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Master
Status
of ICD-10
title style
Challenges and Successes
2014 Infian User Group Meeting
September 17-18, 2014
Presented by: Robin Heath
OBJECTIVES
• Identify the ICD-10 Implementation Date
• Identify why organizational preparation for
ICD-10 is a must
• Identify the steps your organization should
take to ensure a smooth transition to ICD10
• List available ICD-10 training opportunities
• Describe facility challenges and successes
ICD-10 implementation/compliance date?
October 1, 2015
ICD-10 compliance means that a HIPAAcovered entity uses ICD-10 codes for health
care services on or after October 1, 2015.
Dates of Services (DOS): Is it ICD-9 or ICD-10?
• For DOS prior to October 1, 2015 continue to
use ICD-9
• For DOS October 1, 2015 and after use ICD-10
• Practice management systems must be able to
accommodate both ICD-9 and ICD-10 until all
transactions prior to October 1, 2015 have
been processed and/or all insurers are on
board with ICD-10 processing
Partial Code Freeze
• CMS has placed a partial freeze on code
changes until one year after the ICD-10
implementation
• Only codes for new diagnosis and new
technologies will be considered
• Last regular update to ICD-9-CM and ICD-10
was October 1, 2011
• Regular ICD-10 updates begin again on
October 1, 2016
Why should my organization prepare now for
the ICD-10 transition?
Why should my organization prepare now for
the ICD-10 transition?
• ICD-10 will be one of the most significant challenges the
healthcare industry will face in the next several years.
• Increasing the number of codes from approximately 24,000
ICD-9 codes to over 140,000 new ICD-10 codes.
• The transition will change how your organization does
business and most organizations will need to devote staff time
and financial resources for transition activities.
• The results of a recent CMS survey of 242 healthcare shows
providers anticipate a minimum of 10% reimbursement loss
due to improper and denied claims, with 60% of those
surveyed anticipate cash flow issues to arise.
What steps should my organization take to
ensure a smooth transition to ICD-10?
• Organizations must determine areas of risk and opportunity
throughout the organization
• The goal of any assessment is to minimize the negative impact
of ICD-10 implementation on the organization’s revenue cycle.
With proper preparation, organizations can avoid losses and
cash collection delays during ICD-10 implementation due to
increased Accounts Receivable and improper and returned
claims.
• Approaching the conversion from an organizational
perspective, as opposed to solely from a health information
management or information technology perspective, allows
organizations to address the associated impact to facilities,
physicians, operations, and patient satisfaction.
Why should my organization prepare now for
the ICD-10 transition?
• Increased demand for High-Quality Documentation
• High-quality documentation provides a more accurate
clinical picture of quality of care provided
• Better clinical documentation promotes better patient
care
– More accurate acuity, severity, and risk mortality management
– Quality and performance reporting
– Reimbursement
– Severity-level profiles
– Provider profiles
– Present on admission reporting
– Hospital-acquired conditions
Why should my organization prepare now for
the ICD-10 transition?
• Clinical Documentation Challenges
• Ensuring high-quality documentation without
excessive administrative burden or
encroachment on time spent on patient care
• Ensuring sufficient documentation to support
code assignment while continuing to
document in clinical terms
• Need for good clinical documentation not
greater volume
Why should my organization prepare now for
the ICD-10 transition?
• Improvement in clinical documentation has
immediate benefits
What steps should my organization take to
ensure a smooth transition to ICD-10?
• Establish an operational milestone plan
– Establish a organizational steering committee
which includes
• Executive leadership
• Project management team
• Representatives from key departments
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Revenue cycle
IT
Clinical care
Finance
Operations
What steps should my organization take
to ensure a smooth transition to ICD-10?
What steps should my organization take to
ensure a smooth transition to ICD-10?
– Pinpoint ICD-10 Operational Impacts
• Evaluate and update procedures and workflows for ICD10 touch points
• Establish KPI’s that will be used for ICD-10 production
• Review documentation templates, forms and outlines
for deficiencies
• Review referrals, authorizations impacted by ICD-10
changes
• Plan for staff augmentation to address productivity
challenges
What steps should my organization take to
ensure a smooth transition to ICD-10?
• Conduct External vendor and payer testing
– Simulate a standard testing environment
– Establish vendor/payer testing deadlines
– Test comparisons, ranking and trending
– Test flows, processes and data with external
vendors
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•
•
•
Payers
Outsourced billing, coding or collection agencies
Government reporting requirements based on diagnosis
Quality and metric reporting related to meaningful use
What steps should my organization take to
ensure a smooth transition to ICD-10?
• Consider Revenue Cycle Optimization
– FOLLOW THE MONEY
What steps should my organization take to
ensure a smooth transition to ICD-10?
• Understand that those frequently used codes
and the ones that generate the most revenue
provide a window into critical areas of focus.
• Establish current revenue cycle management
performance baseline benchmarks for metric
comparisons with ICD-10.
