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ICD10 Implementation: Lessons from SA’s experience

ICD10 Implementation: Lessons from SA’s experience. Rajesh Patel S eptember 2014 Windhoek, Namibia. Objectives. What is health governance? Need for language standardisation SA background to implementation NAMAF or ?: Coding in Namibia Implementation needs International developments Q&A.

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ICD10 Implementation: Lessons from SA’s experience

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  1. ICD10 Implementation:Lessons from SA’s experience Rajesh Patel September 2014 Windhoek, Namibia

  2. Objectives • What is health governance? • Need for language standardisation • SA background to implementation • NAMAF or ?: Coding in Namibia • Implementation needs • International developments • Q&A

  3. Stakeholders Government/funders Service providers Health governance Medical audit • Health governance Coding relevant for all stakeholders!

  4. Health governance • Health needs • Health services or benefits • Actions, interventions, programs • M&E • Medical Scheme: • Vehicle for the collection of funds to provide for the health needs of “private” members

  5. Dx Prevalence SA (%): Use of coding

  6. Need for language standardization! • ICD or ICPC • ICD10 or ICD11 or other • Which one? • Choose and make the move!

  7. Why Is Diagnostic Coding Important? • used in the health care industry to classify and organize groups of diseases, disorders and symptoms. • intended to improve both the response time and the accuracy of medical organizations. • it improves the services that are available to the average person, and also makes them more manageable from an organizational perspective. • is an information conduit, facilitating communication between different agencies and health care professionals.

  8. Background • Managed care introduction in SA 1995 • Need for clinical information to be captured • Establishment of PHISC from RAMS/BHF • offices • ICD10 • ICPC • ICD9CM • 1997: DG announced adoption of ICD10 • No documented record

  9. Background • MSA & Regulations 1999 • PMB • Minimum data on claims, incl. diagnostic code • PMBs from 2000 • NHA of 2003 chapter 9 • Need for coding to access PMB benefit • ICD10 implementation for private sector billing from June 2005. Implementation TT co-ordinated by CMS • 2011: Role of coding in NHI • 2012 Ministerial implementation task team

  10. Implementation in Namibia • Do you have regulatory support/enabling legislation? • Yes! • No! • Voluntary implementation • Start with funder coding for managed care activities • Lots of documentation from SA • www.health.gov.za

  11. NAMAF or ? co-ordination • Emphasis on coding training • Accredited coders • Coding trainers • Train the trainer programs • Staff coding training • Provider coding training

  12. NAMAF or ? co-ordination • Technical team: ICD10 Implementation Task Team • Coding expertise • Business process expertise • IT system expertise • Clinicians with HIS expertise • Governm. officials

  13. NAMAF or ? co-ordination • Standardisation of rules, use and systems to capture and communicate data • Quality of coding • Confidentiality concerns • Legitimate • Purpose of coding • Excuse for not co-operating • Call centre

  14. Grouper • ACG: Johns Hopkins • DRG: various

  15. International developments • WHO: Family of coding classification • Diagnostic • Procedure • Disability • MRC in SA: collaborating center • ICD10 rollout in US current • Development of ICD11

  16. Thank You

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