The transition to ICD-10 will affect several areas within your hospital, which means changes for most of your staff.
Areas include:
IT Systems Changes
Staff Education and Training
Business Process and Documentation Changes
Changes in Super-Bills Charges
Increased Documentation Costs
Cash Flow Disruptions
Reporting Changes
The ICD-10 Impacts presentation describes these changes and what they mean for your organization.
Use this presentation to educate and prepare your staff for the impacts of the new coding system so they are ready for the transition and the changes they will experience when the October 1, 2014 deadline hits.
Download the presentation here: http://bit.ly/13JjgG9
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ICD-10 Impact Presentation
1.
2. What is ICD-10?!
u ICD-10 is a healthcare coding
system implemented by the World
Health Organization (WHO) in 1993
to replace ICD-9, a now-outdated
system for coding.
u ICD-10 is used in most countries,
except the United States.
u ICD-10 is a far more robust coding
system, needed to accurately
describe health diagnoses and
procedures with the level of detail
needed in modern medicine.
• Healthcare organizations are
required by October 1, 2014, to
convert from ICD-9 coding to
ICD-10 in documenting diagnoses
and procedures.
• Non-compliance will result in non-
payment of claims.
3. "
Why the Change to ICD-10?"
!
u Measures the quality and safety of care
u Ensures more accurate claims payments
u Improves operational and strategic planning
u Monitors resource utilization
u Improves performance: clinical, financial and
administrative
u Improves research and clinical trials
u Reduces healthcare fraud and abuse
u Tracks public health and risks
u Enables the adoption of beneficial new technologies
u Maximizes investment in IT
ICD-10 provides improved data to support 21st century healthcare.
4. Conversion to ICD-10 will
impact systems and
processes across your
organization.
Examples:
§ IT systems changes
§ Staff education and training
§ Business process and
documentation changes
§ Changes in super-bills,
charges
§ Increased documentation
costs
§ Cash flow disruptions
§ Reporting changes
PAYORS
HOSPITAL
DEPARTMENTS
IT VENDORS
& 3RD PARTY
SERVICE
PROVIDERS
Why Should You Care?!
Technology
People
Processes
5. Most staff will be affected by,
disrupted by, and/or need
education on ICD-10.!
u Senior Management
u Physicians / Nurses / Clinicians
u Health information
management
u IT staff and data analysts
u Quality management staff
u Patient access and registration
staff
u Finance and administrative
staff
u Clinical department managers
u Allied health care professionals
ARE YOU
READY
FOR THIS?!
6. It goes beyond adding
specificity to patient charts
or learning a new set of
codes for billing.
It’s a lengthy, complex, and
revolutionary transition
It requires a focused,
converted effort across all
areas of business operations
Most staff will be affected or
disrupted by the code set
Education and training
is required
Diagnosis & Procedure Codes are the foundation of
healthcare.
The transition to ICD-10 diagnosis and procedure codes is the
most profound change our industry has ever faced.
ICD-9-CM
(Diagnosis)
5 characters
= 14,000 codes
ICD-9-CM
(Procedure)
5 characters
= 4,000 codes
ICD-10-CM
(Diagnosis)
7 characters
= 68,000 codes
ICD-10-PCS
(In patient)
7 characters
= 72,000 codes
ICD-10 is More Than it Seems!
7.
u In ICD-10, it’s not just two more characters. It’s a completely new
construct that defines what each character or group of characters
represents in assigning a diagnosis.
u An almost 5-fold increase in the number of diagnosis codes to
choose from.
u An almost 20-fold increase in the number of procedure codes to
choose from.
u ICD-9 codes exists in numerous locations in the organization.
What Makes This Coding System "
So Challenging?!
It is estimated that the
average size hospital may
have 50 - 75 IT systems
or more, in which
ICD-9 codes reside.
8. Key Differences: Procedure Codes!
Sources:
WEDI
ICD-‐10
White
Paper,
2000;
ICD-‐10-‐CM
and
ICD-‐10-‐PCS
Update,
Thirteenth
NaAonal
HIPAA
Summit,
September
2006;
AHIMA
Web
site.
Feature! ICD-9-CM Volume 3! ICD-10-PCS!
Code Set! ICD-9-CM Volume III ICD-‐10-‐PCS
(Procedural
ClassificaAon
System)
Structure! Minimum of 3 digits, max of 4
digits
Decimal point after the 2nd digit
Min/max 7 digits, no decimal point
Numeric Alphanumeric
Limited Multiaxial structure Multiaxial structure, each code character has
the same meaning within the specific
procedure section and across procedure
sections, where possible
Sample Codes! 47.01, Laparoscopic appendectomy 0DTJ4ZZ, Laparoscopic appendectomy
Format!
