PEACE, LOVE & ICD10. Kimberly Barca, RHIA HIM Regulatory & Project Manager Princeton Healthcare System 6/10/2014

Transcription

1 PEACE, LOVE & ICD10 Kimberly Barca, RHIA HIM Regulatory & Project Manager Princeton Healthcare System 6/10/2014

2 AGENDA Brief History of ICD-10 Why ICD-10? Implementation News What Does ICD-10 Mean To My Organization? Preparation, Action and Evaluation Risk & Mitigation Considerations Next Steps Questions & Answers

3 HEALTHCARE TODAY

4 Why ICD10? The History of ICD-9 World Health Organization (WHO) developed ICD-9 for use globally U.S. developed clinical modification (ICD-9- CM) Implemented in 1979 in U.S. It provided for an expanded number of diagnosis codes Developed procedure coding system Uses: calculate payment, adjudicate coverage, compile statistics, assess quality

5 Why ICD10? Consider ICD-9 Today ICD-9-CM is OUTDATED 30 years old technology, disease, and overall healthcare has evolved Many categories are full and cannot expand Not descriptive enough Not flexible, not exact

6 Why ICD10? Mandated by The Department of Health and Human Services (HHS) Currently 18,000 ICD9 codes growing to more than 141,000 ICD10 Will affect EVERYONE who touches a medical record, claim or information coming from them Quoted as being The Perfect Storm ; Bigger than Y2K and DRG s combined Need to prepare NOW

7 Benefits of ICD-10 Better quality of care Greater coding accuracy and specificity Better information for measuring quality, safety and efficiency Reduced coding errors Alignment of the US with coding systems worldwide Improved ability to track and respond to international public threats Recognition of advances in Medicine and Technology

8 But wait I thought ICD10 was: Delayed? Cancelled? Skipping ICD-10 and going to ICD-11?

9 ICD-10 DELAY ICD-10 is not cancelled. On 3/31/2014, the Senate voted (64-35) to approve a bill that included the delay in the implementation of ICD-10-CM/PCS by at least one year to 10/1/2015. Since the decision to delay, it has been noted that CMS has made numerous references to support the new compliance date of 10/1/15; no later.

10 ICD-10 DELAY WHAT S THE PLAN? Stay the course The delay is a gift of time Offers an opportunity to re-evaluate processes and in all areas of operation. Education and training plan timelines

11 ICD-10 Background ICD-10-CM: International Classification of Diseases, 10th Edition, Clinical Modifications (diagnosis coding) ICD-10-PCS: International Classification of Diseases, 10th Edition, Procedure Coding System (procedure coding) ICD-10 was introduced internationally in 1992 by the World Health Organization. The U.S. is the last industrialized nation to use the standard as part of its day to day operations.

12 ICD-10 Background As of date of service *10/1/2015, all health care claims will be submitted to payers with diagnoses coded in ICD-10-CM for all provider types. As of date of service *10/1/2015, health care claims will be submitted to payers with procedures coded in ICD-10- PCS for hospital inpatient services only. CPT and HCPCS codes will continue to be used for professional claims and outpatient services. xxxxxxx

13 ICD-10 ICD-9 ICD-10 CHALLENGES: WHAT S THE BIG DEAL? Dog Dog Large Large Shepard Large Labrador Large Chow Lab Chocolate Lab Yellow Lab Black Male Female Dog Medium Dog Small

14 EXAMPLE OF ICD-10 TRANSLATION

15 ICD-10-CA THE CANADIAN EXPERIENCE Lessons Learned: Training & Education Resources Physician Involvement Documentation Improvement Plan for Delays Plan for Productivity Loss Little Regain Shared Process Across Organization Cost of Conversion Technical Considerations AHIMA Implementation of ICD-10: Experiences and Lessons Learned from a Canadian Hospital

16 ICD10 - Key Stakeholders This is not just a coding thing Health Information Management Clinical Documentation Improvement (CDI) Revenue Cycle (Scheduling, PAS, PFS) Medical Staff (Residents) Clinical Staff Information Technology Contracts Management Performance/Quality Improvement Case Management/UR Finance Senior Leadership Think about your organizational business lines Think about payer and vendor integration

17 ICD10 Major Impacts & Gap Analysis Any area where a code or coded information enters, processes or exits your organization Clinical Revenue Cycle ICD 10 Information Technology Financial

18 What Does This Mean To My Organization? Other Considerations Billing every claim needs an ICD code Pre-Authorization for Services Referrals Gain Sharing / Clinical Quality Incentive Programs (often based on diagnosis) Insurance Company Reviews for Utilization Management)

19 ICD10 Project Planning & Milestones Phase 1 Impact Assessment Phase 2 Prepare for Implementation Phase 3 Go Live Preparation Phase 4 Post Implementation Establish Steering Committee/Stake holders Determine transition strategy/goals Organizational readiness Assess vendor & payer readiness Coding Assessment Documentation Review Contract Analysis IT Inventory Vendor Readiness Implementation Budget Planning Phase Vendor Design Begin staff education Determine impact of transition on data analysis Review impact assessment Determine payer transition plans Upgrade/Modify/ Replace Complete testing and system training Complete education to all impacted staff Parallel/Dual Coding Contract changes Go Live Planning/Support Implementation Communication Plan Monitor Analysis of and Impact on Reimbursement & Claims Coding System Performance Audit Coding Audit Processes Address issues real-time Assess financial impact Constant evaluation of conversion Overall Adoption Management Risk Assessment Roadmap

20 What Does This Mean to My Organization? Be prepared and avoid: Rework expect phone calls from facilities you refer your patients to for testing and other services This will cause Delays in treatment for your patients Inaccuracy - Poor Data to support your performance for Gain Sharing, Quality Programs and Utilization Management

21 ICD10 RISKS & STRATEGIES Time Budget Training Resources Coordination Testing & Validation Productivity and Revenue Internal vs. External Risks Post Go Live Strategy What If Scenarios 21

22 HUMOROUS SIDE OF ICD10 W5922xS Struck by turtle, sequela Z62891 Sibling rivalry Z631 Problems in relationship with inlaws V9107xD Burn due to water-skis on fire, subsequent encounter V9733xD Sucked into jet engine, subsequent encounter Y92253 Hurt at the opera Z621 Parental overprotection 22

23 Questions? 23