Preparing for ICD-10: Education and Clinical Documentation

Preparing for ICD-10: Education and Clinical Documentation

Agenda Background Road to Readiness Education Clinical Documentation Quick Start Today s presentation and recording will be sent to all attendees via email by Friday, July 19 th

ICD-10 Recommended Timeline

Background: why? ICD-9 is a 30 year old framework that cannot accommodate additions Limits ability to add codes to describe clinical conditions and use of healthcare services Details can help with claim processing, healthcare utilization, treatment planning, public heath improvements, among others

Reminders Diagnosis codes are used in many places for many different reasons by many different systems and people. This is not the usual annual update: it s a new language Common cold: acute nasopharyngitis ICD-9 460 ICD-10 J00 ICD-10 is different from ICD-9 in: Length Number Value Terminology

ICD-10 Is Different ICD-9-CM Size: 3-5 characters ICD-10-CM Size: 3-7 characters Number: 13,000 Number: 68,000+ Format: Mostly numeric and always begins with a number except for E and V Format: Alphanumeric and always starts with a Letter except for U Alphabetic characters NOT case sensitive Terminology

Do I Have To Do This? YES! It s not optional. Professional claims must contain ICD-10 values for dates of service on and after October 1, 2014. Institutional claims must contain ICD-10 values for dates of discharge on and after October 1, 2014. 7 2013 Navicure, Inc.

Lets review key activities that you have hopefully finished or are a work-in-progress

Road to Readiness: First half 2013 Highlight of items that should be finished or underway: Does your practice have an ICD-10 champion/coordinator? Does the ICD-10 planning team have a basic understanding of ICD-10? Enough to understand the scope and breadth of effort? Do you have physician and practice management staff: Awareness Commitment Organizational awareness Administrative and clinical staff Internal plans, educational events, regularly scheduled meetings

Road to Readiness: First half of 2013 Highlight of items that should be finished or underway: IT and service vendor outreach Do your IT and service vendors know about ICD-10? Have they communicated update plans, timelines, costs? Have they communicated required and enhanced capabilities and services? Identified other initiatives that must be done in tandem or coordinated along with ICD-10. Began preliminary budgeting.

Road to Readiness: First Half of 2013 Highlight of items that should be finished or underway: Diagnosis Use Assessment a diagnosis inventory Do you have a document that describes where, how and who uses diagnosis codes throughout your practice? Administrative and clinical? Front, middle and back office Electronic and paper, e.g., Superbills, processes Contracts, quality reporting, public health reporting, spreadsheets Creators, senders and receivers

Road to Readiness: First Half of 2013 Highlight of items that should be finished or underway: Create an Action Plan (Last Month June 2013) Review and assess facts and information obtained with your assessment Determine what additional information you need Create a list of things that need to be done to get your practice ready to be accurately using ICD-10 by the October 1, 2014 compliance date.

Action Plan Components Critical plan elements can be generated from your practice diagnosis assessment and outreach to vendors, but your plan should also contain: Education strategy planning personnel, when, where, level Review of payer contractual arrangements, quality reporting requirements, and fee schedules based in part or whole on diagnosis codes Clinical documentation assessment, audits Compliance requirements and/or monitoring efforts to ensure performance Implementation steps of new or changed technology, processes or information. Monitoring steps to ensure things work as expected Risk mitigation

Keys to Readiness: Education and Documentation Our focus today will be on two critical and essential ICD-10 components: Education Clinical documentation 14 2013 Navicure, Inc.

Education Education and training are not optional and essential to success. What are the costs associated with undertraining? Denied claims, revenue take-backs, lower quality scores result from under trained or poorly-trained coders. Education is not the place to shave costs. 15 2013 Navicure, Inc.

Education Planning: Where to Start First a goal ensure staff acquire the necessary skills and knowledge about ICD-10, business processes, procedures, and policies and system updates to implement ICD-10 use in our practice. 16 2013 Navicure, Inc.

Assess Training Needs and Develop a Plan Who? List affected staff members Identify staff competence and skill gaps How? Determine how to tailor training to individuals or user groups Choose the best approach training methods Timetable? Decide on optimal timing to receive training and certification Evaluate! Assess icd-10 proficiency after training and provide additional training to address identified areas of weakness 17 2013 Navicure, Inc.

