Medaille Healthcare System ICD-10 Implementation and Training HIA 340E Management and Organization for Health Professionals By Amanda Foster, Erin Frankenberger and Michelle Wisniewski

ICD-10 PCS-CM Clinical Coding The World Health Organization published the International Classification of Disease Set and, in 1990, updated to ICD-10. All covered entities – as per HIPAA –will be required to use ICD-10 codes beginning October 1, 2014. This change will affect anyone who uses health care information that has a diagnosis and/or inpatient procedural code.

Why ICD-10? The limitations of the current ICD-10 codes, which include outdated terminology, overcrowding of codes in ICD-9 categories, and insufficient detail, has made an upgrade to ICD-10 a necessity. ICD-10 is a more detail orientated and up-to- date code set that will improve both the accuracy of coding and reimbursement.

Benefits of ICD-10 Increased detail of codes will improve payment processing and reimbursement. Enhanced and more specific coding to categorize anatomic site, etiology and severity of disease. Terminology and disease classifications now mirror current medical practices and advances in technology. More detailed data will allow for improved analysis of disease patterns and the tracking and responding to public health outbreaks.

ICD-10 Implementation Timeline Winter 2012 Form ICD-10 steering committee. Representatives should be included from the following disciplines: Administration, Billing, Health Information Management/Coding, Information Systems, Revenue Cycle Management, Ancillary Services, Emergency Department, Nursing, Medical Staff, Pharmacy and Therapies. Perform an impact assessment and identify prospective changes to current workflow and business processes. Collect information from hospital departments regarding who will need to be trained in ICD-10 and to what extent.

Timeline, Cont. Begin developing a budget that includes software and software license costs, purchase of hardware, and training costs. Begin communications with 3M, clearinghouses and billing departments regarding their readiness with ICD-10. Research anticipated time for testing and availability. Work with 3M to start internal system design and development. Begin educating staff on ICD-10 and relevant documentation changes.

Timeline, Cont. Begin and complete system design and development. Begin conducting internal testing coordinating effort with internal coding, billing, IT and 3M. Office and provider staff should begin working with IT to start implementation of ICD-10 project plan for the course of ICD-implementation. Activities include review of sample data reports, testing and accuracy evaluation. Spring 2013 Continue staff education on ICD-10 and relevant documentation requirements.

Timeline, Cont. Office staff should continue working with IT to implement the ICD-10 project plan for the course of ICD- implementation. Activities include review of sample data reports, testing and accuracy evaluation. Summer 2013 Continue staff education on ICD-10 and relevant documentation requirements. Continue internal testing and 3M code deployment. Office and provider staff should continue working with IT to implement the ICD-10 project plan for the course of ICD- implementation. Activities include review of sample data reports, testing and accuracy evaluation.

Timeline, Cont. Fall 2013 Complete staff education on ICD-10 and relevant documentation requirements. Complete internal testing and 3M code deployment. Initiate external testing process. Office and provider staff should continue working with IT to implement the ICD-10 project plan for the course of ICD- implementation. Activities include review of sample data reports, testing and accuracy evaluation.

Timeline, cont. Winter 2013 Continue external testing process. Office and provider staff should continue working with IT to implement the ICD-10 project plan for the course of ICD- implementation. Activities include review of sample data reports, testing and accuracy evaluation. Spring 2014 Begin intensive training program for coders (6 months).

Timeline, Cont. Office and provider staff should continue working with IT to implement the ICD-10 project plan for the course of ICD- implementation. Activities include review of sample data reports, testing and accuracy evaluation. Summer 2014 Complete external testing process. Work with 3M to transition ICD-10 systems to production. Continue coder training program.

Timeline, Cont. Fall 2014 Work with 3M to complete transition ICD-10 systems to production. Complete coder training program. October 1, 2014: ICD-10 implementation complete. Systems are fully in compliance. *ICD-9 codes will continue to be used for services rendered prior to October 1, 2014.

