ICD-10 Webinar
Dr. Denise W. Hines, PMP, FHIMSS
GA-HITREC-Director of Education & Outreach
Overview
• GA-HITREC
• What is ICD-10?
• What’s the Big Deal? Scope & Costs
• Project Management Steps
• Questions
GA Health Information Technology
Regional Extension Center (GA-HITREC)
• MSM-National Center for Primary Care
• Grant Funded to work with 4200 PCP & 56 Rural
& CAHs
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Provide Education and Outreach (HTH)
Help providers at all phases reach MU
Offer EHR Vendor Selection & Implementation Support
Focus on Workforce Development
Launched Group Purchasing Program
GA-HITREC Online Education
www.ga-hitrec.org
ONC Workforce Curriculum Available:
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ONC Component 1: Introduction to Health Care and Public Health in the U.S.
ONC Component 3: Terminology in Health Care and Public Health Settings
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ONC Component 8: Installation and Maintenance of Health IT Systems
WEBINARS:
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Patient Engagement Strategies
Medicare/Medicaid Attestation
Meaningful Use and Value Based Purchasing
Using Patient Data to Improve Health Outcome
The Secure Exchange of Health Information
Planning, Management, Leading for Health IT
Health Information Management Systems – Coding
ICD-10
GA-HITREC Group Purchasing
Program
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Tax Credit Advisory Services
Document Conversion
Telecom and Data Center Solutions
Halfpenny Lab Hub
• HIT Consulting
• Privacy & Security Assessments
• Online Education and Certification Training
• ICD-10 Compliance & Remediation
Contact Us!!
GA-HITREC
Online training center, Resources, & ICD-10 tool kit
and services
www.ga-hitrec.org
1-877-658-1990
or
Contact Sherri Ackerman (Hometown Health)
What is ICD-9?
• International Classification of Diseases (ICD) code
set
– Published by the World Health Organization
– Defines diseases, signs, symptoms, abnormal findings, complaints,
social circumstances, and external causes of injury or disease
• U.S. uses the Ninth Edition (ICD-9) in 2 parts:
– ICD-9-CM (Clinical Modification), used in all health care
settings/diagnosis coding
– ICD-9-PCS (Procedure Coding System), used only in
inpatient hospital settings
– Originally published in 1977
– Been using for over 30 years
ICD-9 to ICD-10
• ICD-10
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WHO updated in 1990
Other countries adopted in 1994
U.S. only partially adopted in 1999 for mortality reporting
HHS announced the requirement to update from ICD-9-ICD10
Original compliance date was October 1, 2013
HHS received push-back from the industry
Proposed compliance date is October 1, 2014
5010 Compliance required
Who is impacted?
• All “covered entities”—as defined by the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)—
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Hospitals
Health care practitioners and institutions
Health insurers and other third-party payers
Electronic-transaction clearinghouses
Hardware and software manufacturers and vendors
Billing and practice-management service providers
Health care administrative and oversight agencies
Public and private health care research institutions
• Does NOT affect Current Procedural Terminology (CPT) and
Healthcare Common Procedure Coding System (HCPCS)
codes.
Limitations of ICD-9
• Over 30 years old with outdated terminology and not
consistent with current medical practice
• Many ICD-9 categories are full
• Codes are not specific and do not provide accurate
anatomical descriptions
– Limits the ability to analyze for utilization, costs and
outcomes, resource use and allocation, and performance
measurement
– Limits streamlined, automated claims processing
– Limits the characters available (3-5) for complexity and
severity
Benefits of ICD-10
• Reflects current medical practice
• Provides more detailed data:
– Inform health care providers and health plans of patient
incidence and history
– Improve analysis of disease patterns to track public health
outbreaks
– Increase opportunities to develop new pricing and
reimbursement structures
– Improve detection and investigation of potential fraud &
abuse
• Reduces volumes of rejected claims
• Adds flexibility for future updates
Timeline for ICD-10
• June 30, 2012-compliance for 5010 Transaction set
• Original compliance date: Oct 1, 2013
• April 9, 2012-Proposed rule released: Compliance
Date to Oct 1, 2014
• Final rule not issued yet.
