MPAA Conference: Planning and Executing your ICD-10 Implementation

2. MPAA Conference:Planning and Executing your ICD-10 Implementation Tracey McKnight – Sr. Director, Revenue Cycle, RN, MM Spectrum Health Hospitals Friday, November 16, 2012

3. About Spectrum Health • Spectrum Health is a not-for-profit system of care dedicated to improving the health of families and individuals. Our organization includes a medical center, regional community hospitals (7), a dedicated children’s hospital, a multispecialty medical group, affiliated physicians and a nationally recognized health plan, Priority Health. • Spectrum Health has over 16,700 employees and 1,500 physicians

4. Revenue Cycle Overview

5. ICD-10 It’s Coming. Are You Ready? OCTOBER 1, 2013 October 1, 2014 Go Live

6. Background • Effective October 1, 2014 • ICD-9-CM developed in 1979; ICD-10 developed by WHO in 1993 • Many countries have already adopted ICD-10, including Canada (2001), Germany (2000), Australia (1998), France (1997), UK (1995) • Impact of the Transition from ICD-9 to ICD-10 • Requires process reengineering of clinical and business processes • Requires replacement, remediation, upgrading, or outsourcing of legacy information systems

7. Background continued • Experience • Provider experience in other countries showed an initial doubling of days in accounts receivable and an initial fifty percent reduction in coder productivity • Because of the implementation of ICD-10-PCS as well as more advanced use of EHR systems, the US implementation effort will be far more complex and difficult than it was for other countries

8. ICD-9 To ICD-10 • Largest transformation of core clinical and support processes in the last 30 years – larger than Y2k • much larger than CPOE • from approx 16,000 codes to155,000codes • Requires significant changes in: • Technology platforms (48 major IT systems) • Clinical documentation (training for 3,500+ staff and providers) • All reports, dashboards, and solutions that use billing data

9. ICD-10 Impact to Patient Billing • There are many potential impacts to Patient Finance: • Payer issues on go-live • Delayed payments • Increased Denials • Increase in DNFB (Discharge Not Final Billed) • Rise in Customer Service calls due to increased Denials • Payers may not be ready • Non-HIPAA payers (i.e. Workman’s Comp and Auto Insurance) aren’t required to use ICD-10

10. What’s Changing • No changes regarding diagnosis and procedure codes apply to the following: • MS-DRGs • APC • HCPCS • CPT 10

11. ICD-10-CM (Diagnoses) Structure . . X X X X X X X X X X X X 307.81 – Tension headache G44.209 – Tension type headache, unspecified, not intractable

12. The ICD-10 code set is a full replacement of the ICD-9 code set that will provide additional granularity for diagnosis and procedure codes. This additional granularity is the primary driver of value. The basics of the ICD-10-CM change An Example of Structural Change ICD-9 ICD-10 . . . Category Etiology, anatomic site, manifestation Category Etiology, anatomic site, manifestation X X X X X X X X X X X X Extension . Type 1 diabetes mellitus with diabetic neuropathy, unspecified An Example of One ICD-9 code being Represented by Multiple ICD-10 Codes E 1 0 4 0 One ICD-9 code is represented by multiple ICD-10 codes . Type 1 diabetes mellitus with diabetic mononeuropathy E 1 0 4 1 . . Type 1 diabetes mellitus with diabetic amyotrophy Diabetes mellitus with neurological manifestations type I not stated as uncontrolled E 1 0 4 4 2 5 0 6 1 . Type 1 diabetes mellitus with other diabetic neurological complication E 1 0 4 9 The industry expects that mapping ICD-9 and ICD-10 codes will be a complex task

13. Code structure in Medical and Surgical Section Procedure Code ICD 10 Structure

14. This is what specificity looks like ICD-10 ICD-9

15. ICD-10 Program ICD-10 Program Business & Clinical Workflows Project Human Resources Retention and Recruitment Business Technology Project

16. Guiding Principles • The ICD-10 Transition Program is not a series of technology projects within a program; technology is only a small part of the solution • Dedicated Core Program Management Team focused on ICD-10 Transition • Make use of Project Management Methodology and Business Analysis processes

