Shelly Guffey PREPARING FOR ICD-10 IMPLEMENTATION

OVERVIEW 2 Understanding ICD-9 to ICD-10 Assessment of your business for ICD-10 readiness Preparing your systems for ICD-10 Preparing your staff and physicians Current status of industry

WHY THE CHANGE? ICD-9-CM is running out of codes. Hundreds of new diagnosis codes are submitted annually. – 30 year old code set contains outdated terminology & lack of specificity ICD-10-CM will allow for more codes & greater specificity; thus better tracking – This will allow providers to better identify certain patients with specific conditions Enhances quality measures Research capabilities will improve patient care CHANGE FROM ICD-9 TO ICD-10 3

UNDERSTANDING ICD-9 VS. ICD-10 4 ICD-9 has approximately 13,600 codes that mostly are numeric. 3 to 5 digits ICD-10-CM for Diagnosis coding ICD-10-CM plans to have approximately 69,000 three to seven digit alphanumeric codes beginning with a letter followed by a mix of numbers and letters ICD-10-PCS for in-patient procedure coding ICD-10-PCS (facility inpatient coding only - not physicians) will go to 87,000 procedure codes vs. current 8,660 ICD-9 (vol.3) codes

5 CharacteristicICD-9 ICD-10 CM Field Length3-5 characters3-7 characters Available CodesAbout 13,600About 69,000 Code CompositionDigit 1= alpha or numeric Digit 2-5= numeric Digit 1= alpha Digit 2= numeric Digit 3-7= alpha or numeric Sample Code Open fracture of head of radius S52123C- Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB or IIIC UNDERSTANDING ICD-9 VS. ICD-10

6 CharacteristicICD-9 (Vol.3) ICD-10 PCS Field Length3-4 characters7 Alpha-numeric characters Available CodesAbout 8,660About 87,000 Procedure DescriptionLacks description of procedure approach Has detailed description of procedure approach Sample Code3924- Aorta-renal Bypass 04104J3- Bypass Abdominal Aorta to Right Renal Artery with Synthetic Substitute, percutaneous Endoscopic Approach UNDERSTANDING ICD-9 VS. ICD-10

We are the only country that uses coding for reimbursement and one of the last to convert Some countries use very limited code sets for some in-patient payments We are the only country with a multi-payer system and innumerable payer policies 7 ICD-10 FACTS

GETTING YOURSELF READY Work Plan Analysis Budgeting Execution Post Implementation Auditing WORK PLAN 8 IMPLEMENTATION PLAN

INCLUDE ENTIRE STAFF IN PLAN & FOLLOW A LOGICAL IMPLEMENTATION Steering High Level Committee Project Committee (in the details) – Operations – Systems – Trainings – Communications – Budget – Contract review – Future on going YOU SHOULD HAVE ALREADY BEGAN 9 WHO SHOULD BE ON COMMITTEES?

All systems should be inventoried: internal and external Review software and hardware Review EMR impact Potential system acquisitions Identify vendors and their readiness Data conversions System modifications Reporting/forms modifications Make sure you have the right people reviewing your system SYSTEMS 10

Define, plan & schedule time for IT changes Can system handle ICD-9 and ICD-10? Can you do any crosswalks/mapping? What else? SYSTEMS 11

12 HIM ( HEALTH INFO MANAGEMENT) * DRG grouper * Encoding Software * Abstract systems * Med records REGISTRATION SYSTEMS BILLING/FINANCIAL SYSTEMS ALL REPORTING SYSTEMS CLINICAL SYSTEMS *Protocols * Test ordering systems *Clinical & Disease systems * Pharmacy systems SUPPORT SYSTEMS * Case mix systems * Utilization management * Quality management * Case Management SYSTEMS

YOU MUST BE READY ICD-10 move could range from $84,000 to $2.7 Million depending on practice size Education, Process Analysis, Super-bill changes, IT costs, Increased Documentation, Cash Flow Disruption, Over Time, additional staff. Key is to have strategic Planning ESTIMATE BUDGET 13 ESTIMATES

CASH FLOW ANALYSIS / REPORTING BUDGET 14 Line of Credit ready Minimum of 6 months of cash reserves Contact payers, are they going to offer contingency plans?

Understand and review payer contracts Identify high volume diagnosis/procedure codes and focus on these key revenue drivers Talk to other groups, peers, networks to do combined effects to save in costs Consulting and audit costs Labor will go up BUDGET 15 MORE TO THINK ABOUT

PREPARE TO SEE: Post Implementation education/training costs Decreased productivity/accuracy Delays in processing claims Increased denial/claims rejections WHAT TO EXPECT 16

STAFF AND PHYSICIAN TRAINING Audience – physicians, providers, staff, etc. Identify training sources Define time requirements & resources Set timeframes for training Determine coverage during training Ongoing support/training Dual ICD-9 and ICD-10 TRAIN EVERYONE 17 DEVELOP TRAINING PLAN

MAKE SUGGESTIONS TO IMPROVE CLINICAL DOCUMENTATION & PROCESSES Will you have the detail needed to generate correct ICD-10 Codes? Completing up-front documentation is your key to saving wasted time and dollars Work flows must be reviewed and revised Identify and rank risks TRAINING 18

PERFORM GAP ANALYSIS Plan MD Education to close gaps in documentation for both diagnosis and procedural coding Start with your top diagnosis codes for training Identify areas of weakness in coding staff and target more education there Canada’s implementation: 50% productivity slowdown in 1st six months, 18-20% never regained. (Didn’t implement ICD-10 PCS) TRAINING 19

ICD-10 IMPLEMENTATION PLAN WORKSHEET 20

GO-LIVE PLAN GET READY – SET – GO !! Are you ready to run parallel systems for three months prior to go-live? (Internal) Check lists all updated EXECUTION 21

DOESN’T STOP AUDITING 22 Compliance Risk Management Audits & Documentation Continued Training Communication & Awareness

23 ICD-10 WILL HAPPEN

October 1, 2014 Continue with your efforts, or start NOW if you haven’t started yet Use the extra time to better prepare NEW ICD-10 COMPLIANCE DEADLINE 24 WILL YOU BE READY?

Q + A 25

SHELLY GUFFEY MANAGER, PREMIER ACCOUNTS AND VENDOR PARTNERS GATEWAY EDI 26

GENERAL ICD-10 INFORMATION AAPC TRANSACTIONS AND CODE SETS REGULATIONS ATIONS.ASP WEDI- WORKGROUP FOR ELECTRONIC DATA INTERCHANGE AHIMA- THE AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION 27 SOURCE AND RESOURCES

THANK YOU. PREPARING FOR ICD-10 IMPLEMENTATION