ICD-10: A Street View. 2 Agenda © 2013 TM Floyd & Company www.tmfloyd.com  Timelines for Compliance  Payers & Providers  Readiness Updates  Priorities.

Slides:



Advertisements
Similar presentations
Transitioning to ICD-10-CM/PCS. Agenda Overview Implementation Team Organization Awareness Impact Analysis Financial Impact Training Plan Timeline.
Advertisements

An Eye for ICD-10s Jaye Benson Marketing Manager MEDITECH.
Overview of ICD-10 Transition
What is this course? This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical to our organization.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
Introduction ICD-10-CM Overview Presented By Erline Franks CCS-P.
ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012.
High Value Revenue Cycle Audits AHIA 2009 Annual Conference September 1, 2009.
ICD-10 Planning and Assessment
Preparing for ICD-10 Department of Vermont Health Access in cooperation with Vermont Office of Rural Health and Primary Care, Blue Cross Blue Shield of.
ICD-10 Transition Community Physician Impacts and Risks.
The Healthcare People The Healthcare People
MGMA Product Review Laura Palmer, FACMPE October 7, 2013.
Acumen insight ideas attention reach expertise depth agility talent TORCH Annual Conference Rural Hospital Finance Update April 8, 2015 Deborah Whitley.
Imagine that. Ingenious. Surviving and Thriving in the ICD-10 Transition Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS February 2014.
Segment Five: Provider Communication Idaho ICD-10 Site Visit Training segments to assist the State of Idaho with the ICD-10 Implementation January 26-27,
Overview Clinical Documentation & Revenue Management: Capturing the Services Prepared and Presented by Linda Hagen and Mae Regalado.
Healthcare Human Resource Management Flynn Mathis Jackson Langan
Shelly Guffey PREPARING FOR ICD-10 IMPLEMENTATION
Preparing for ICD-10 Implementation WV HFMA 2012 Revenue Cycle Spring Workshop.
Segment Two: Business Requirements Drive the Technical Updates January 26-27, 2012 Idaho ICD-10 Site Visit Training segments to assist the State of Idaho.
ICD-10: Practice Insight Readiness Presented by: Jim Goerlich – VP of Sales.
The Business Impact of ICD-10 Jessica Williams, Greater Louisville Medical Society.
ICD-10 IMPLEMENTATION – ARE YOU WHERE YOU NEED TO BE? Maureen Doherty, CPC, CPC-H EisnerAmper Healthcare Services Group June 2012.
The Transition to ICD-10 November 8, 2013 Dickon Chan Health Insurance Specialist Centers for Medicare & Medicaid Services 1.
Preparing for ICD-10 Transition Teleconference Hosted by Community Health Association of Mountain/ Plains States (CHAMPS) January 30, 2013, 12:00 PM –
Revenue Cycle Management Medical Technology Acquisition and Assessment Team Members: Joseph Dixon, Michael Morotti, Mari Pirie-St. Pierre, David Robbins.
Assessing The Value of Web 2.0 on Knowledge Management A HEALTH CARE REIMBURSEMENT STUDY ICELW CONFERENCE JUNE 2013.
© 2009 ICD-10-CM/PCS TIP Audience: Admitting Medical Terminology/Terms need to be accurate even in the registration/admitting process. Learn the basics.
0 Presentation to: Medical Associations and Societies - Group Meeting Presented by: Department of Community Health (DCH) Medicaid Division June 12, 2013.
Presented by Joan Kossow Data Compliance Manager The Changing Face of Claims Processing &
IHIMA ICD-10 UPDATE Insert presentation date here Presented by: Presenters name here.
ICD-10 Staff Awareness. WHAT IS THIS COURSE? This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical.
ICD- 10 READY OR NOT ! Terrance Govender, MD, MBBCh, C-CDI, CHBC.
© 2015 TriZetto Corporation ICD-10: Ready, Set, Go! August 27, 2015.
Physician Champion Community of Practice June, 2015 ICD-10 Physician Champion Questionnaire.
0 Presentation to: Providers, Trading Partners & Billing Firms Presented by: Sheldia Evans-Maddox Department of Community Health (DCH) Medical Assistance.
ROCHESTER HEALTH INFORMATION MANAGEMENT ICD-10 WAS ALMOST HERE !!! Amy M. Crowfoot, MSHA, RHIA, C-CDI April 23, 2014.
Steps for Success in EHR Planning Bill French, VP eHealth Strategies Wisconsin Office of Rural Health HIT Implementation Workshop Stevens Point, WI August.
EMR Remedies Electronic Health Record Solutions Copyright – EMR Remedies Corporate Overview and General Information on Federal.
2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara.
By: Heather Smith LDR 609. On January 15, 2009, the Department of Health and Human Services (HHS) released the final regulation to move from the current.
0 Presentation to: Providers, Trading Partners & Billing Firms Presented by: Sheldia Evans-Maddox Department of Community Health (DCH) Medical Assistance.
Nurse Executive Case Management Workshop Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton.
ICD-10 Transition September Modern History of ICD-10  The World Health Organization’s (WHO) International Classification of Diseases has served.
Know.Right.Now Presented by: Rayellen Kishbach 2015 ICD-10 Tools on MediRegs.
1 HSCRC ICD-10 Hospital Survey Information Exchange II May 28, 2015.
WILL YOUR PRACTICE BE READY? THE CLOCK IS TICKING ON THE TRANSITION TO ICD-10 Entire Presentation Copyright All Rights Reserved. Presentation will.
Draft Transition Plan for the Transfer of the Drug Medi-Cal Treatment Program Fourth Series: Stakeholder Meetings Department of Health Care Services Department.
Facilitators: Kit Cairns, Dean Health Greg Margrett, Netwerkes/Ingenix.
Segment 6: Provider Communication California ICD-10 Site Visit Training segments to assist the State of California with the ICD-10 Implementation June.
National HIPAA Audioconference: Analysis of the National Provider Identifier Preparing for the NPI Transition January 11, 2006.
ICD-10 What’s Ahead. What is it? A renovation of coding, requiring field size expansion, change to alphanumeric digits, and complete redefinition of code.
Integrating Data Analytics Technology and Services to Maximize Quality-Based Payments for Hospitals October 2015.
Illuminating Britelite’s Internal Services for Success Strategy for Process Improvement.
Click to edit Master title style Status of ICD-10 Challenges and Successes 2014 Infian User Group Meeting September 17-18, 2014 Presented by: Robin Heath.
Welcome Update on REC activities September 25, 2012.
ICD-10 Operational and Revenue Cycle Impacts Wendy Haas, MBA, RN Dell Services Healthcare Consulting.
© 2014 By Katherine Downing, MA, RHIA, CHPS, PMP.
Lessons Learned from ICD-10 and Challenges in the Future Deborah Grider, CCS-P, CDIP, CPC, COC, CPC-I, CPC-P, CPMA, CEMC American Medical Association Author.
© 2016 Global Market Insights, Inc. USA. All Rights Reserved U.S. Healthcare Revenue Cycle Management Market to hit $38bn by 2024
NARROWING THE LANGUAGE GAP BETWEEN ICD-9 AND ICD-10
What is the Best Way to Select an EHR
Maxim Health Information Services
Health Information Professionals
ICD-10 Updates.
The ICD-10 Transition | Simplified
Pam Matthews, FHIMSS Director of Business Information Systems Business Information Systems is focused around administrative and financial information.
Understanding the ICD-10 Transition
ICD-10 INITIATIVE -Update DRH Practice Management
Presentation transcript:

