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ICD-10 IMPLEMENTATION – ARE YOU WHERE YOU NEED TO BE?

ICD-10 IMPLEMENTATION – ARE YOU WHERE YOU NEED TO BE?. Maureen Doherty, CPC, CPC-H EisnerAmper Healthcare Services Group June 2012. Overview of Topics. ICD-10 Definition Who Is Affected? ICD-9 CM Volume 3 vs. ICD-10 PCS Implementation Phases Cost Impact Are You Where You Need To Be?.

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ICD-10 IMPLEMENTATION – ARE YOU WHERE YOU NEED TO BE?

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  1. ICD-10 IMPLEMENTATION –ARE YOU WHERE YOU NEED TO BE? Maureen Doherty, CPC, CPC-H EisnerAmper Healthcare Services Group June 2012

  2. Overview of Topics • ICD-10 Definition • Who Is Affected? • ICD-9 CM Volume 3 vs. ICD-10 PCS • Implementation Phases • Cost Impact • Are You Where You Need To Be? 2

  3. ICD-10 Definition • ICD-10 • The International Classification of Disease tenth revision (ICD-10) is a system of coding created by the World Health Organization that notes various medical records including diseases, symptoms, abnormal findings and external causes of injury. • Created in 1992 as the successor to previous ICD-9 system • United States ICD-10 System to begin October 1, 2014 • ICD-10-CM – Clinical Modification – Outpatient Diagnostic Coding • ICD-10-PCS – Inpatient Hospital Procedure Coding 3

  4. ICD-10 – Who Is Affected? • ICD-10 – Who Is Affected? • Clinicians • Documentation improvement to capture specificity of ICD-10 • Ancillary Departments • Documentation to capture specificity of ICD-10 • Health Information Management (HIM) • ICD-10 CM and PCS structure and coding guidelines • Patient Registration • Documentation • Impact on Medical Necessity and Present on Admission (POA) 4

  5. ICD-10 – Who Is Affected? • ICD-10 – Who Is Affected? • Patient Financial Services • Impact on grouping and payment • Denials Management • Utilization Management • Documentation to capture specificity of ICD-10 • Impact on reporting and databases • Managed Care Contracting • Compliance Staff • ICD-10 CM and PCS structure and coding guidelines • Proper documentation 5

  6. ICD-10 – Who Is Affected? • ICD-10 – Who Is Affected? • Information Technology • Interface and internal systems impact • Quality Management • Impact on reporting, databases and cost accounting • Accounting and Finance • Impact on reporting, cost accounting, grouping and payment 6

  7. ICD-9-CM VOLUME 3 vs.ICD-10-PCS • ICD-9-CM Volume 3 • 4,000 Procedure Codes • 3 to 4 Digit Codes • Numeric Codes with Decimal Point • Includes some diagnosis information • ICD-10- PCS • 72,000 Procedure Codes • 7 Digit Codes • Alphanumeric Codes with No Decimal Point • No diagnosis information 7

  8. Overall Implementation Process • Plan Development / Impact Assessment • Implementation • “Go Live” • Post-Implementation 8

  9. Implementation-Phase I • Implementation – Phase I – Key Players • Senior Executives • HIM Management Team • Coding Staff • Medical Staff • Financial Management (Accounting/Billing) • IT Personnel • Clinical Department Managers • Quality Management, Utilization Management, Case Management • Business Associates • System Vendors, Providers, Payers 9

  10. Implementation-Phase I • Implementation – Phase I • Identify business impact areas • Educational session with key stakeholders • Create steering committee and assign project manager • Utilize internal and/or outsourced resources • Establish Implementation Timeline • Conduct the following assessments: • Onsite impact assessment of all business impact areas • Identify all impacted people, processes and systems • System remediation and/or replacement • Education and training needs • Budgetary needs 10

  11. Implementation-Phase I • Implementation - Phase I • Conduct the following assessments: • IT Assessment • Product upgrade timelines • Hardware impact • Testing timelines • Costs associated with system remediation/replacement efforts • ICD-9-CM to ICD-10/ICD-10 to ICD-9-CM translation methodology • Inventory of Reports and Interfaces • Confirm number of reports and interfaces • Determine continued need/efficiencies that can be realized • Remediation effort 11

