ICD-10 Education – Strategic Considerations for Organization-Wide Impact
Optum Webinar
September 11, 2012
Introduction of OptumInsight Presenter
Shely O’Laughlin
Vice President – National Solution Leader ICD-10 & CDIP
Shely is the Solution Leader for both ICD-10 and CDIP Provider Program
and is based in Kansas. Prior to her current role, Shely was the Director of
the GE Revenue Cycle team, managing a team that provides patient access
and revenue cycle services. Shely has more than 17 years of experience in
the health care industry. Shely has also worked at provider organizations,
having served as a billing operations manager at a large multi-specialty clinic
in the Midwest. Her background includes all facets of the revenue cycle and
clinical operations. She is able to offer a unique perspective and solutions
from an operational and systematic approach based on her past experience
and knowledge working across an entire organization to promote change.
Proprietary and Confidential. Do not distribute.
2
Objectives
At the conclusion of this presentation, attendees will be able to:
Identify the various areas of impact across your organization
Better plan when education should start for each role
Understand the specific educational needs and develop a training
plan that takes all learning activities into consideration
Proprietary and Confidential. Do not distribute.
3
Areas of Impact
Business Impact Areas
People
Patient Access
Registration (Central;
ED; Ambulatory;
Ancillary)
Scheduling
Admitting/Discharge/
Transfers
PriorAuthorizations/PreCertifications
Medical Necessity
Checks
Bed Management
Clinical and
Ancillary
Systems
Health
Information
Management
Physician & Nurse
Documentation
Coding and
Abstracting
Ancillary and
Support Services
Documentation
Deficiency
Tracking
Order Entry &
Results
Workflow
within EMR
Case Management
Clinical Research
Workflow and
Transfers Between
Clinical Units
Claim Edit Work
Lists
NCCI/LMRP Edits
Encoding and
Grouping
Physician Query
Clinical
Documentation
Improvement
Patient
Financial
Services
Charge Entry
Payer &
Clearinghouse
Edits
Contracting
Facility &
Professional
Billing
Follow Up and
Denial
Management
Claims Status
Analytics
and Reporting
Strategic
Initiatives
Quality/Outcomes
Reporting
Implementation of
New Business
and/or Clinical
Systems
Financial/Revenue
Reporting
Public Health
Reporting
Clinical Registries
Data Warehouse
ICD-9 to ICD-10
Mapping and
Translation
Compliance
Transition to
Paperless
Environment
Opening of New
Facility
Narrowing of IT
Vendor Portfolio
Implementation of
ComputerAssisted Coding
Organizational Support: Project Management - Education and Training - IT
Proprietary and Confidential. Do not distribute.
5
Overview of ICD-10 Transition Phases
Phase 1
Phase 2
Phase 3
ASSESSMENT
ADOPTION
ANALYSIS

Identification of business impact areas

ICD-10 impact assessment kick-off and educational session
with key stakeholders


People, Process & System Assessment

ICD-10 reimbursement and coding risk/impact analysis
Provider, Coder, Revenue
Cycle & IT ICD-10 Education
Program

System remediation support
(technical & coordination)