ICD-10: A Street View

2 Agenda © 2013 TM Floyd & Company  Timelines for Compliance  Payers & Providers  Readiness Updates  Priorities  Budgets & Risks  Expediting the process  Solutions

Background on ICD-10 3 © 2013 TM Floyd & Company

A Strategically Planned ICD-10 Timeline 4 © 2013 TM Floyd & Company PROGRAM MANAGEMENT Process Reengineering Process Change Outsource ProcurementOutsource Transition Product Upgrade/Consolidation/RetirementInterface Remediation Product Procurement Product Implementation Process Reengineering Warehouse Upgrade Warehouse Remediation GAP ANALYSIS BUDGET DEVELOPMENT IMPLEMENTATION PLANNING MAJOR ICD-10 STRATEGIES Reimbursement Technology Products Analytics Provider Contracts Code Mapping Tools ICD-10 EDUCATION © 2012 TM Floyd & Company Today

Testing A Typical ICD-10 Plan 5 © 2013 TM Floyd & Company ICD-9 and ICD-10 dual processing capability 01/1201/1301/1401/15 Budget Development Strategic Planning Technology Remediation ICD-10 Compliance Date Implementation Planning Technology Audit, Reporting, and Analytics Business Process & Training Audit Business Process Remediation Dual Processing ICD-10 Gap Analysis ICD-10 Training & Clinical Documentation Improvement Today ICD-10 Compliance Timeline

A Challenged ICD-10 Compliance Plan 6 © 2013 TM Floyd & Company Today ICD-10 Compliance Period 01/1301/1401/15 Skills Assessment Business Process Assessment Technical Assessment RH Feedback and Guidance Finalize Remediation Schedules Remediation Determine Financial Neutrality Testing Training Contact Vendors Implementation Today

Payers  Top 5  Blue Plans  National/Regional Multi-State  Regional/Single State/Specialty  Medicare  Medicaid Payers & Providers – Sizes and Approaches 7 © 2013 TM Floyd & Company Providers  Multi-State  Multi-Location/Shared State Lines  Facilities with Clinics (Rural and Metro)  Facilities without Clinics (Rural and Metro)  Physician Groups  Individual Physicians