What Needs to Be Learned? Inpatient: ICD-10-PCS Outpatient: ICD-10-CM Because of ICD-10's specificity: Biomedical knowledge: anatomy, physiology, medical terminology, pharmacology 18 2013 Navicure, Inc.

Assessing Who Needs Training Include both Administrative and Clinical Staff Physicians Nurses Nurse practitioners Physician assistants Medical technicians Administrative staff and coders 19 2013 Navicure, Inc.

Assessing Who Needs Training Understand experience, current skill set and gaps in understanding coding medical and administrative records use of diagnosis codes in documenting patient activities use in information technology systems of medical procedures in health plan relations and contracts 20 2013 Navicure, Inc.

Sample Training Types Type ICD-10 Basic Understanding Clinical definitions Description Understand differences between ICD-9 and ICD-10 Why adopt ICD-10? Understand existing tools Understand ICD-10 structure and format ICD-10 clinical terminology and meaning ICD-10 Coding ICD-10 Clinical Documentation ICD-10 coding knowledge Affects on ICD-10 on clinical documentation Updated business and IT systems Understand how both ICD-9 and ICD-10 are used in updated systems

Match Type with Group Type Basic Clinical definition ICD-10 coding Group Physicians, NP, PA, clinical researchers, administrative staff, coders Physicians, NP, PA, clinical researchers, administrative staff, coders Coders and administrative staff ICD-10 Clinical documentation Physicians, NP, PA, clinical researchers, administrative staff, coders, compliance staff Updated business and IT systems IT staff, administrative staff, compliance staff

Approaches to Training Attempt to tailor training to individuals or user groups as much as possible: administrative v. clinical staff Many ways and formats: On-site Community courses Web-based and Webinars Certification courses Boot camps Train-the-trainer

Education Resources American Academy of Professional Coders (AAPC) http://www.aapc.com/ American Health Information Management Association (AHIMA) http://www.ahima.org/ Practice Management Institute (PMI) http://www.pmimd.com/

Example: AAPC Bootcamp ICD-10 Code Set Training 16 hour intensive training course On-line or in-person Covers such things as ICD-10-CM format and structure Coding conventions General coding guidelines Complications, principal and secondary icds, symptoms, previous conditions, abnormal test findings Chapter specific coding guidelines Infectious and Parasitic Diseases Neoplasms Diseases of Blood, Nervous System, Eye, circulatory System, etc

Basic Understanding Resources WHO ICD-10 Introduction Tool http://apps.who.int/classifications/apps/icd/icd10train ing/icd-10%20training/start/index.html

WHO ICD-10 Overview WHO ICD-10 Introduction Tool http://apps.who.int/classifications/apps/icd/icd10training/icd-10%20training/start/index.html

Basic Understanding Resources CMS ICD-10-CM Official Guidelines for Coding and Reporting 2013 http://www.cdc.gov/nchs/data/icd10/10cmguidelines_2013_final.pdf

CMS ICD-10 Coding Guidelines

Training: how long and when? AHIMA estimates it will take 50 hours of education for hospital inpatient coding staff needing both ICD-10-CM and ICD-10-PCS 8 hours for physicians 10 hours for outpatient coders Coding staff should complete comprehensive education no more than 6 to 9 months before the compliance date to make sure info is retained.

Training: Important Last Step Evaluate! Assess staff for proficiency after training Identify, document and review common inaccurate coding and clinical documentation errors FAQs, quick reference sheets, system user prompts, refresher courses

Training: Questions to Consider What resources will staff need after training to resolve questions as they come up? For example, manuals, system prompts, troubleshooting guides, or FAQs lists How much will the training cost? Average cost of training per coder is 12,200.

Training: Questions to Consider How will staff maintain operations during the training process? Consider the need for additional coding staff to during the transition period. Consider the need for auditing services on and following the transition. Assess whether outsourcing some or all coding pre-during-post transition. How will staff experience and knowledge be used during the period when both I-9 and I-10 will be necessary?

