the project as necessary?

� What are your plans to continuing assessing CDI practices?

� Have you reviewed your reimbursement impact?

� Have you developed Risk Mitigation Strategies to minimize transition

problems?

� Have you developed plans to mitigate decreases in productivity and

quality?

� Do you continue to expand the ICD-10 Communication Plan?AHIMA – 2011 Clinical Terminology/Classification Practice Council AHIMA – 2011 Clinical Terminology/Classification Practice Council

Implementation: ‘Self’ Status Questions

58

◦ Take a deep breath

◦ Get organized

◦ You CAN do this

http://www.icd10monitor.com/index.php?option=com_content&view=article&id=501:take-

a-deep-breath-get-organized-you-can-do-this&catid=48:icd10-enews&Itemid=106

The Delay was a Gift

59

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12/8/2013

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Betty B. Bibbins, MD, BSN, CHC, C-CDI, CPEHR, CPHIT

President & Chief Medical Officer

Physician Executive Educator

DocuComp LLC

[email protected]

Contact Information

� American Health Information Management Association (AHIMA)

� Hay Group, Inc.� Healthcare Information Management Systems Society

(HIMSS)� RAND� Robert E. Nolan Company � Pricewaterhouse Coopers� http://www.cms.hhs.gov/TransactionCodeSetsStands/0

2_TransactionsandCodeSetsRegulations.asp� http://www.cms.gov/ElectronicBillingEDITrans/18_5010

D0.asp� 3M Solutions 2011

References

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bibbins ppt - hcca official site · canada sweden china japan venezuela germany switzerland italy...

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