The Healthcare People The Healthcare People ICD-10: Anticipate the Impact Presented by: American Consultants Linda Gerber V.P. Health Information Technology Darrell Jones, PMP, ITIL Director, Health Information Technology

The Healthcare People ICD-10 Agenda Background Project Approach Training ICD-10 Impacts Project Management Readiness

The Healthcare People ICD-10 Background ICD-10 must be used for transactions with dates of service/date of discharge on or after October 1, 2014 ICD-9 will no longer be accepted. Deadline is firm, no further delays are expected.

The Healthcare People Coding Specificity XXXXX. ICD-9ICD-10 XXXXXXX Category Etiology, anatomic site, manifestation.. Extension An Example of Structural Change Type 1 diabetes mellitus with diabetic neuropathy, unspecified E1040. Type 1 diabetes mellitus with diabetic mononeuropathy E1041. Type 1 diabetes mellitus with diabetic amyotrophy E1044. Type 1 diabetes mellitus with other diabetic neurological complication E1049. Diabetes mellitus with neurological manifestations type 1 not stated as uncontrolled An Example of One ICD-9 code being Represented by Multiple ICD-10 Codes One ICD-9 code is represented by multiple ICD-10 codes

The Healthcare People Project Approach Governance Structure is required. ICD-10 Implementation is a project, there’s a deadline. Needs Executive-Level Sponsorship & Leadership o CEO, CFO, COO Needs input from many different sources. o Physicians, Vendors, Payers, etc… A path to Go-Live Create your Implementation Plan

The Healthcare People Executive Sponsor Executive Steering Committee CEO, CFO, CIO, CNO, CMIO, HR, IT, HIM ICD-10 Program Manager EducationPhysicians Coders & Billers CDI Revenue Cycle HIM Governance Structure ICD-10 Core team Work Groups

The Healthcare People Path to Go-Live Secure Budget, Impact Assessment, Gap Analysis Establish Steering Committee & Project Program System Design & Remediation External Partner Testing Training – Coders & Physicians Operational Readiness Testing October 1 st, 2014 GO-LIVE

The Healthcare People ICD-10 Implementation Plan Assess Plan Remediate Optimize  Exec sponsors/stakeholders  Coding Assessment  Documentation review  Organizational readiness  Contract analysis  IT product inventory  Vendor readiness  Process readiness  Risk assessment  Roadmap assessment  Budget assessment  Exec sponsors/stakeholders  Establish steering committee  Establish PMO  Program Planning  Budget planning  Establish structure  Establish communications & reporting  Establish change mgmt.  Application/Interface  Workflow  Payer  Vendor coordination  Upgrade/Modify/replace  Testing  Coder education  Staff education  System training  Contract changes  Sensitivity analysis  Parallel Coding  Go-live planning  Go-live support  Change mgmt. & awareness  Risk management  Managing adoption  Reporting & analysis  AR/DNFB  Claims analysis  Process audits  Coding audits  Documentation updates  Systems Monitoring  Vendor support  Go-live support  Program closure ICD-10 Organization Wide Education Formal Training—Provider, Coding, Clinical Documentation, etc... On-going Sustainment training

The Healthcare People Who needs to be trained? Administrative – Basic training Registration, Schedulers, Office Managers Non-Physician Clinician – Moderate training PAs, Nurses, Lab, Radiology, Support Personnel Physician – Training by specialty or codes Family, Specialty, Surgeons Coder/Billing – In-depth code training

The Healthcare People Train coding professionals in high risk areas first. Highest volume codes and codes with largest revenue impact. Code areas with the most changes (e.g. diabetes). Conduct training needs analysis, only train on codes practitioners will use. Train your best coders first and early. They will become super coders to help you train the rest. Plan several shorter training sessions over time rather than marathon training sessions. If, however, your staff prefers workshop style training, then plan “review” sessions to reinforce learning over time. Training Timeline Break it down

The Healthcare People Number of training hours needed: The Medical Group Management Association recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff Average Costs of training per doctor or coder = Provider and staff education and training, estimated between $500 to $2500 per individual. ICD-10 Training

The Healthcare People We all know ICD-10 impacts clinical documentation and coding, but what is the impact to your organization? ICD-10 Impact

The Healthcare People

The Healthcare People Impact Types TechnologyPeopleFinancial Process

The Healthcare People System upgrades, replacements, testing, and go-live Vendor readiness and management Potential clinical department workflow process changes Clinical Documentation changes Interface development and testing Technology Impact

The Healthcare People Clinical Processes Documentation Training Code Review Revenue Cycle Coding Billing Denials Customer Service Information Systems System Upgrades Reporting Testing Vendor Management Project Management Processes Impact

The Healthcare People Documentation: The need for specificity dramatically increases by requiring laterality, stages of healing, weeks in pregnancy, episodes of care, and much more. Code Training: Code increases from 17,000 to 140,000. Physicians must be trained. Code Review: A practice of using coders to review physician diagnosis’ can drastically improve your denials and reimbursement. People Impact Physicians

The Healthcare People Patient Coverage: Health plan policies, payment limitations, and new ABN forms. Superbills: Revisions required and paper super-bills may be impossible. ABNs: Health plans will revise all policies linked to LCDs or NCDs, etc., ABN forms must be reformatted, and patients will require education. People Impact Clinical

