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ICD-10 as a Team Sport: Lessons Learned from the End-to-End Testing Pilot in North Carolina

ICD-10 as a Team Sport: Lessons Learned from the End-to-End Testing Pilot in North Carolina. October 8, 2013 MGMA 2013 Annual Conference, San Diego, CA Holt Anderson, Executive Director NCHICA (North Carolina Healthcare Information and Communications Alliance, Inc .).

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ICD-10 as a Team Sport: Lessons Learned from the End-to-End Testing Pilot in North Carolina

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  1. ICD-10 as a Team Sport:Lessons Learned from the End-to-End Testing Pilot in North Carolina October 8, 2013 MGMA 2013 Annual Conference, San Diego, CA Holt Anderson, Executive Director NCHICA (North Carolina Healthcare Information and Communications Alliance, Inc.)

  2. In collaboration with NCHICA members including: http://www.ncmgm.org

  3. Where are MGMA Members ?

  4. About NCHICA – Team Sport Convener • 501(c)(3) Nonprofit Organization est. 1994 • 300+ Member Organizations including: • Providers • Professional Associations Payers • Government Agencies • Business Partners / Vendors • Consulting Firms • Operate as neutral, trusted, venue for building consensus-based solutions for implementation • Support roundtables, workgroups, task forces that are member and issue driven

  5. NCHICA ICD-10 Task Force • Established by NCHICA Transactions, Code Sets, and Identifiers Workgroup in February 2010 • Monthly Meetings since Feb. 2010 • 75+ Organizations • Including Providers, Payers, Clearing Houses, Professional Associations, Government Agencies (NC DHHS and CMS), Labs, Law Firms, Vendors, etc. • 128+ Individuals • Periodic Bulletins for Distribution to NCHICA Members and Members of Professionals Associations • Collaboration on Educational Events • Recent ICD-10 Summit – Sept. 11, 2013, Asheville, NC

  6. ICD-10 Task Force Activities ICD-10 Web Site: www.nchica.org/HIPAAResources/icd10.htm

  7. Task Force Bulletins

  8. ICD-10 Pilot Testing Participants Include

  9. NCHICA Pilot Intended Benefits • Business Driven Approach to Testing • Coding Analytics for Providers and Payers • Shared Delivery Model vs. Silo Delivery Model • Gives Health Plans More Clinical Data not Mapped Data • Gives Health Plans Greater Provider Testing Involvement • Visibility into Provider Contracts and Revenue Cycle • Verifiable Results to Assess Trading Partner Readiness 9

  10. NCHICA Pilot Scope • Top 3 DRGs Per Specialty/Clinical Data • Known Payment Changes • Positive, Negative & Neutral • A“Source-of-Truth” for Claim Scenarios • Dual Coded ICD-9 and ICD-10 Transactions • Experienced ICD-10 Coders and Clinician Peer Review • Test Data Reusable Across All Trading Partners • Agile Testing – Know the Answer Prior to Start 10

  11. 4 Stages of Testing Using Common Data STAGE 2 STAGE 1 • SHARED CODING RESULTS • DUAL-CODED TRANSACTIONS • CODING CONSENSUS • ICD-10 CODING ACCURACY • SHARED WITH ALL TRADING PARTNERS (EG. CLEARINGHOUSES, HEALTH PLANS AND VENDORS) • ADDITIONAL CODING REVIEW BY TRADING PARTNERS (IF REQUIRED) • BILLING TESTING • DEFECT RESOLUTION • INTERNAL UNIT/INTEGRATION • MEDICAL RECORD SELECTION • DUAL-CODING EXERCISE • DUAL-CODED CLINICAL RECORDS • ICD-10 CODING ACCURACY • WORKFLOW PROCES IMPROVEMENT • ICD-10 TRAINING • COMPUTER ASSISTED CODING • COMPLIANCE TESTING STAGE 4 STAGE 3 • END-TO-END TESTING • DUAL-CODED TXN’S • END-TO-END TESTS • COMPLIANCE TESTING • DEFECT RESOLUTION • HELP DESK • TRADING PARTNER TESTING • BUNDLED MEDICAL RECORDS • DUAL CODING WORKSHEETS • DRG ASSIGNMENTS • 5010 TRANSACTIONS • SHARED WITH ALL TRADING PARTNERS (EG. CLEARINGHOUSES, HEALTH PLANS AND VENDORS) • ADDITIONAL CODING REVIEW BY TRADING PARTNERS (IF NECESSARY)

  12. 4 Stages of Testing – A Closer Look An Iterative Process STAGE 1 STAGE 2 STAGE 4 STAGE 3

  13. 4 Stages of Testing – A Closer Look • Stage 1 - INTERNAL UNIT/INTEGRATION • MEDICAL RECORD SELECTION • DUAL-CODING EXERCISE • DUAL-CODED CLINICAL RECORDS • ICD-10 CODING ACCURACY • WORKFLOW PROCES IMPROVEMENT • ICD-10 TRAINING • COMPUTER ASSISTED CODING • COMPLIANCE TESTING

  14. 4 Stages of Testing – A Closer Look • Stage 2 - SHARED CODING RESULTS • DUAL-CODED TRANSACTIONS • CODING CONSENSUS • ICD-10 CODING ACCURACY • SHARED WITH ALL TRADING PARTNERS (EG. CLEARINGHOUSES, HEALTH PLANS AND VENDORS) • ADDITIONAL CODING REVIEW BY TRADING PARTNERS (IF REQUIRED) • BILLING TESTING • DEFECT RESOLUTION

  15. 4 Stages of Testing – A Closer Look 4 Stages of Testing – A Closer Look • Stage 3 - TRADING PARTNER TESTING • BUNDLED MEDICAL RECORDS • DUAL CODING WORKSHEETS • DRG ASSIGNMENTS • 5010 TRANSACTIONS • SHARED WITH ALL TRADING PARTNERS (EG. CLEARINGHOUSES, HEALTH PLANS AND VENDORS) • ADDITIONAL CODING REVIEW BY TRADING PARTNERS (IF NECESSARY)

  16. 4 Stages of Testing – A Closer Look 4 Stages of Testing – A Closer Look • Stage 4 - END-TO-END TESTING ** • DUAL-CODED TRANSACTION’S • END-TO-END TESTS • COMPLIANCE TESTING • DEFECT RESOLUTION • HELP DESK • **This phase is not yet complete due to scheduling conflicts

  17. NCHICA Pilot Status (as of July 1, 2013) • The participating pilot hospitals have provided to date, more than 200 highly relevant clinical dual coded and peer reviewed scenarios • Another 100+ scenarios are still in progress, and this dual coding exercise will continue through the end of October when we will begin the physical testing effort. • Defining the scope for Physician Offices- Volume of charts and # of test cases • Dual Coding of Physician practice cases will begin In November • Sharing of dual coded clinical scenarios with the participating health plans is underway 17

  18. Thank You! Holt Anderson holt@nchica.org (919) 558-9258 www.nchica.org ICD-10 Task Force Information & Bulletins http://www.nchica.org/HIPAAResources/icd10.htm

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