Janice Redden, CCS, CPC H System Director of Revenue Integrity Phone: 502 485 4840 E Mail: janice.redden@nortonhealthcare.org
Norton Healthcare Faith Based Integrated Delivery Network of Five Not for Profit Hospitals 15 Out patient Centers 130+ Physician Practices 700 Employed Providers
ICD 10 Timeline 1995 Great Britain 1997 France 1998 Australia 2000 Germany 2001 Canada 2009 US Implementation 10 1 13 2012 US Implementation 10 1 14
Congressional Delay Timeline March 27, 2014 Passed House as part of HR 4302 March 31, 2014 Passed Senate April 1, 2014 To President s desk July 31, 2014 To be implemented on October 1, 2015
Training 32 Hours of ICD 10 CM/PCS Training 40 Hospital Coders 13 Revenue Integrity Coders 7 RN Auditors 15 Clinical Documentation Improvement RN s 15 Coders from Affiliate Facilities 16 Hours of CM Training 91 Physician Practice Coders
Training Outside of ICD 10 CM/PCS Training 12 A&P Modules 13 Root Operation Modules 3 Pharmacology Modules 8 hours Advanced Training Sessions on each specialty: Respiratory Urology Cardiology OB Musculoskeletal Spine GI Neurology
Board of Trustees 1. Stay the Course 2. Slow Down 3. Stop and wait until late 2014/early 2015 to begin training again
MS DRG Shifts 1. Identify the top 20 DRG families 2. Recode in ICD 10 3. Determine Shifts a. Identify causes i. Documentation ii. Coding iii. Guideline changes iv. Coding Clinic changes
Documentation Templates Current State 1. Approximately 275 standard templates 2. Unknown number of individual templates Plan 1. Revise the templates to include information vital to ICD 10 2. Practitioners can add to the template but they can t delete any original information
Clinical Documentation Improvement 1. Monthly meetings between coders and CDI 2. DRG Mismatch 3. Revised post discharge query process 4. CDI nurses had same ICD 10 CM/PCS training as coders 5. Problem list cleanup
ICD 10 CM/PCS Documentation Tips http://bok.ahima.org/pdfview?oid=300621 http://bok.ahima.org/pdfview?oid=300621
1. Aging Workforce 2. Coder Shortage 3. Contract Coders 4. Mix of Current Staff 5. Vacation Freeze 6. Onsite Location Staffing Issues
Aging Workforce and Coder Shortage 6 Hospital Coders are 55+ years of age (17% of total) Human Resources Workforce Development Cohort program through Indiana University Southeast for Coding Certification Candidates are from: Patient Financial Services Employee Health (LPN) Laboratory Pre Service Vendor Support
Contract Coders Mix of Current Staff 1. Identify outsourcing company 2. Lock in contract 3. Working to advance all coders to code all chart disciplines a. One on one training with an assigned mentor
Staffing Go Live Issues 1. Blackout period for vacations in September and October 2015 a) Work down the backlog b) Coordinate with HIM Department regarding physician delinquent reports 2. Onsite location at Go Live a) Workspaces b) PC Setup c) Oversight 3. Increase bill hold days 4. Pre bill Audits
Coding Going Forward 1. Began Dual Coding in December 2014 a) Structure b) Monitor Productivity c) Unspecified code impact 2. Shadow Review with CDI 3. Continued education based on audit findings a) Revise audit policies 4. Testing with payers
Physician Assessment 1. Ran diagnosis frequency from physician billing 2. Cross walk to ICD 10 CM codes 3. 5% of codes equaled 70% of the volume
Physician Training Web Based Specialty courses based on need Anesthesiology Cardiology Critical Care Emergency Medicine and Trauma ENT/Ophthalmology Family Medicine GI General Surgery GYN HEM/ONC Infectious Disease
Physician Training Web based specialty courses based on need continued: Mental Health Neonatology Neurology/Neurosurgery Obstetrics Orthopedics Pediatrics Pulmonary Radiology Rehab Orthopedic Aftercare Urology
Physician Training 1. Orthopedics a) Joint Replacement I. Metal II. Metal on Polyethylene III. Ceramic IV. Ceramic on Polyethylene b) Spinal Fusions I. Infusion Device II. Internal Fixation Device III. Spinal Stabilization Device, Pedicle Based IV. Spinal Stabilization Device, Facet Replacement V. Spacer
Physician Training Tip Sheets comparing ICD 9 and ICD 10 documentation requirements ICD 9 CM ICD 10 CM Status Acute Chronic Acute on Chronic Status With Acute Chronic Acute on Chronic Unspecified Hypercapnia Hypoxia Unspecified whether with hypoxia or hypercapnia
Additional Staff Training 1. Basic Awareness a) Registration b) Patient Financial Services c) Compliance d) Nursing 2. Intermediate Awareness a) Physician office staff for pre certs and auths b) Hospital scheduling department c) Clinical areas, such as radiology
Vendor Readiness Medicare and state Medicaid agencies Large Private Payers Software vendors Clearinghouses
Current Activity February 11 US House of Representatives Energy and Commerce Subcommittee Hearing March 4 Received word that Rep. Pete Sessions was looking to draft language to delay ICD 10 March 4 Letter from the AMA to CMS signed by 100 physician professional organization
Current Activities CMS Testing Results 3% had invalid ICD 10 codes 3% had invalid ICD 9 codes 13% had administrative errors AMA Spin on testing 19% error rate Possible dual coding model?
2015 SGR BILL Physicians face 21% reduction in Medicare reimbursement Proposal Cost exceeds $200 billion Includes a two year extension of the CHIP s program
Questions? Thank You!