The Healthcare People New Policies and Procedures: Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRI must be revised. Vendors and Payer Contracts: All contracts must be evaluated and updated. Budgets: Changes to software, training, new contracts, and new paperwork will have to be paid for. Training Plan: Everyone in the practice will need training on the changes. People Impact Managers

The Healthcare People Policies and Procedures: All payer reimbursement policies may be revised. Training: Billing department must be trained on new policies and procedures and the ICD- 10-CM code set. People Impact Billing

The Healthcare People Code Set: Codes will increase from 17,000 to 140,000. As a result, code books and styles will completely change. Clinical Knowledge: More detailed knowledge of anatomy and medical terminology will be required with increased specificity and more codes. Concurrent Use: Coders may need to use ICD-9- CM and ICD-10-CM concurrently People Impact Coding

The Healthcare People Systems: Updates to systems may impact patient encounters. Testing of interfaces and documentation will take time away from operational work. Vendor Management: Projects should be underway to upgrade outdated systems. Project Management: Competing priorities with other projects, e.g. Meaningful Use People Impact Technology

The Healthcare People An Increase in Discharged Not Final Bill (DNFB) as more claims will be denied with the lack of specificity of codes. Productivity in the Coding and Billing Departments will decrease during the adjustment to the new codes sets. Beyond Coding and Billing, a decrease in productivity will occur for anyone else involved in coding: Physicians, Revenue Cycle, Case Management, Clinical Documentation. NEED TO GET SPECIFICS - unspecified means unpaid! Payers and Vendors will also experience delays since they are going through this same transition for the first time. Dual coding will bring a need for additional coders, as the work load will be doubled. Payer contract management & Payer readiness Financial Impact

The Healthcare People Many IT systems will have to be updated, upgraded, or replaced. The transition will bring new Workflows that will need to be monitored, adjusted, and documented. Think continuous improvement Many reporting systems will need to be adjusted or replaced. Backfilling for work hours used for employee training. A good percentage of the employees will need to complete some level of education. Backfilling for Physician training will be difficult, which will have a direct effect on patient volumes. Financial Impact Cont.

The Healthcare People Identify processes, people and technology gaps between the current state and desired target state: Work flow issues System Issues Revenue Cycle/Charge Master Other issues that were not evident Gap Analysis

The Healthcare People Develop roadmap / work plan that includes all tasks required to ensure all people, processes, training, and technology are ICD-10 ready. Plan for modifying systems to accommodate code structure in all functional systems. Plan for modifying business process to manage revised components of the value chain. Determine approach and timing for updating analytics and reporting to support effort. Plan for testing, go-live, and contingencies. Roadmap / Work Plans

The Healthcare People Implementation Timeline ICD-10 Area AMA Recommended Actual Impact Analysis3-6 Months1-3 Weeks Assess Vendors readiness2-3 Months1 Month Assess Payers, Billing Service, and Clearinghouse readiness 2-3 Months1 Month Installation of Vendor Upgrades3-6 Months2 Months Internal Testing2-3 Months Update Internal Processes4-6 Months2-3 Months Formal Staff Training4-6 Months External Testing with Clearinghouses, Billing Service, and Payers 6-9 Months4-6 Months ICD-10 Go live: October 1, 2014

The Healthcare People Readiness Are you ready?

The Healthcare People Readiness: Assessment Areas OperationsFinancialExternal Revenue Cycle Clinical Documentation Coding Clinical Operations Human Resources Administration Marketing Credentialing Compliance Budgeting Reimbursement Managed Care Contracting A/R Management and Cash Flow DNFB Management Reporting and Planning Research and Intellectual Property Patients Physicians Payors Outsourced Solutions Trading Partners Outsourced Operations Coders Clearinghouses Solution Vendors

The Healthcare People What applications, databases, interoperability feeds, and reporting are impacted by ICD-10? Are your people/process/technology analyzed and assessed? Will the ICD-10 change be vendor-supported or require in-house changes? For vendor-supported systems, is there an acceptable upgrade/remediation path, or will the systems need to be replaced? Readiness: Internal

The Healthcare People What are the vendor-related and internal actions required to prepare for and conduct the migration? What is the estimated timeline, level of effort and anticipated costs? What staffing resources are needed to support multiple replacements/upgrades? How will the IT department sequence system replacements/upgrades and conduct unit and integration testing? Readiness: Vendors

The Healthcare People When can you begin testing ICD-10 transactions? When will your clearinghouses/billing services, payers begin testing? Do they have any upgrades that need to be completed? Are your payer contract negotiations/medical policies completed to accommodate the ICD-10 code set? Ask them about: Review, auditing, coverage, and medical policy changes Impact on coverage decisions and reporting requirements Readiness: External Partners This phase can take 2-3 months to complete and needs to be completed during the assessment phase Especially if you start late!

The Healthcare People Evaluate the options for implementation and compliance. Focus on competitive advantage and strategic imperatives to support evaluation. Select future-state solution that best meets the objectives and constraints. Develop more detail on the technology, operations and people impacts of the solution. Include a bucket for unplanned hurdles in the budget (10% of budget). Technology Alternatives Be prepared to change direction if needed:

The Healthcare People Q & A The Healthcare People Play Offense not Defense – Start Now Let us help you determine your game plan

The Healthcare People Contact Information AMERICAN CONSULTANTS ~ ICD-10 Information Darrell Jones, PMP, ITIL Director, Health Information Technology (O) (C) Linda Gerber V.P., Health Information Technology (O) (C)