X X X X. 1 2 3 4 5 6 7
Body system or site
of the procedure
Specific code with relation
to site, purpose, technique
or diagnosis
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
9. Key Differences: Diagnosis Codes!
Sources:
WEDI
ICD-‐10
White
Paper,
2000;
ICD-‐10-‐CM
and
ICD-‐10-‐PCS
Update,
Thirteenth
NaAonal
HIPAA
Summit,
September
2006;
AHIMA
Web
site.
Feature! ICD-9-CM Volume 3! ICD-10-PCS!
Code Set! ICD-9-CM Volume I & II ICD-‐10-‐CM
(Clinical
ModificaAon)
Structure! Minimum of 3 digits, max of 5
Decimal point after the 2nd digit
Minimum of 3 digits, max of 7
Decimal point after the 3rd digit
Numeric, except for supplementary
codes – V codes & E codes
Alphanumeric, with codes using alpha lead
character
Structure of injuries designated by
would type
Structure of injuries designated by body part
(location)
No laterality (left vs. right) Laterality (left vs. right)
Sample Codes! 733.01, Senile osteoporosis M80.011a. Postmenopausal osteoporosis
with current pathological fracture, right
shoulder, initial encounter for fracture
Format!
X X X X. X X X X X X
Category
Significant axis, such
as anatomical site
Category
X
Etiology or disease
manifestation
Subclassification
. X
Ecology
Extension: visit encounter or
sequelae for injuries and
external causes
10.
11. Administration
u Compliance
u Risk Management
u Vendor Partners
u Trading Partners
u Relationship and Contracts
u Contingency Planning
u Finance (fiscal well being)
Providers
u Documentation
Requirements
u Training
u Modification of Order Sets,
Protocols
u Provider Profiling Changes
u Pay for Performance
Protocols
ICD-10 Will Impact!
12. Medical Management
u Disease Management
u Utilization Review Processes
u Pre-cert/Referral
u Preventive Care Programs
u Profiling
u Quality Measurement
u State Reporting
u Managed Care Reporting
Care Delivery
u Medical Policy Management
u Clinical Protocols
u Orders
u Clinical System Triggers
u Documentation
Requirements
u Pharmacy Triggers
u Utilization Review
u Compliance and Reporting
ICD-10 Will Impact!
13. Systems
u Interfaces
u EDI
u Data Collection Field
Delimiters
u Data Warehouse Schemas
u Triggers (clinical systems)
u Customer Support / Help
Desk
u Testing
Revenue
u ABN Modifications
u Medical Necessity Edits
u All Coding (encoding,
abstracting, billing)
u System Logic Edits
u National and Local Coverage
Criteria
ICD-10 Will Impact!
14.
15. ICD-10 Requires Systems Changes!
u Multiple system upgrades will be needed.
u New systems may have to be purchased
to replace non-compliant systems.
u Upgraded and replaced systems must go
through testing cycles.
u Interfaces will need to be created or
updated.
u Existing IT staff may need to be
augmented.
u New collaboration with payers to adapt
to their upgraded systems.
u The medical record will require a greater
level of specificity in documentation.
16. Impact of ICD-10 on Systems!
Pharmacy
DocumentaAon
Orders
and
Protocols
Financial
Payments
CMS
DRG
Grouper
Provider
Pricing
Membership
&
Provider
Portals
Provider
EffecAveness
and
PredicAve
Modeling
Profiling
Claims
Submission
Billing
Demographics
&
Payments
Provider
ContracAng
Actuarial
&
AnalyAcal
Systems
Disease
Management
Case
Alerts
Compliance
AbstracAng
Encoding
ABN
Systems
RegistraAon
Scheduling
UR
/
Precert
EDI
Claims
HIM Systems
Patient RegistrationProvider Contracting
Delivery of Care
17. ICD-10 Requires Process
Changes!
u Business process analysis of
contracts, coverage, and
documentation
u AdapAng
to
new
vendor
compliant
IT
systems
(related
to
screen
changes,
new
tables,
etc.)
u Processes
related
to
new
systems
or
tools
used
to
support
ICD-‐10
conversion
u Processes
related
to
record
coding
(e.g.