Design/Revision of Clinical
Documentation
Improvement Program

Coding and documentation assessment

Education & Training (Staffing) needs assessment

Communication Plan/Awareness Campaign

Mapping & translation

Vendor/Payer Readiness Assessments

Contingency Planning

Road Map to ICD-10 Readiness


Refinement of ICD-10 Budget
Coder Career Ladder
Program development

Strategic Alignment

Productivity/Revenue
Mitigation Strategy

Presentation of findings and recommendations to key
stakeholders

Best Practices Design

End-state measurement
and documentation

Implement review
and improve process

Implement
compliance program

Development of quarterly audit
process and metrics
Phase 1-3: Project Management
Proprietary and Confidential. Do not distribute.
6
Learner Categories & Educational Needs
Required ICD-10 Education & Training
Learner Categories & Roles
Learner Categories
Typical Roles/Credentials
Coders
CCS, RHIM, RHIT,
CPC, etc.
Revenue Cycle, IT &
Reporting/Analytics
Claims, Appeals, Referral/Prior
Authorization, Billing, Patient
Accounts, Analysts, Report
Writers, etc
Identify
Train
Maintain
Providers, Nurses,
CDI Specialists
MD, NP, PA, Ancillary Providers,
Therapists, RN, Case Managers,
CDI Specialists, etc.
Executives/Key
Stakeholders
CEO, CFO, CIO, CCO,
CNO, COO, CMO,
CMIO, etc.
Proprietary and Confidential. Do not distribute.
8
Levels of Training
Level 1
Overview
• Provides high-level
education of ICD-10
mandate to ensure
learner has baseline
knowledge of why
the industry is
moving from ICD-9
to ICD-10; the
associated benefits
and challenges;
timeline; and impact
to systems and
workflows
Level 2
Knowledge-Based/
Skill Transfer
• Meant to provide a
deeper
understanding of the
ICD-10 code set and
content will vary
dramatically by job
function
Level 3
On-the-job
• Transitions learners
from a structured
classroom/eLearning
environment to
applying the
knowledge obtained
in Level 1 and 2
courses to their
specific job function
Proprietary and Confidential. Do not distribute.
9
Overview of ICD-10 Education & Training Program
Learner Categories & Associated Education Levels
Learner Categories
Education Levels
Coders
Level 1:
Overview
Level 2:
KnowledgeBased/Skill
Transfer
Revenue Cycle, IT &
Reporting/Analytics
Level 1:
Overview
Level 2:
KnowledgeBased/Skill
Transfer
Providers, Nurses,
CDI Specialists
Level 1:
Overview
Level 2:
KnowledgeBased/Skill
Transfer
Executives/Key
Stakeholders
Level 3:
On-the-job
Level 3:
On-the-job
Level 1:
Overview
Proprietary and Confidential. Do not distribute.
10
Content Creation
Education Created by Experts
Certified AHIMA Trainers
Registered Nurses
American Registry of Radiologic Technicians
Certified Case Managers
Certified Coding Specialists
Registered Health Information Managers
Registered Health Information Technician
Physician/Clinicians
Certified Professional Coders
Clinical, Revenue Cycle & IT Consultants
Proprietary and Confidential. Do not distribute.
11
Core Education Requirements
Course
Coders
CDI Specialist
Provider
Overview – Revenue Cycle
Rev Cycle
IT &
Reporting
Quality, PI,
Case Mgt., UR
X
Overview – Clinical
X
X
X
Overview – IT/Reporting & Analytics
X
ICD-10 Provider Documentation
Enhancement for ICD-10
X
ICD-10-CM Code Set Training
X
X
ICD-10-PCS Code Set Training
X
X
X
ICD-10 Coding for Non-Coder - Clinical
X
ICD-10 Coding for Non-Coder - Financial
X
X
X
Beyond the Books
•
•
•
•
Instructor-led
Train-the-trainer – physicians
champions
Dual-processing environment/auditing
Physician Coder/Office Staff training
•
•
•
•
Ask-an-ICD-10 Expert (“Phone a
Friend”)
Awareness Campaign content
Community Physician Outreach/Toolkit
Coder Remediation
Proprietary and Confidential. Do not distribute.
12
Education Program Planning
Program Considerations & Key Decisions
•
•
•
•
•
•
•
•
Understand the needs across your entire organization
Make it informative & relevant for the job role
Determine strategy for employed vs. non-employed
Community physicians/Other hospitals in the area
Are you a health system that also has a health plan
Determine testing/attest requirements for each role
Consequences for inadequate assessment results
Determine delivery methodology that makes sense for each learner
category
• Dual-coding strategy (will impact the timeline)
Education must be Concise, Relevant and Accurate.
Proprietary and Confidential. Do not distribute.
14
Learner Category Timeline
Executive/Stakeholders
Prior Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014
Level 1
Rev Cycle
Level 1 Level 2
To prepare for report remediation
IT/Reporting
Level 1
Level 2
Coders/HIM
Level 1
Level 1
Level 2
Level 2 Level 2/3 Level 3
Level 1
Level 1
CDI Specialists
Level 1
Providers/Nurses
Level 2*
Level 2
Level 2 Level 2/3 Level 2/3
Level 3
Level 3
Level 2/3 Level 3
Level 3
Compliance
October 1, 2014
Learner Category
*Depending upon dual-coding strategy
Proprietary and Confidential. Do not distribute.
15
Focus on Coders
Sandbox/Audits
Instructor-Led or
Web-based
eLearning
Overview of Content
Level 1: ICD-10 Fundamentals
• Coders (all); may vary by skill level
• Anatomy & Physiology; Pharmacology; Pathophysiology; Medical