• Determine the financial impact of the transition
to ICD-10
What steps should my organization take to
ensure a smooth transition to ICD-10?
•
Clinical Documentation Improvement Strategies
• Identify documentation improvement opportunities
that could impact initiatives-this may not be only ICD10 coding
• Determine best solution to address each
documentation gap – One size does not fit all!
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Modification forms or templates
EHR documentation template
System Prompts
Education
Workflow or operational process changes
• Prioritize – start with “low hanging fruit” or issues with
greatest impact
The System Impact of ICD-10
What types of ICD-10 training is available?
• The American Health Information Management
Association (AHIMA)
• http://www.ahima.org/education/onlineed/Programs/ICD10
• CMS
• [email protected]
• EDI - Workgroup for Electronic Data Interchange
• http://wedi.org/workgroups/icd-10
• HIMSS
• http://www.himss.org/ResourceLibrary/GenResourceDetail.a
spx?ItemNumber=30568
What is Infian doing to prepare for the ICD-10
transition?
Available with Version V72 – Service Pack 13 & 19
– Utility to Import ICD-10 Code files from CMS
• Includes new codes and updates to codes
– Utility to Import ICD-9 to ICD-10 Mapping file from
CMS
– Tools to assist with mapping ICD-10 Codes to
existing TIME ICD-9 codes.
– ICD-10 Look-up
– Reassign Diagnosis Codes
– Unmapped Diagnosis Codes
What is Infian doing to prepare for the ICD-10
transition?
• CMS provides a file which includes a list all of the current ICD-10 codes.
• You will need to download this file to a location on a workstation that is
also accessible from the TIME system
• Infian provides tools to import and merge these ICD-10 codes into TIME
What is Infian doing to prepare for the ICD-10
transition?
• CMS provides another file that maps ICD-9 codes to ICD-10 Codes
• You will need to download this file to a location on a workstation that is
also accessible from the TIME system
• Infian provides a tool to import the file into TIME so that it can be used in
the mapping process
What is Infian doing to prepare for the ICD-10
transition?
• Once the mapping file has been imported, you can use a utility in TIME to
map instances where there are
– 1 ICD-9 code linked to 1 ICD-10 code
– 1 ICD-9 code linked to many ICD-10 codes
– Many ICD-9 codes linked to 1 ICD-10 code
•
What is Infian doing to prepare for the
ICD-10 transition?
After all codes have been mapped using the files provided by CMS, you can use the
TIME system to identify any Diagnosis Codes that have not been mapped to an
ICD-10 code in TIME
– Determine whether existing TIME codes are now obsolete and need to be logically
deleted
– Identify which Diagnosis codes may need to be reassigned to a new Diagnosis code and
linked to an ICD-10 code
•
TIME also provides a utility to identify patient records using old diagnosis codes
and update them with new diagnosis codes which have been assigned ICD-10
codes
What is Infian doing to prepare for the ICD-10
transition?
• ICD-10 Roadmap
• The purpose of this document is to assist users with the process for
downloading and importing ICD-10 codes into TIME. This document is
comprised of 3 sections for each step.
• The first section, ‘Application & Procedure’, will provide the TIME
applications associated with the process. It will also give you the
steps needed to complete the process.
• The second section, ‘Menu(s)’, provides either the link to the CMS
website or the path to the TIME application used within this step.
• The third section, ‘Purpose’, provides the objective (s) for the
procedure outlined in the ‘Application & Procedure’ section of
the Roadmap.
Changes to existing applications
Diagnosis Code Table
• TIME will still use the existing Diagnosis Code
Table to support ICD-10 codes
– A new subtab has been added for ICD-10 codes
– A new field in the main browser has been added
for ICD-10 codes.
Diagnosis Code Table Updates
ICD 10 Tab
Lookups where diagnosis codes are used
Insurance Codes
Insurance Codes
Claim Data and Service Trx – Service Tab
Claim Data and Service Trx – Claim Tab
Claim Data and Service Trx – Claim
Diagnosis Maintenance
Claim Data and Service Trx – Additional
Info Tab
Claim Data and Service Trx – Additional Info
Tab – Claim Reason For Visit Diagnosis
Maintenance
Claim Data and Service Trx – Additional Info
Tab – Claim External Cause of Injury Diagnosis
Maintenance
Service Charting
Service Charting
Medication Orders
Physician Rounding App and Encounter
Home Page
Progress Note Template
Reports
Hemodialysis Flowsheet
Peritoneal Flowsheet
Undone Labs and Meds
Ordered Lab
Patient Review
Physician Rounding
Medication Summary
Adequacy/Bundled Payments – Detail
Print DX Codes
Monthly Services
Preparing for the future ICD-10 Implementation
Panel Discussion
Panelist
Kristy Hamilton
Judy Pata
Francisco Rodriguez
Damaris Velazquez
Eduardo Velazquez
Ylene Velazquez