17. Guiding Principles continued • Program includes SHHG/SHMG partnership with PH • Recognize and seize opportunities for Business & Clinical Process Improvement • Focus on managing and mitigating all risks and issues related to Financial Readiness • Baseline Program Planning assumptions are best estimates with information to date

18. Project Organizational Structure

19. Approved Program Objectives • Coding • Coder productivity will be at 80% after six months • Coder accuracy will be at 95% after six months • Financial • Cash, AR, Denials will return to July 2011 levels • Technical • Core applications will be upgraded by April 2013 • Inventory of all applications were identified by 12/31/11 with a 5% margin of error • Testing will have only a 5% margin of error

20. ICD-10 Program ICD-10 Program Business & Clinical Workflows Project Human Resources Retention and Recruitment Business Technology Project

21. Spectrum Health’s ICD-10 Transition Project Structure Business and Clinical Workflows Project Business and Clinical Workflows Workgroup Coding Workgroup Communication Workgroup Education and Training Workgroup Physician Champions Workgroup

22. ICD-10 Business & Clinical Workflows Project Dedicated Project Manager and Analyst Goal: Ensure enterprise wide ICD-10 compliant workflows and processes. Plan: 1) Who/What process flow analysis 2) Coding, Training & Communication Processes 3) Validate Process Readiness 4) Validate Final Readiness (A Week in the Life)

23. Process Flow Workgroup • Accomplishments: • Completed Impact Analysis of organization. Currently beginning in-depth review highly impacted departments • Developing a Financial dashboard to report daily or weekly metrics such as # of denials, claims submitted, # of accounts in work queues etc. This dashboard will help identify problems early by closely monitoring these items • Next Steps: • Continue work with highly impacted departments and modify current processes as needed to be ICD-10 compliant • Continue to engage the Central Billing Office to ensure financial readiness. This will involve working closely with payers and clearinghouses as well

24. Education Workgroup • Accomplishments: • 31 Coders were trained by AHIMA to be certified trainers • AHIMA material such as PowerPoint’s and lesson plans will be utilized to create curriculum for staff • Coding staff who select diagnosis codes will be trained the same (Medical group and Hospital group) • Completed the Basic ICD-10 Education module • Next activities: • Develop Intermediate Training lesson plan • Select Online Education Software vendor for ICD-10 content

25. Coding Workgroup • Accomplishments: • Completed a case review in 10 highly impacted areas identified by a 3M audit • Began in depth analysis of the top selected diagnosis and procedure codes. Review will be done by chapter of the current ICD-9 book to represent each specialty Next Steps: • Continue analysis of top diagnosis and procedure codes • Work with the Education Workgroup as they develop Physician Education content to incorporate findings of analysis • Update any forms or electronic templates with ICD-10 codes

26. Communications Workgroup • Accomplishments: • Created an ICD-10 Video which can be used to create awareness • Developed content for Physician awareness • Continue providing monthly documentation topics outlining the changes needed for ICD-10 Next Steps: • Begin Physician awareness campaign • Focus on marketing the benefits of ICD-10 to ease any fears and gain a positive perspective throughout the organization

27. Physician Champions Workgroup • Accomplishments: • Reviewed documentation templates with Physician Champions. Workgroup selected summary format • Example: Total Hip Replacement (ICD-9 code 81.51) • Documentation Considerations:    • Laterality     • Device Type: Ceramic, Autologous Tissue, Nonautologous Tissue, Synthetic • Cement: Need to specify whether it is cemented or uncemented (where applicable) • Approach: Open    

28. Physician Champion Workgroup • Accomplishments: • Physician and provider networks identified for ICD-10 awareness communications for SHGR, SHMG • Next Steps: • Identify other physician and provider groups that need communication • Refine Physician and provider awareness plan for 2012

29. Spectrum Health’s ICD-10 Transition Project Structure Business Technology Project Reports and Data Warehouse Workgroup Forms Workgroup Application and Interface Workgroup