• NO ICD-9 claims submitted after compliance
date!!!
What’s the Big Deal?
ICD-9
ICD-10
13,000 codes
68,000+ codes
Mostly numeric
Digit 1 = alpha or numeric
Digits 2-5 = numeric
Alpha or numeric
Digit 1 = alpha
Digit 2 = numeric
Digits 3-7 = alpha or numeric
3-5 digits
3-7 characters
Does not identify left versus right
Identifies left versus right
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Incorporates anatomical location &
surgical technique
Pressure Ulcers-9 codes to broad body
locations & wound depth
125 codes-includes anatomical
coordinates and wound depth
Angioplasty-1 code
Angioplasty-854 different codes including
body part, method, instrumentation
ICD-10 Readiness and Costs
• HHS cites a CMS survey finding that one quarter of
providers do not believe they will be ready by
October 1, 2013, and a recent WEDI readiness
survey in which nearly 50 percent of the 2,140
providers responding did not know when they would
complete their impact assessment.
• HHS projects that ICD-10 will cost commercial and
government health organizations between $650
million and $1.3 billion
Costs to Delay Compliance to
2014
• Savings would come from the avoidance of costs that would
occur as a consequence of significant numbers of providers
being unprepared for the transition to ICD-10.
• HHS determined a cost avoidance of between $3.6 billion
and $8 billion – but acknowledged that “a 1-year delay of the
ICD-10 compliance date would add 10 to 30 percent to the
total cost that these entities have already spent or budgeted
for the transition.”
• HHS demonstrated that a 1-year delay in the compliance
date of ICD-10 would cost the entire health care industry
approximately $1 billion to $6.5 billion.
Reactions to the Delay (10/1/13
to 10/1/14)
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American Medical Association-Applauded the delay
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College of Health Information Management Executives-(CHIME)Appreciates the extra breathing room but doesn’t want to lose focus.
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Medical Group Management Association (MGMA)-wants ICD-10
certification of practice management system vendors,
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American Hospital Association-"welcome news, particularly for smaller
hospitals”
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American Health Information Management Association (AHIMA)preferred no extension and supports the shortest extension period;
continued delay is in no one’s best interest
Impacted Hospital Functions
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Patient intake /registration
Eligibility
Authorization
Certification
Scheduling
Care management/disease management (including clinical
documentation)
Coding and supporting clinical documentation requirements
Billing and reimbursement
Contracts and fees
Payment reconciliation (including denial management)
Regulatory and compliance reporting
Quality assessment and management
Case mix and population risk assessment
$Costs to Consider
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Training Costs
System Upgrades
Contract Re-negotiations
Coding Tools
Coder (staff) support
Productivity Losses
Underpayments & Denials
ICD-10 Project Management
Steps
• Designate a PM, Team, Ex.Committee
• Develop Communication & Work Plans
– Health Information Management
– Clinical Departments
– Information Technology/Systems
– Revenue Cycle/Finance
– Application Assessment & Readiness
• Plan for Physician and Staff Training
ICD-10 Project Management
Tasks
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Assess Internal & External Impact
Assess Education
Form Budget
Upgrade/Change Systems & Business
Processes
Internal Testing & Validation
External Testing & Validation
Go-live
Follow-up & Evaluation
Project Management Tips
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Gain buy-In from Administration/Executive Team
Identify a physician champion
Use a Steering Committee
Provide On-going education about the importance of
the project and the status
• Offer a variety of training methods and tools:
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One-on-one
Off-site training sessions
Rounding
Departmental/Medical Staff Meeting
Summary/Take-Away Points
•Transitioning from ICD-9 to ICD-10 will be
challenging
–Requires more complete and accurate documentation
by physicians
–Thorough knowledge of anatomy and physiology by
nurses, clinical staff, and coders
•Benefits include more complete patient
information (severity of illness, medical necessity)
and improved reimbursement
•Don’t be afraid to ask for help!
•Use a project management methodology
Resources
GA-HITREC
Online training center, Resources, & ICD-10 tool kit
and services
www.ga-hitrec.org
1-877-658-1990
www.cms.gov/ICD10/
www.himss.org
www.ahima.org
www.dch.ga.gov
QUESTIONS ????