Post Implementation Strategy After implementation, the ICD-10 steering committee will continue to meet on a monthly basis to evaluate ICD-10 success. Included in this evaluation will be a review of reports of coded data accuracy and quality to assess the need for continued staff training. A study will begin on actual vs. planned progress, reimbursement, denials and rejections, and fraud and abuse monitoring. A plan will be formulated to quickly address and resolve these issues.

Approximate Budget It is estimated that the overall implementation of 1CD-10 and training process will cost approximately 15 million dollars. Expense categories: Implementation ( Training, hardware, software, support ) Management ( loss revenue/ productivity)

Detailed Expenses Training: classes, software, travel, materials, books Outsourcing: trained coders to fill gaps in the transition Hardware: software modifications or adjustments, vendor fees, test server, workstations, and testing stations Software: any software upgrades, new software systems, programming, test applications

Detailed Expenses Loss of Revenue: 1) Coding Productivity may decrease due to additional time needed to code patient charts 2) There may be an increase in claim rejections 3) Slow responses for payment

ICD-10 Steering Committee An interdisciplinary steering committee will be established to oversee the implementation of ICD-10 and training. Members of this committee will include HIM, HIM coding professionals, senior management, medical staff, financial management and Information Technology.

3M 360 Encompass System Medaille Healthcare System will utilize 3M’s ICD-10 software. Includes ICD-10 readiness tool with complete ICD-10-CM and ICD-10-PCS coding content Features include code entry and retrieval To increase coding accuracy; anatomy images are integrated with coding workflow We will also incorporate Computer Assisted Coding (CAC) software to increase productivity and accuracy through the use of Natural Language Processing (NLP)

Internal and External Auditing Internal testing will be done within Medaille Healthcare System to determine if the software was installed successfully Process takes 2-3 months External testing consists of trials where we will send and receive transactions that include ICD-10 with the billing department and payers to ensure the software is functional Process takes 3-6 months There will be annual internal and external auditing of clinical coding, provided by 3M’s Registered Clinical Coding Auditors

Chargemaster (CDM) The charge description master is a database of services provided to patients and their cost. CDM: ensures accuracy of data, improves reimbursement Avoids undercharging or underpayment ,any rejected claims, penalties and fines Included in the CDM are descriptions of CPT and HCPCS codes, revenue codes, department codes, charge codes and charge status

Chargemaster Committee Includes: 1) Physicians 2)Representatives from HIM 3) Financial Services 4) Representatives from radiology, laboratory, nursing Responsibilities: Include the development of policies and procedures for the chargemaster review process and the annual review.

How Will ICD-10 Affect Cash Flow? To ensure that cash flow disruptions are kept to a minimum, we will outsource trained coders from Kforce Healthcare. These trained coders will “pick up the slack” while Medaille Heathcare System’s coders are undergoing training.

Staff Training The Medaille Healthcare facility consists of the hospital and two ancillary departments (radiology and a lab). It is also associated with a physician group. There are many different departments that will need to be trained. The level of training will vary depending on access with coding professionals being the most detailed.

Staff Training, cont. The following departments and staff will need to undergo ICD-10 training: Health Information Management Staff Billing/Financial Office Accounting Professionals Corporate Compliance Office Staff Quality Management Staff Auditors Clinicians/Nursing Personnel

Staff Training, cont. Clinical Department Managers Utilization Management Staff Patient Access and Registration Staff Researchers Ancillary Department Staff (physical therapists, occupational therapists, respiratory therapists, radiologists, lab technicians) Visiting Nurses Hospice Professionals Outpatient Service Billing Personnel

Staff Training, cont. Data Quality Management Staff Data Security Personnel Internal and External Data Analysts Information Technology and Information Systems Personnel

Staff Training, cont. According to the American Hospital Association and AHIMA, the HIM managers and coders will need the most intense training. Those coders who assign diagnosis codes will need training on the guidelines, definitions and methodology for using ICD-10 CM. Those who have the task of assigning inpatient acute care procedure codes will need to be trained to use ICD-10 PCS. AHIMA estimates that coding staff working who assign diagnosis codes will require 16 hours of training and those coders in in-patient hospitals will need approximately 50 hours of training since they need to learn both ICD-10 PCS and ICD-10 CM. Coding staff should complete their training no more than 3-6 months before the implementation date.