30. ICD-10 Business Technology Project Dedicated Project Manager and Analyst Goal: Ensure enterprise wide ICD-10 compliant applications, databases, forms, reports, and FTP sites while maintaining ICD-9 capabilities Plan: Prepare and validate application readiness Clinical and Business form identification and standardization GEMs Mapping tool implementation Determine report analysts/generators

31. ICD-10 Application Status Dashboard *As of 1/9/2012

32. Applications and Interfaces Workgroup Accomplishments: • Continued discussions regarding coordination of concurrent coding within 3M for Spectrum Health Coding department in 3M • Continued discussions regarding testing coordination and timeframes for core systems • 3M platform upgrade in October 2012 will provide preliminary ICD-10 grouping capabilities • HealthQuest upgrade in March 2013 will provide PROD grouping capabilities • Finalized detailed ICD-10 application data map

33. Application and Interfaces Workgroup • Next Steps: • Continue to obtain vendor certification documentation from analysts • Continue to obtain outstanding analyst responses, estimate of hours and cost associated with upgrade of application • Continue to configure work estimator for Core application customizations

34. Forms Workgroup • Accomplishments: • Document Approval Team (DAT) continues to meet twice monthly for clinical form review and consolidation • Clinical forms standardization • Identification of all business forms Next Steps: • Continue forms work group meetings (clinical and business) • Formulating a business form approval/ICD-10 compliance committee to match DAT (but for business forms)

35. Data Warehouse and Reports Workgroup • Accomplishments: • GEM’s Mapping Tool vendor presentations reviewed • Recommendation document completed for GEM’s Mapping Tool selection • Next Steps: • Select and Implement GEM’s Mapping tool • Determine report analysts and generators

36. Spectrum Health’s ICD-10 Transition Project Structure Human Resources Project Career Development Leadership Development Recruiting Resource Planning

37. Career Development Workgroup • Accomplishments: • Researched employee preferences related to growth and development • Gathered data on existing jobs and “informal” career paths • Next Steps: • Plan an internal recruitment program for future medical coders based on estimated needs and timing • Develop a career path framework to outline opportunities within the organization

38. Leadership Development Workgroup • Accomplishments: • Surveyed employees and leaders on factors influencing retention • Designed learning tracks at Spectrum Health University to focus on leadership development at multiple levels • Next Steps: • Launch leadership development curriculum with leaders of medical coding groups • Implement additional leadership development activities that help leaders improve levels of engagement and retention

39. Recruiting Workgroup • Accomplishments: • Launched new talent acquisition software to streamline selection of candidates • Revised strategies and tools for selection assessments • Next Steps: • Enhance our employment brand and relationships with educational institutions in our region • Follow through on hiring plans and monitor process effectiveness

40. Resource Planning Workgroup • Accomplishments: • Developed a three-year employee supply and demand forecast based on anticipated workforce needs • Next Steps: • Monitor and update workforce forecast based on actual data and plan changes • Develop recruitment and hiring plans aligned with the forecast • Assess options for internal resource pool management

41. Program - Next Steps • Partner with clinical documentation strategy • Identify appropriate collaboration for quality metrics • Implementation of Computer Assisted Coding Software • Develop future state process flows for highly impacted areas • Kickoff “awareness” campaign throughout Spectrum Health • Complete training plans for all staff • Coding workgroup to complete analysis of the top diagnosis codes by body system, ICD chapter and specialty • Finalize vendor decisions for translation tool and online education

42. Reminder: Patient Finance is Impacted! • Key Tasks • Begin Payer readiness assessment • Plan for Payer testing • Develop post go-live dashboard to capture key metrics • Create staff education plan by role • Assess risk and plan for how to mitigate delayed payments

43. High Level Timeline Progress to-date OCTOBER 1, 2013 October 1, 2014 Non-negotiable

44. ICD-10 It’s Coming. Are You Ready? 10.01.2014 Jim Anderson, Program Manager & Business & Clinical Workflows PM james.anderson@spectrumhealth.org Derek Mazurek, Business Technology Manager- derek.mazurek@spectrumhealth.org