ICD-10: Anticipate the Impact

1. Presented by:American Consultants Darrell Jones, PMP, ITIL Director, Health Information Technology Linda Gerber V.P. Health Information Technology ICD-10: Anticipate the Impact

2. ICD-10 Agenda • Background • Project Approach • Training • ICD-10 Impacts • Project Management • Readiness

3. ICD-10 Background • ICD-10 must be used for transactions with dates of service/date of discharge on or after October 1, 2014 • ICD-9 will no longer be accepted. • Deadline is firm, no further delays are expected.

4. Coding Specificity An Example of Structural Change ICD-9 ICD-10 . . . X X X X X X X X X X X X Category Category Etiology, anatomic site, manifestation Etiology, anatomic site, manifestation Extension . E 1 0 4 0 . An Example of One ICD-9 code being Represented by Multiple ICD-10 Codes Type 1 diabetes mellitus with diabetic neuropathy, unspecified E 1 0 4 1 One ICD-9 code is represented by multiple ICD-10 codes . E 1 0 4 4 . Type 1 diabetes mellitus with diabetic mononeuropathy Diabetes mellitus with neurological manifestations type 1 not stated as uncontrolled 2 5 0 6 1 . E 1 0 4 9 Type 1 diabetes mellitus with diabetic amyotrophy Type 1 diabetes mellitus with other diabetic neurological complication

5. Project Approach • Governance Structure is required. • ICD-10 Implementation is a project, there’s a deadline. • Needs Executive-Level Sponsorship& Leadership • CEO, CFO, COO • Needs input from many different sources. • Physicians, Vendors, Payers, etc… • A path to Go-Live • Create your Implementation Plan

6. Governance Structure • Executive Sponsor • Executive Steering Committee • CEO, CFO, CIO, CNO, CMIO, HR, IT, HIM • ICD-10 Program Manager • ICD-10 Core team • Education • Physicians • Coders & Billers • CDI • Revenue Cycle • HIM • Work Groups • Work Groups • Work Groups

7. Path to Go-Live

8. ICD-10 Implementation Plan Assess Plan Remediate Optimize • Exec sponsors/stakeholders • Coding Assessment • Documentation review • Organizational readiness • Contract analysis • IT product inventory • Vendor readiness • Process readiness • Risk assessment • Roadmap assessment • Budget assessment • Exec sponsors/stakeholders • Establish steering committee • Establish PMO • Program Planning • Budget planning • Establish structure • Establish communications & reporting • Establish change mgmt. • Application/Interface • Workflow • Payer • Vendor coordination • Upgrade/Modify/replace • Testing • Coder education • Staff education • System training • Contract changes • Sensitivity analysis • Parallel Coding • Go-live planning • Go-live support • Change mgmt. & awareness • Risk management • Managing adoption • Reporting & analysis • AR/DNFB • Claims analysis • Process audits • Coding audits • Documentation updates • Systems Monitoring • Vendor support • Go-live support • Program closure ICD-10 Organization Wide Education Formal Training—Provider, Coding, Clinical Documentation, etc... On-going Sustainment training

9. Who needs to be trained? Administrative – Basic training Registration, Schedulers, Office Managers Non-Physician Clinician –Moderate training PAs, Nurses, Lab, Radiology, Support Personnel Physician – Training by specialty or codes Family, Specialty, Surgeons Coder/Billing – In-depth code training

10. Training Timeline • Train coding professionals in high risk areas first. • Highest volume codes and codes with largest revenue impact. • Code areas with the most changes (e.g. diabetes). • Conduct training needs analysis, only train on codes practitioners will use. • Train your best coders first and early. They will become super coders to help you train the rest. • Plan several shorter training sessions over time rather than marathon training sessions. • If, however, your staff prefers workshop style training, then plan “review” sessions to reinforce learning over time. Break it down

11. ICD-10 Training Number of training hours needed: • The Medical Group Management Association recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff • Average Costs of training per doctor or coder = Provider and staff education and training, estimated between $500 to $2500 per individual.

12. ICD-10 Impact We all know ICD-10 impacts clinical documentation and coding, but what is the impact to your organization?

14. Impact Types

15. Technology Impact • System upgrades, replacements, testing, and go-live • Vendor readiness and management • Potential clinical department workflow process changes • Clinical Documentation changes • Interface development and testing

16. Processes Impact Clinical Processes • Documentation • Training • Code Review Revenue Cycle • Coding • Billing • Denials • Customer Service Information Systems • System Upgrades • Reporting • Testing • Vendor Management • Project Management

17. People ImpactPhysicians • Documentation: The need for specificity dramatically increases by requiring laterality, stages of healing, weeks in pregnancy, episodes of care, and much more. • Code Training: Code increases from 17,000 to 140,000. Physicians must be trained. • Code Review: A practice of using coders to review physician diagnosis’ can drastically improve your denials and reimbursement.