Readiness Outreach 8 © 2013 TM Floyd & Company Others State Level Organizations Payers Vendors

Readiness Outreach - MGMA 9 © 2013 TM Floyd & Company

Readiness Outreach - MGMA 10 © 2013 TM Floyd & Company

Readiness Outreach - MGMA 11 © 2013 TM Floyd & Company ICD-10 Implementation Study, June 2013

 Internal Organizational  Regulatory Reporting  Training & Staffing  Outsourced Solutions  Budgets  Equipment & Infrastructure  Noise  Things that keep CEO’s up at night  Where does compliance fit into the picture Healthcare Priorities 12 © 2013 TM Floyd & Company

 Multi-Year Impact  Cash Flow & Revenue  Enabling Staff  Neutrality & Analytics Products  KLO Budgets & Risks 13 © 2013 TM Floyd & Company

Budget Shifts – DRGs 14 © 2013 TM Floyd & Company  DRG Shifts  DRG Analysis (Payer and Provider Software Neutrality & Analytics Tools)  Maximized Clinical Documentation (Improvement)  Use of Additional ICD-10 Codes for Maximum Reimbursement  Additional Specificity  Participation in Dual Coding / Dual Processing with Payers  Training at All Levels

ICD-10 Potential DRG Shift – Case Example 15 © 2013 TM Floyd & Company ICD-9-CM Anemia in neoplastic disease ICD-9 DRG 812: Red blood cell disorders without MCC (weight.7872) National Average Payment* $5,444 ICD-10-CM C85.82 Other specific types of non-Hodgkin lymphoma, intrathoracic lymph nodes ICD-10 DRG 842: Lymphoma and non-acute leukemia without CC/MCC (weight ) National Average Payment* $11,441 Payment Difference in ICD-10 $5,997 * 2012 Example: Patient is admitted for the management of anemia associated with malignancy. Management of Anemia Associated with Malignancy ICD-9-CM guidelines require coders to code anemia followed by a malignancy when providers direct treatment at the anemia. In ICD-10-CM, coders must report the malignant neoplasm first.

ICD-10-CM Diagnosis Code Mapping - Level of Effort 16 © 2013 TM Floyd & Company

Expedite The Process – Use A Dashboard 17 © 2013 TM Floyd & Company HospitalStatus Date of Last Call Technical Assessment Business Process Assessment Skills Assessment 08/13/ /13/ /30/ /13/ /13/ /30/ /7/ /13/ /13/ /13/

Budget Shifts – Claim Denials 18 © 2013 TM Floyd & Company  Pre-Authorizations  Medical Necessity  Coding  ICD-10-CM  ICD-10-PCS  Manual Review  Payer Contracts  Payer Medical Policies  Payer ICD-10 Readiness (Think Payer Software Vendors)  Payer ICD-10 Coding Edits

Source: U.S. Department of Health and Human Services, Office of the National Coordinator for Health IT Office-Based Provider Adoption of Basic EHRs (Percent) 19 © 2013 TM Floyd & Company

Hospital Adoption of Basic EHRs (Percent) 20 © 2013 TM Floyd & Company Source: U.S. Department of Health and Human Services, Office of the National Coordinator for Health IT

 Executive Leadership  Determine the State of Your Organization  [ ] Well on the way  [ ] Somewhere in the middle  [ ] Just getting started  Schedule Compression Solutions (Risks)  Fast Tracking – Overlapping Activities  Crashing – More Resources (Cost)  Testing  Traditional  Sprints Expedite The Process 21 © 2013 TM Floyd & Company Now Action Take

Expedite The Process – Define Milestones & Set Goals 22 © 2013 TM Floyd & Company TaskDate StartedDate Completed Technical Assessment Develop an Application Inventory Categorize Inventory by Type Identify Applications using Codes Identify Level of Impact Identify Remediation Approach Business Process Assessment Identify Functional Areas Develop an ICD BP Inventory Identify Level of Impact Assess the Types of Risk for BPs Identify Remediation Approach Skills Assessment Identify Employees and Position Types Group Position Types Assess Level of Impact on Job Groups Assess Training Requirements

 Redefine the ICD-10 Direction for Your Organization  Focus on the Impact to Readiness Preparation and Testing  Applications  CDI and Training  Providers  Opportunity for Payers  End-To-End Testing with a Dual Processing Testing Component  Communicate Solutions 23 © 2013 TM Floyd & Company

ICD-10 Compliance Date 24 © 2013 TM Floyd & Company Tuesday – September 30, 2014 Cut-Over Date Wednesday – October 1, 2014 Compliance Date

Wrap-up / Conclusion