Computer
Assisted
Coding)
u Need
for
temporary
“dual
coding”
(ICD-‐9
&
ICD-‐10)
u New
or
updated
workflows,
reports,
forms,
and
policies
and
procedures
Process
Culture
People
Change
Management
Technology
18. Initial Patient Point of Entry Payment for Services!
Patient Access
Services HIM Services
Revenue Cycle
Services
IS Services
ICD-10 Impact!
Clinical/Patient
Services
• Pre-Registration
• Patient Registration
• Appointment
Scheduling
• Financial Counseling
• Document Review
• Forms Audit
• Coding - Auditing
• OE Clinical
Procedures
• Physician/Clinician
Clinical
Documentation
• Case Management
• Charge Processing
• Forms & Reports Use
• CDM Maintenance
• Charge Processing
• Claims Production
• Payment Processing
• Resubmit/Appeals
• Contract Mgmt
• A/R Follow up
• Vendor Systems
• Interfaces
• Data Extract Files
• Reports
Impact of ICD-10 On"
Business Processes!
ý= Minimal or none ý= Medium ý= High
ý
ý
ý
ý
ý
19. u Coders must learn new, more difficult codes, and handle
substantially increased queries.
u Physicians must be trained to adopt new codes and documentation.
u Clinicians must be trained, and ensure clinical documentation
enhancement, with procedures reflecting increased ICD-10 detail.
u Information technology staff, already burdened with Meaningful
Use / EHR initiatives must take on more, highly specialized work.
u Financial management and administrative staff must learn new
codes and deal with reduced revenue cycle productivity.
u Management must address shortages of required, specialized skills
to manage and conduct implementation.
Impact of ICD-10 on Workforce"
Almost all areas of the organization will experience disruption.
Training will be key – and will require a major enterprise-wide effort.
20.
21. § UpdaAng
of
medical
coding,
billing,
claims
processing
and
A/R
management
§ Reconfiguring
eligibility
and
uAlizaAon
management
§ UpdaAng
of
protocols
for
medical
necessity,
policy
checks
and
related
§ Planning
for
Increased
costs
related
to
ICD-‐10
changes
§ OpportuniAes
to
leverage
the
stronger
capabiliAes
of
ICD-‐10
should
be
idenAfied
to
§ achieve
process
opAmizaAon
§ more
accurately
reflect
services
provided
§ offset
higher
business
costs
§ miAgate
new
financial
risks
§ make
be_er
strategic
business
decisions
ICD-10 Requires Changes in Revenue
Cycle Management!
CMS and industry leaders
predict dire consequences to
healthcare operations and
revenue if ICD-10 is not
implemented properly.
22. Impact of ICD-10 On"
Revenue Cycle!
ý= Minimal or none ý= Medium ý= High!
Encounter
Charge
Capture
Coding
Medical
Record
Documentation
Financial
Counseling
Scheduling/
Registration
Certification
Contract
Management
Claims
Submission 3rd Party
Follow-Up
Rejection
Processing
Payment
Posting
Appeals
Encounter
Charge Capture
Coding
Utilization
Review
23. Potential Impact of ICD-10 "
On Finances!
Decrease in cash
flow and loss of
revenue
Slowdown in
payments for up to
two years
Increase in claims
errors and returns
Increase in
denial rates
Initial increase in
costs (training &
implementation)
Mitigation of financial risks
must be planned and executed
24.
25. Areas for Assessment Consideration!
Revenue
Cycle Systems
Admin
Systems
Interfaces
Data Extract
Files
Clinical
Systemsa
• Registration
• Patient
Management
• Coding System/
HIM
• Professional
Billing
• Patient Accounts
Data Extract
Files
• Decision Support
System
• Data Warehouse
• Business
Intelligence
System
• Emergency
Department
• Laboratory
• Pharmacy
• Radiology
• Surgical Services
• ADT
• Charges
• Coding Abstract
• Internal Systems
• External Systems
• Professional Fee
Billing
• Reports
• Forms
Don’t Delay – Get Started…!
26. !
Free One-Day Assessment to!
…with a!
u Define scope of work
u Identify project and approximate deadlines
u Identify education needs
u Define areas of concern
If interested, let us know and one of our !
ICD-10 experts will be in touch!
27. Phoenix Health Systems has the
expertise you need.!
With over 20 years of healthcare IT experience, Phoenix is
passionate about supporting exceptional healthcare.
We support hospitals to solve critical challenges like ICD-10
conversion, Meaningful Use, IT strategic planning and more.
Vendor-independent, we bring objective, highly experienced senior
level IT leaders and project managers to every client engagement.
To learn more about how Phoenix can help your organization,
contact us.