18. People ImpactClinical • Patient Coverage: Health plan policies, payment limitations, and new ABN forms. • Superbills: Revisions required and paper super-bills may be impossible. • ABNs: Health plans will revise all policies linked to LCDs or NCDs, etc., ABN forms must be reformatted, and patients will require education.

19. People ImpactManagers • New Policies and Procedures: Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRI must be revised. • Vendors and Payer Contracts: All contracts must be evaluated and updated. • Budgets: Changes to software, training, new contracts, and new paperwork will have to be paid for. • Training Plan: Everyone in the practice will need training on the changes.

20. People ImpactBilling • Policies and Procedures: All payer reimbursement policies may be revised. • Training: Billing department must be trained on new policies and procedures and the ICD-10-CM code set.

21. People ImpactCoding • Code Set: Codes will increase from 17,000 to 140,000. As a result, code books and styles will completely change. • Clinical Knowledge: More detailed knowledge of anatomy and medical terminology will be required with increased specificity and more codes. • Concurrent Use: Coders may need to use ICD-9- CM and ICD-10-CM concurrently

22. People ImpactTechnology • Systems: Updates to systems may impact patient encounters. Testing of interfaces and documentation will take time away from operational work. • Vendor Management: Projects should be underway to upgrade outdated systems. • Project Management: Competing priorities with other projects, e.g. Meaningful Use

23. FinancialImpact • An Increase in Discharged Not Final Bill (DNFB) as more claims will be denied with the lack of specificity of codes. • Productivity in the Coding and Billing Departments will decrease during the adjustment to the new codes sets. • Beyond Coding and Billing, a decrease in productivity will occur for anyone else involved in coding: Physicians, Revenue Cycle, Case Management, Clinical Documentation. NEED TO GET SPECIFICS - unspecified means unpaid! • Payers and Vendors will also experience delays since they are going through this same transition for the first time. • Dual coding will bring a need for additional coders, as the work load will be doubled. • Payer contract management & Payer readiness

24. Financial ImpactCont. • Many IT systems will have to be updated, upgraded, or replaced. • The transition will bring new Workflows that will need to be monitored, adjusted, and documented. Think continuous improvement • Many reporting systems will need to be adjusted or replaced. • Backfilling for work hours used for employee training. A good percentage of the employees will need to complete some level of education. • Backfilling for Physician training will be difficult, which will have a direct effect on patient volumes.

25. Gap Analysis Identify processes, people and technology gaps between the current state and desired target state: • Work flow issues • System Issues • Revenue Cycle/Charge Master • Other issues that were not evident

26. Roadmap / Work Plans • Develop roadmap / work plan that includes all tasks required to ensure all people, processes, training, and technology are ICD-10 ready. • Plan for modifying systems to accommodate code structure in all functional systems. • Plan for modifying business process to manage revised components of the value chain. • Determine approach and timing for updating analytics and reporting to support effort. • Plan for testing, go-live, and contingencies.

27. Implementation Timeline

28. ReadinessAre you ready?

29. Readiness:Assessment Areas

30. Readiness:Internal • What applications, databases, interoperability feeds, and reporting are impacted by ICD-10? • Are your people/process/technology analyzed and assessed? • Will the ICD-10 change be vendor-supported or require in-house changes? • For vendor-supported systems, is there an acceptable upgrade/remediation path, or will the systems need to be replaced?

31. Readiness:Vendors • What are the vendor-related and internal actions required to prepare for and conduct the migration? • What is the estimated timeline, level of effort and anticipated costs? • What staffing resources are needed to support multiple replacements/upgrades? • How will the IT department sequence system replacements/upgrades and conduct unit and integration testing?

32. Readiness:External Partners • When can you begin testing ICD-10 transactions? When will your clearinghouses/billing services, payers begin testing? • Do they have any upgrades that need to be completed? • Are your payer contract negotiations/medical policies completed to accommodate the ICD-10 code set? Ask them about: • Review, auditing, coverage, and medical policy changes • Impact on coverage decisions and reporting requirements This phase can take 2-3 months to complete and needs to be completed during the assessment phase Especially if you start late!

33. Technology Alternatives • Evaluate the options for implementation and compliance. • Focus on competitive advantage and strategic imperatives to support evaluation. • Select future-state solution that best meets the objectives and constraints. • Develop more detail on the technology, operations and people impacts of the solution. • Include a bucket for unplanned hurdles in the budget (10% of budget). Be prepared to change direction if needed:

34. The Healthcare People www.thehealthcarepeople.com 866-319-6975 Q & A Play Offense not Defense – Start Now Let us help you determine your game plan

35. Contact Information Darrell Jones, PMP, ITIL Director, Health Information Technology (O) 866-319-6795 (C) 303-956-5716 Linda Gerber V.P., Health Information Technology (O) 866-319-6795 (C) 913-515-0290 AMERICAN CONSULTANTS ~ ICD-10 Information http://www.thehealthcarepeople.com/health-information-technology/icd-10-transition/