IHIMA ICD-10 UPDATE Insert presentation date here Presented by: Presenters name here

Background ICD-9-CM  Current coding classification system  Introduced 30 years ago  No longer fits with 21 st century health system ICD-10-CM & ICD-10-PCS  International standard - diagnostic classification for all general epidemiological and many health management purposes  Track, report and compare morbidity and mortality  Supports achievement of EHR benefits  Transition to ICD-10 required by federal regulation

Global Use of ICD-10

Background ICD-10  Available since 1992  Approximately 100 countries use ICD-10 including Canada, Australia, and the United Kingdom  United States: Only industrialized nation not using ICD-10  United States: ICD-10 go-live date is October 1, 2013

Background (continued) Comparison of the two systems: Expansion of codes 13,000 diagnosis codes in ICD-9-CM / 69,000 unique diagnosis codes in ICD-10-CM 4,000 procedure codes in ICD-9-CM/ 72,000 procedure codes in ICD-10-PCS  Different code structure, diagnoses for example: ICD-9-CM: digits / limited alpha characters ICD-10-CM: 3 -7 digits / additional alpha characters

Benefits Higher quality information for measuring healthcare service quality, safety, and efficacy More accurate payment for new procedures Fewer miscoded, rejected, and improperly reimbursed claims Better understanding of the value of new procedures and healthcare outcomes Improved disease management Data comparability internationally

Impacts More than Just a Larger Coding Inventory of Systems According to the Healthcare Information Management Systems Society (HIMSS) Registration Registration and scheduling systems Advance Beneficiary software Performance management systems Medical necessity edits Clinical Systems Clinical systems Clinical protocols Test ordering systems Clinical reminder systems Medical necessity software Disease management systems Decision support systems Pharmacy systems HIM DRG grouper Encoding software Abstract systems Compliance software Medical record abstracting Reporting Provider profiling Quality measurement Utilization management Disease management registries Other registries State reporting systems Fraud management Aggregate data reporting Clinical systems Patient assessment data sets (e.g. MDS, RAI, OASIS) Support Systems Case Mix systems Utilization management Quality management Case Management Billing/Financial DRG grouper Conversion of other payment methodologies National and local coverage determinations System logic and edits Billing systems Financial systems Claim submission systems Compliance checking systems

Impacts

Impact Assessment – Next Steps Continue to investigate systems for potential impact Determine impact (if any) to pharmacy systems Continue vendor/system support analysis meetings Finalize overall plan/timeline Finalize budget impact Obtain Project Charter approval

Costs Training Lost productivity during implementation & training System upgrades/changes Contract re-negotiation Additional resources to support and manage implementation

Costs – System Implementation

Costs - Additional

Preparation Early Preparation A well-planned, well-managed implementation process will increase the chances of a smooth, successful transition Experience in other countries has shown that early preparation is the key to success. An early start allows for resource allocation, such as costs for systems changes and education, process evaluation and change, as well as staff time devoted to implementation processes, to be spread over several years. Potential Consequences of Inadequate Preparation: Decreased coding accuracy Decreased coding productivity Increased compliance risks Increased claims rejection An adverse impact on patient care and administrative decision-making

HIPAA 5010 Background HIPAA legislation mandates that the healthcare industry use standard formats for electronic claims and related transactions  The formats currently used must be upgraded from X12 Version 4010A1 to 5010 and from NCPDP 5.1 to D.0 Version 5010 includes changes to the following transactions:  270/271, Eligibility Benefit Inquiry and Response  276/277, Claim Status Request and Response  278, Health Care Services – Request for Review and Response  820, Premium Payment for Insurance Products  834, Benefit Enrollment and Maintenance  835, Claim Payment/Advice  837, Claim including Coordination of Benefits (COB) and subrogation claims  NCPDP D.0, Pharmacy Claim Required to prepare the infrastructure needed to support ICD-10

HIPAA 5010 Background cont’d Level I Compliance by: December 31, 2010 Level II Compliance by: December 31, 2011 All covered entities have to be fully compliant on: January 1, 2012 Level I compliance means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." Level II compliance means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards."

Compliance Timeline per Federal Rule

Progress Interviewed potential project managers Steering Committee continues to meet and add members as needed Capturing IT costs as they become known (software, resources)

Next Steps Continue to investigate systems for potential impact Incorporate ICD10 in system inventory Secure project manager for ICD10 Determine official project sponsorship Identify point of contact for all facilities and organizations Formal collaboration between HIPAA 5010 and ICD10 teams Continue and expand leadership education efforts Bring further information and decision points to ITGC

Questions?

Resources American Health Information Management Association (AHIMA) Hay Group, Inc. Healthcare Information Management Systems Society (HIMSS) RAND Robert E. Nolan Company Pricewaterhouse Coopers ctionsandCodeSetsRegulations.asp ctionsandCodeSetsRegulations.asp