ehr and icd 10 convergence - lexicompmeaningful use objectives, measures, and icd‐10 item core...

EHR and ICD‐10 Convergence Understanding ICD‐10 Synergies with Meaningful Use

Michael F ArrigoNo World Bordershttp://www.noworldborders.com

Presented for Wolters Kluwer Webinar

1www.noworldborders.com

The information provided in this presentation is not intended to and does not render legal, accounting, tax, medical, medical coding, or other professional advice or services, and no client relationship is established with Wolters Kluwer, Michael Arrigo or No World Borders by making any information available in this presentation, or from you transmitting an email or other message to us.

Risk‐Sharing Contract Analysis


Agenda

I. Regulatory Update

II. Meaningful Use Measures: 20+ EHR clinical processes impacted by ICD‐10

III. The clinician knowledge management crisis: data, documentation, and ICD‐10

IV. Best practices


Audience Today

• Providers:– Hospitals– Ambulatory providers– Pharmacists

• Payors• Healthcare IT firms / professionals


I. Regulatory Update


Buying a Hospital or Physician Group?

When you acquire a provider, you acquire their liabilities including IT, process, public statements…

1. False Claims Act risk2. HIPAA Privacy and Security / breach risk3. Safeguards as Provided for by MU compliance risk4. FBI, Attorney General, CMS audit risk5. OIG audit risk6. Documentation supporting proper coding7. White collar crime / whistleblower investigations8. Discrete data supporting MU and clinical documentation, RAC Audit

Risk9. Medicare Part C and ACO Plans: Documentation supporting proper risk

adjustment10. ICD‐10 reimbursement, hospital revenue bonds – proper statements

regarding forward looking risk


ICD‐10 Regulatory Update

• The recent CMS / AMA announcement on ICD‐10 implementation – no denied claims

• The reality– Medicare Part A – no delay– Medicare Part B providers only get a reprieve on reimbursement risk and ICD‐10, but must have a diagnosis code, CPT codes remain for procedures

– Realistic probability: can CMS or any payor adjudicate some claims?

– Hospitals (Part A) who own clinics (Part B)


State Medicaid, Four Exceptions

• California, Maryland, Montana and Louisiana– Still must “comply” with ICD‐10 however cross walking vs. native ICD‐10

– Receiving ICD‐10 claim and mapping back to “9” and paying on that for certain scenarios will yield different results


II. Meaningful Use and ICD‐10

1. Meaningful Use CFRs and ICD‐10

2. E.H.R. Clinical Workflows and ICD‐10

3. Behavioral Health / Substance Abuse Example


Meaningful Use Objectives, Measures, and ICD‐10

Item Core Measures1 SNOMED/ICD-9 Mapping 2 Clinical Decision Support, UI, 9 required elements3 Patient Specific Education 4 Transitions of care – receive, display and incorporate transition of care/referral summaries5 Transitions of care – create and transmit transition of care/referral summaries6 Clinical Reconciliation – incorporate a C-CDA for electronic reconciliation of information

7 Data portability8 Clinical Quality Measures9 View, download, and transmit to 3rd party10 Ambulatory setting only -clinical summary11 Secure Messaging Ambulatory Setting12 Automated measure calculation


Example:170.314(a)(5) & (a)(13): SNOMED and ICD‐10 Mapping

• Examine approach to include ICD‐10 codes

– Determine whether the CDS is firing based on ICD‐9 specific information that will be problematic under ICD‐10

– Solution / detail approach : See best practices section of this presentation

Your E.H.R. may have mapping tools, or you may have pre‐packaged mappings from SNOMED to ICD‐9. Make sure that these are updated for ICD‐10 AND you MUST test these mappings (see best practices)


Example: 170.314(a)(15)Patient Specific Education

• Determine medical concepts related to patient condition and how the condition is documented or collected to support ICD‐10

• Change the workflow for (a)(15) or the patient specific documentation that is provided based on these updates.

• Solution / detail approach : See best practices section of this presentation


CDS: ICD‐9 to ICD‐10 examples of SNOMED CT and ICD codes


Example: 170.314(a)(15)Patient Specific Education

• Patient Specific Education May Include intersection with ICD‐10 CM Diagnosis, ICD‐10 PCS Procedure, or CPT Coded Procedure:– Medication List– Medication Allergies– Demographics– Lab test results data– Vital sign data

• Solution / detail approach : See best practices section of this presentation


170.314 (a)(8) Shows ability to search by various clinical decision support criteria


E.H.R. Process Impacts of ICD‐10(Well Over 20)