Staff Training, cont. Physicians, physicians assistants, nursing, researchers, ancillary staff, billing, administrative staff, coders and vendors should all have a basic understanding of ICD-10, knowledge of ICD-10 definitions and terms and ICD-10’s effects on clinical documentation.  Physicians, PA’s, nursing, ancillary staff and IT staff must be trained to use the new software that previous systems will be updated to.  Physicians will also need to be educated on the importance of accurate and complete documentation.

Training for ICD-10 NON- CODING STAFF= 4.5-7 hours of training material in 2 stages STAGE I- Awareness, implementation preparation and readiness. Explanations on how organizations will be affected STAGE II- Foundations, coding systems, instruction and implementation tools. Covers basics and introduces ICD-10

Training for ICD-10 Mandatory training sessions- In the format suggested by AHIMA because it is geared toward each profession. Training timeline is two years, from 2012 – 2014 We are aware there are several different learning styles, and therefore there will be a few different options available

Training for ICD-10 STAGE III- Actual teaching of ICD-10 ACUTE CARE= 58-66 hours of training in 4 stages STAGE I- Overview of ICD-10 and introduce training course STAGE II- Introduce coding system (3M) and instructions STAGE III- Actual teaching of ICD-10 STAGE IV- Practice coding sessions for both impatient and outpatient settings

Training for ICD-10 SPECIALITY TRAINING= 35-38 hours of training in 3 stages STAGE I- Overview of ICD-10 coding and training materials STAGE II- Introduce ICD-10 and coding instructions STAGE III- Teach the instructions for coding different specialty settings

Readiness Assessment There is a coder readiness assessment exam given at the end of training 100 question exam, identifies individual strengths and weaknesses All coders must take an ICD-10 Proficiency Assessment 75 question exam, open book, and must be passed in no more than 2 attempts over the 2 year training period.

Additional Training 3M created a program consisting of 22 modules in 90min sessions Includes an overview of ICD-10, with self – assessments Focuses on medical terminology, physiology, pharmacology, anatomy, and pathophysiology depending on job functions Training videos are available if needed The World Health Organization created a program consisting on 22 chapters Includes an overview of ICD- 10, instructs coding by body system Covers certifications, confidentiality, ethics, data quality, rules, and guidelines for morbidity and mortality coding

Motivation To keep staff motivated there will be a newsletter and announcements for each stage of training All employees are then aware of the training process, and the different materials offered We will be giving Continuing Education Credits (CEC’s) to all clinical and coding staff that demonstrates their knowledge and skills of ICD- 10

References http://www.cms.gov/Medicare/Coding/ICD10/downloads/I CD10SmallandMediumPractices508.pdf http://journal.ahima.org/2012/10/01/case-study- computer-assisted-coding-increases-productivity/ http://solutions.3m.com/wps/portal/3M/en_US/Health- Information-Systems/HIS/Products-and-Services/Products- List-A-Z/360EncompassSystem/ http://library.ahima.org/xpedio/groups/public/documents /ahima/bok1_047258.hcsp?dDocName=bok1_047258 http://static.aapc.com/ppdf/AAPCICD10Roadmap2014B1.p df http://www.ahima.org/downloads/pdfs/DistanceEd/RoadM ap_011712.pdf

References, cont. http://multimedia.3m.com/mws/mediawebserver?mwsId=S SSSSufSevTsZxtUoxme4Y_UevUqevTSevTSevTSeSSSSSS-- &fn=cs_educ_program_fs.pdf http://news.3m.com/press-release/company/3m- introduces-icd-10-physician-education http://journal.ahima.org/icdsummit/2011/04/tips-for- successful-training-2/ http://www.ahima.org/ContinuingEd/Campus/courseinfo/I CD10.aspx http://www.himss.org/content/files/ICD- 10Budgeting20091119.pdf