Terminology
• ICD-10-CM/PCS: Deciphering the Code
Level 2: Coder Training
• All coders
• ICD-10-CM Code Set Training (all coders)
• ICD-10-PCS Code Set Training (inpatient coders)
• Interactive practice cases throughout each session
Level 3: Dual-Coding/Practice Environment
• All coders
• Development of practice environment so coders can begin coding real cases
in ICD-10 prior to ICD-10 transition date
• Provide feedback based on case codes in ICD-10 (one-on-one or group)
• Needs will vary by organization, HIM department will need to ensure an
effective and efficient practice environment is established; determine audit
and review procedures; and establish feedback and education policies
Proprietary and Confidential. Do not distribute.
16
Web-based ~ 2 hours
Web-based ~ 1 hour
Focus on Revenue Cycle, IT/Reporting & Analytics
Overview of Content
Level 1: Impact of ICD-10 Overview – Revenue Cycle
• Patient Access, Patient Financial Services, Managed Care Contracting,
Other
• Overview of ICD-10 Mandate + review of impact to processes/workflows
Level 2: Impact of ICD-10 Overview – IT/Reporting & Analytics
• IT resources, Data Warehouse, Reporting/Analytics
• Overview of ICD-10 Mandate + review of mapping pitfalls and need for
dual-processing
Level 2: Coding for Non-Coders - Clinical
• Quality, Infection Control, Registries, Research, Risk Mgt.,
Compliance, Clinical Documentation Specialists
• Review of ICD-10 Code Set + practice scenarios
Level 2: Coding for Non-Coders - Financial
• Staff involved with Medical Necessity Verification, PriorAuthorizations, Claims Edits, Denials, Audits, other.
• Review of ICD-10 Code Set + practice scenarios
Proprietary and Confidential. Do not distribute.
17
Level 1: Impact of ICD-10 Overview – Clinical
~ 1 hour
• Providers, Nurses, Quality Reporting, Clinical Documentation Specialists
• Overview of ICD-10 Mandate + review of impact to clinical
documentation and reimbursement
• The “Sell” – why should we care?
Level 2: Impact to Nursing Documentation
• Practicing Nurses
• Review of how nursing documentation can support level of
specificity of ICD-10 (Examples: Laterality, BMI, Dominant/NonDominant, Glasgow Coma Scale, Skin Ulcers)
~ 30 min/module
~ 1 hour
Focus on Clinical
Overview of Content
Level 2: Provider Documentation Enhancement for ICD-10
• Providers, CDI & Professional Reimbursement Coordinators
• Organized by body system => 21 Modules
• Specialties mapped to modules based on relevance to
diseases/conditions treated
• Review “delta” – how must documentation be enhanced to support
specificity of ICD-10
• Offer instructor-led extended version for CDI and PRC staff
Proprietary and Confidential. Do not distribute.
18
ICD-10 Provider Education
• Providers will need to document
for ICD-10-CM diagnoses, ICD10-PCS procedures, CPT and
HCPCS codes
• Tens of thousands of new ICD10-CM and PCS codes
• Reimbursement will be affected if
the provider doesn’t document
things right
• The diseases have not changed,
the classification system has
changed
• Smaller percentage of codes get used often, a larger percentage of
codes are hardly used at all
• A cardiologist couldn’t care less how orthopedics gets coded
Proprietary and Confidential. Do not distribute.
19
ICD-10 Provider Education
• Focus should be on the provider’s documentation
– What do they need to know to document properly
• Identify relevant concepts in documenting their work
– The provider needs to now what to document, not how to code
• Identify how ICD-10 is different than
ICD-9
– Some codes are identical, others are not
• Teach the provider the difference
– Providers do not need or want to be taught
what they already know
Proprietary and Confidential. Do not distribute.
20
Focus on Providers – Interaction Is Important
• Leverage train-the-trainer sessions
– Peer-to-peer education has proven to be the most effective
• Identify Physician Champion(s):
– Conduct informal/formal education sessions at department
meetings, physician forums, physician lounge, etc.
– Provide one-on-one coaching to the “repeat offenders”
– Be the ICD-10 SME to the physician community
• Integrate with existing Concurrent Documentation
Improvement Programs (CDIP)
• Prioritize education around high impact disease
processes (both frequency and dollar)
• Offer CME credits
Proprietary and Confidential. Do not distribute.
21
Wrap-up and Key Considerations
•
•
•
•
•
•
•
Know WHO you need to educate
Understand WHAT they need to learn
Integrate learning into Awareness/Communication Plan activities
Content should be created by experts (internal or external)
Understand your strategy for employed vs. non-employed physicians
Plan WHEN training will begin for the roles
Think holistically when planning education timeline with other
initiatives that may be happening – take advantage when you can
• Understand HOW you need to train the various learners –
methodology may vary across your organization
Proprietary and Confidential. Do not distribute.
22
Thank you!
Shely O’Laughlin
VP, National Solution Leader ICD-10 and CDI
316.775.3313
[email protected]
www.optum.com