Training: Tips and Timelines Focus on and train to your medical specialty ICD-9 and ICD-10 Timelines Oct 1, 2011 last regular updates to both ICD-9 and ICD-10 Oct 1, 2012 and 2013 limited code updates to both ICD-9 and ICD-10 Oct 1, 2014 limited code updates to ICD-10 no updates ICD-9 since it will no longer be used Oct 1, 2015 regular annual update to ICD-10 will begin

Medical Documentation and ICD-10 The Cornerstone upon which success starts and rests! "If it hasn't been documented, it hasn't be done. Just as true with ICD-10 as with ICD-9: ICD-10 specificity requires clinicians to document to greater levels of detail

Assess Documentation Enhancements Start with most frequently used diagnosis codes by provider. Assess whether current documentation meets ICD- 10 specificity requirements. Educate providers and clinicians on the specifics relevant to them. Start including these details now.

Medical Documentation Overview Must be legible, complete, clear, consistent, and contain precise information about: patient's health history present illness course of treatment observations evidence of medical decision making treatment plan outcomes of all tests, procedures and treatments Should be complete and specific as possible and include information such as Level of severity specificity of anatomical site etiology of symptoms

Uses of Medical Documentation Disease reporting for physician performance profiling Physician E&M payment Pay-for-performance Reimbursement Quality reporting Care coordination

Medical Documentation and Queries Don't forget to review your Query process aka clinical clarification, documentation alerts or clarification Because of ICD-10, you will likely see an increase in queries. A routine communication and education tool to ensure complete and compliant documentation. Must bridge the gap between the clinical language used by providers and what can be captured by ICD-9 or ICD-10 while preserving the provider's intent. However, as before, coders can't "lead" providers with queries.

Medical Documentation and Queries If queries are not retained in the clinical record or at all, consider retaining queries indefinitely. Retaining demonstrates efforts to communicate to the medical staff. If not already present, consider adding options like "clinically undetermined" and "other" that allow the provider to add free form text. If you do not have one, consider implementing an escalation policy to address unanswered queries.

Documentation and ICD-10 Because of ICD-10 s specificity requirements, clinicians will need to provide additional medical documentation details in order to support ICD-10 s new specificity abilities. Medical documentation should be audited to ensure it captures such things as Laterality Specific anatomic site(s) Associated and related conditions Causes of injury Episode of care (initial, subsequent, etc) Complications Stage of healing (routine, delayed, malunion, etc)

Documentation and ICD-10: all in the details Examples where more specificity means more documentation diabetes mellitus diabetes type, affected body system, complication or manifestations, long-term insulin Pregnancy trimester now requires Fractures site of fracture, type of fracture laterality and location Injuries external cause place of occurrence activity code

Impact on Documentation Unspecified ICD-10 codes do exist, but may mean unpaid Not addressing ICD-10 s impact on clinical documentation, may result in increased denials Will take clinicians and coders longer to do their job. Monitor productivity Account for reductions in both coder and provider productivity Audits are not going away, e.g., RAC. RACs through Dec 2012 took back $1.2 billion in complex denials reviews due to medical record issues

Let s Hope With additional information, there will be reduced need for follow-up with health-plans about pended or claims rejected for unsubstantiated diagnosis code(s) reduced need to additional information more precise reimbursement smoother and better care transitions

If you haven t already done so, please start today.

Navicure Tools Overview Appeal denied claims simply, using pre-populated letters and payer forms. Easily research denied claims with access to both denial reasons and remarks. Streamline your denial workflow with personalized work lists for role-based user-specific reporting that fits your practice. Identify potential problems with rejections that may be disrupting your cash flow. Fix any operational inefficiencies prior to the October 1, 2014, ICD-10 transition date.

Navicure ICD-10 Training - Webinars Next Month - August: Implementing Updates Date: Wed., August 7, 2013 @ 1 PM EDT September: Review and Current Industry Status Date: Wed., Sept. 11, 2013 @ 1 PM EDT

ICD-10 Resources Navicure Clients resource for all ICD-10 education and materials 48 2013 Navicure, Inc.

wwwicdhub.com

ICD-10 Industry Resources ICD-10 Hub website devoted to making the transition to ICD- 10 easier CMS www.icd10hub.com http://www.cms.gov/medicare/coding/icd10/index.html CMS: Latest ICD-10 News http://www.cms.gov/medicare/coding/icd10/latest_news.ht ml Final Rule http://www.gpo.gov/fdsys/pkg/fr-2012-09-05/pdf/2012-21238.pdf ANSI X12 Website http://www.x12.org/ 50 2013 Navicure, Inc.

Ken Bradley VP of Strategic Planning Navicure kbradley@navicure.com Twitter: @Ken_Bradley 51