  12. Implementation-Phase I • Implementation - Phase I • Conduct the following assessments: • ICD-10 reimbursement and coding/documentation impact analysis • What is the magnitude of the impact ICD-10 will have on your revenue • DRG weights • Conditions/services at high risk • Able to generate additional revenue from implementation • MS-DRG assignments based on ICD-10 denominated MS-DRG v28 R1 grouper • CMS releasing MS-DRG v29 grouper for ICD-10 • Spring 2012 • Deficiencies in coding/documentation for ICD-9 • Education/training and Documentation Improvement 12

  13. Implementation-Phase I • Implementation - Phase I • Clinical Data Quality Assessment • Inpatient Data Quality Assessment • Coding/MS-DRG assignment • Code validation • Present on Admission (POA) status/discharge • Review of ICD-9-CM documentation • Clinical data – time of admission • Attending physician – plan of care • Patient’s course of care • Physician orders, labs, radiology, consultations • Discharge summary 13

  14. Implementation-Phase I • Implementation - Phase I • Clinical Data Quality Assessment, continued • Electronic Health Record (EHR) Review • ED documentation • Physician documentation • Encounter • H & P • Procedure/Operative Reports • Pathology, Lab, Imaging Reports • Nursing flow sheets, wound care, respiratory, PT/OT, etc. • Encounter Forms • Technical and professional • Diagnosis codes 14

  15. Implementation-Phase I • Implementation - Phase I • Clinical Data Quality Assessment, continued • Clinical data quality assessment • Risk assessment • Vendor and Payer readiness assessments • Timetables • Impact to current contracts • Develop • ICD-10 education and training approach • ICD-10 workflow to readiness 15

  16. Implementation-Phase I • Implementation - Phase I • Create Budget • Software Modifications • Software/Hardware Upgrades • Staff Training/Materials • Testing-Related Costs • Temporary/Contract Staffing • Consulting Services • Development of New Reports • Data Conversion 16

  17. Implementation-Phase 2 • Implementation – Phase 2– Key Players • HIM Management Team • Coding Staff • Medical Staff • IT Personnel • Quality Management, Utilization Management, Case Management • Business Associates 17

  18. Implementation-Phase 2 • Implementation - Phase 2 • Project Governance • Implement education and training program • Staff and providers • Policies and Procedures • Software Upgrades • ICD-10 CM • Anatomy & Physiology • Specificity Requirements • Implement clinical documentation improvement program • Technical resources 18

  19. Implementation-Phase 2 • Implementation - Phase 2 • Testing, design and management • Implement systems changes • Internal/External Testing • Operational and systematic workflow • ICD-9-CM to ICD-10/ICD-10 to ICD-9-CM mapping and translation 19

  20. Implementation-Phase 3 • Implementation – Phase 3– Key Players • HIM Management Team • Coding Staff • Medical Staff • IT Personnel • Financial Management • Business Associates 20

  21. Implementation – Phase 3 Implementation - Phase 3 – “Go Live” • System Vendors • Changes & Upgrades Are Completed • Complete Internal Testing • ICD-10 Transaction Testing • Review/Test Contingency Plan for Continuing Operations • Coding Staff Training • Six months prior to “Go Live” • Documentation Assessments 21

  22. Implementation-Phase 4 • Implementation – Phase 4– Key Players • HIM Management Team • Coding Staff • Medical Staff • IT Personnel • Financial Management • Business Associates 22

  23. Implementation – Phase 4 Implementation - Phase 4 – Post Implementation • Monitoring and Improvement • End-state measurement and documentation • Implement review and improve process • Denials • Coding/Documentation Accuracy • Update compliance program 23

  24. Cost Impact • ICD-10 Budget Costs • Large hospitals • $2 - $5 Million • Large Systems • Up to $20 Million • Reimbursement Issues • Coding Backlogs • Changes in DRG Weights • Changes in Case Mix Index • Changes in Reimbursement Schedules • Changes in Payment Policies • Delayed Payment and Claims Adjudication 24

  25. Are You Where You Need To Be? • Phase I – Plan Development/Impact Assessment • First Quarter 2010 – Second Quarter 2012 • Phase 2 – Implementation • First Quarter 2012 – Second Quarter 2014 • Phase 3 – “Go Live” • First Quarter 2014 – Third Quarter 2014 • Phase 4 – Post Implementation • Fourth Quarter 2014 – Fourth Quarter 2015 25

  26. Contact Information • Contact Information • Maureen Doherty, CPC, CPC-H EisnerAmper, LLP, Manager, Healthcare Services Group Maureen.Doherty@eisneramper.com CEU CODE 26190PHDBB 26

  27. EisnerAmper LLP is an independent member firm of PKF International Limited

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