Item Title1 Provider - Scheduling - Provider Scheduling Template2 Provider - Scheduling - Insurance Verification3 Provider - Scheduling - Preauthorization/Certifications4 Provider - Scheduling - Medical Necessity / ABN5 Provider - Scheduling - Pre-Order Entry/Ancillary6 Provider - Registration - Admitting (or scheduling or registration) Diagnosis7 Provider - Patient Care / Clinical Ops - Check-in / Admission 8 Provider - Patient Care / Clinical Ops - Medical Documentation 9 Provider - Patient Care / Clinical Ops - Case Management 10 Provider - Patient Care / Clinical Ops - Check-out / Discharge Process 11 Provider - Patient Care / Clinical Ops - Clinical Pathways12 Provider - Patient Care / Clinical Ops - Documentation13 Provider - Patient Care / Clinical Ops - Documentation Templates 14 Provider - Patient Care / Clinical Ops - Physician Training/Education 15 Provider - Coding & Charge Entry - Charge Capture16 Provider - Coding & Charge Entry - Charge Review Work queues 17 Provider - Coding & Charge Entry - HIM Based Coding 18 Provider - Patient Financial Services - General19 Provider - Patient Financial Services - Claim Submission20 Provider - Patient Financial Services - Denial Management / Rebilling21 Provider - Patient Financial Services - Appeals Process22 Provider - Patient Financial Services - Collections Process23 Provider - Patient Financial Services - Bad Debt Write Off24 Provider - Support Services - Training and Development25 Provider - Support Services - Clinical Quality 26 Provider - HIM Administration & Reporting - Continuous Documentation Improvement (CDI) 27 Provider - HIM Administration & Reporting - Security of Patient Information 28 Physician Leadership


Example: Provider Process Impacting Payor Process:

Scheduling - Insurance Verification

Providers: Do you have ICD-9 centric information embedded in systems or processes?

Payors: Do you have ICD-9 centric information embedded in systems or processes?


Example: Provider: Registration – Admitting

(or scheduling or registration) Diagnosis

Evaluate the process of obtaining the admitting diagnosis from the evaluation of the patient, Access Services, & Patient Admitting Department. If the patient is readmitted to our facility how can we have Access Services reference that diagnosis?


III. Clinician Knowledge Management Crisis


Biomedical Informatics and the Clinician Knowledge Crisis

• Professor Enrico Coiera of Macquarie University: health informatics is the logic of healthcare

• Dr. Mark Musen MD PhD Professor, Stanford Medical School – Biomedical Informatics– digital information has made knowledge infinitely larger for clinicians,

– clinicians now are in a knowledge management crisis– getting the right information to health care administrators, clinicians, IT personnel and others at the right time is the challenge.


Biomedical Informatics and the Clinician Knowledge Crisis

• Although the name ‘health informatics’ came into use around 1973 (Protti 1995)

• The world is aging and there are increasing numbers of people with chronic disease; key sustainable strategy is planning delivery of healthcare through technology innovation.

• Biomedical Informatics seeks to discern the difference between data, information, knowledge and wisdom by increasing sharing and comprehension.


ICD‐10 and Clinical Documentation

• Clinical scenarios• Medical specialties• Intersection of Meaningful Use and ICD‐10: discrete data must be stored in the E.H.R., not scanned physician notes


IV. Best Practices


Best PracticesBuying a Hospital or Physician Group?

Proper Regulatory Risk Diligence• Your attorney is probably competent but not prepared for the nuances of MU and ICD‐10 without expert advisory

• Solution: Expert witness services with your attorney ([email protected])


Best PracticesBuying a Hospital or Physician Group?

Testing• Testing your E.H.R.

– ICD‐10 documentation specificity support– ICD‐10 workflows perspective– Payor perspective on reimbursement risk

• Use of Clinical Scenarios – Clinical scenarios for your setting / place of service:

• Inpatient• Ambulatory

• If you have Medicaid claims in CA, MD, LA, MT, results will vary


Our Offerings

• ICD‐10 / Meaningful Use Synergies– Tool Kits – full list of impacts and remediation– Mapping issues back to CFRs and requirements– Workflow impact assessments– Meaningful Use Audit Defense– Clinical Documentation Improvement, guided clinical ontologies for clinicians for their specialty

• Expert witness : State, Federal Court Experience


How to Reach Me

www.twitter.com/marrigo

Email: [email protected]

www.noworldborders.com

Contact Wolters Kluwer for my phone contact


Conclusion

• Beware of “automatic” solutions• Proper regulatory diligence• YOU THE PROVIDER, not the E.H.R. are required to become ICD‐10 compliant

• Remember that there are three components– MU compliance– Workflows– Clinical Documentation


ehr and icd 10 convergence - lexicompmeaningful use objectives, measures, and icd‐10 item core...

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