Title: Current Status on ICD 10 Implementation
1Current Status on ICD-10 Implementation
Presented By Victoria, thepracticebridge
2- We will be using ICD-10 another 19 days. Before
that I will make you to walk through the status
on ICD-10 implementation.
3I have few questions in my mind
- Does the claims errors will Increase?
- Will A/R could rise?
- Will there be a rise in claim denial rates?
4- 2015 survey was intended only for healthcare
providers. 60 responded on behalf of a hospital
or health system. Hope we will get more
clarifications if we go through the survey.
5- According to the survey, just 7 of physicians
said they have started transitioning to ICD-10
extensively. - 31 of respondents said they had not started the
transition at all. - Among solo physicians, 82 said they have not
started the transition at all or have made only
limited - 42 of respondents said they are "not at all
confident" that the implementation of ICD-10 will
cause no serious disruptions. - 83 of respondents expect the transition to
result in delayed or denied claims - 36 expect to face disruptions that require them
to draw from personal funds
6- 32 said they might reduce staff size, work hours
or benefits and - 30 said they might retire early because of
anticipated cash-flow issues related to the
transition - 65 said they are capable of processing ICD-10
codes - 52 said their practice management software was
capable of processing ICD-10 codes - 1 said they will need to completely replace
their IT systems to comply with ICD-10.
7A recent survey of 1,100 organizations found
- More than half of respondents were uncertain of
the actual ICD-10 deadline. - And more than half had not yet completed
end-to-end testing. - Some providers still believe the switch to
ICD-10 isn't going to happen this year.
8- "This is an off-election year, and if I was a
politician, I would roll ICD-10 out during an
off-election year rather than delay it," says Mr.
Joshua Berman, Relay Health ICD-10 Director.
9- Provider organizations that haven't adequately
prepared for the switch are going to have issues
with the processes that ICD-10 requires. However
even organizations that have prepared may still
have problems.
10This isn't a technology change, it's a
process change
- The switch to ICD-10 requires coding staff,
physicians and all others who document conditions
to be properly trained to ensure billing is done
correctly.
11- All providers are likely to encounter some issues
with the switch to ICD-10, including an increase
in claim denials and the amount of time it takes
payers to process claims
12- For small practices Road to 10 from CMS has
primer for clinical documentation, clinical
scenarios, and other specialty-specific resources
to help with implementation.
13- Medicare claims processing systems will not have
the capability to accept ICD-9 codes for dates of
services after September 30, 2015
146 foundations for ICD-10 implementation you
cant ignore!
- ICD-10 CM/PCS Communication
-
- Coding Education
-
- Clinical Documentation Initiatives
- IT Plan
- Revenue Cycle Plan
-
- Post "Go Live" Health Information Management
coding activities
15 Communication
- Concise Messaging
- Vision Statement
- Partners Roles
- Timelines
- Defined Methods of Communication
16 ICD-10 CMS/PCS Vision Statement
- Clarity-steering the team in the right direction
- Inspiring and meaningful versus compliance driven
- Expected outcomes-how we will be working
differently following ICD-10 implementation
17Partners and Roles
- Identify
- Internal groups
- External groups (Partners)
- Agreed upon communications
18- Have a timeline that outlines milestones,
secondary tasks and deadlines keep implementation
teams on task. - Multiple communication methods should be used
Thumb of rule says, seven times, seven ways
19 Coding Education
- Self assessment goals checklists
- Rate your self on a scale 1(Goal not accomplished
at all) to 5(Goal accomplished) - Are you aware of your foundational knowledge
strengths related to AP, disease processes,
pharmacology, etc.? - Are you completing tasks to improve your
weaknesses related to AP, disease processes,
pharmacology, etc.?
20- Are you networking with a subject matter expert
and peers? - Are you practicing and applying codes to real
world documentation? - Are you working to understand the ICD-10-CM/PCS
coding guidelines? - Are you gaining a deeper understanding of the
clinical documentation improvement protocols? - Do you work collaboratively with clinical
documentation specialists when a clarification or
query is needed?
21 Clinical Documentation Improvement
- The success for this includes
- physician involvement
- communicating documentation gaps
- Other key data findings
- Which agree upon goals of a CDI improvement
process and ongoing focused reviews with
feedback.
22- Medical staff, CDI staff the coding staff will
need education on the findings from documentation
reviews - Findings should include discussion of the
documentation elements needed to support ICD-10
codes through use of specific examples. - The value of more concise data capture for high
quality data should be emphasized.
23 IT Block
- For the most part, IT plans for the transition to
ICD-10 are well underway, due in part to the
conversion to 5010 compliance. - Important elements of the IT building block for
ICD-10 readiness to be monitored throughout the
implementation include.
24- Communications to and from vendors
- Testing of system capabilities
- The costs associated with IT implementations
- Necessary upgrades and system maintenance.
- Decisions around how ICD-9 and ICD-10 databases
will be accessed and maintained will need to be
made.
25 Revenue Cycle Block
- The 9 pieces of advice from Government Health IT
practices must consider - Practices should develop a budget and strategy to
provide for additional cash reserves should
delays in payment occur. - Practices should conduct financial modeling to
understand the impacts of moving from ICD 9 to
ICD 10 the impacts should be looked at by
provider, by facility, by service line, and by
geography if applicable.
26- The potential for backlogs in medical Coding,
billing, and claim edits should be analyzed and a
strategy developed to work the backlogs. - A strategy for pre and post ICD 10 denials
management should be developed. - Assess the readiness of external vendors who
support coding, billing, follow up and denials. - Any audits currently performed (compliance, RAC,
etc.) should be reviewed to determine ICD 10
impact.
27- Managed care contracts should be reviewed and if
necessary, renegotiated to decrease negative
impacts to the bottom line. - The readiness of high volume payers should be
assessed to determine their ability to process
claims. Many payers are now posting readiness
information on their web sites. - Conduct CDI reviews using ICD 10 code sets to
determine if documentation contains the
specificity necessary for ICD 10.
28Post Go Live HIM/Coding Activities.
- Most important block for ICD-10 implementation is
to plan the activities to undertake following the
deadline. As Sir Walter Scott said, I can give
you a six-word formula for success Think things
through then follow through
29- Practices must follow through and monitor coding
accuracy and productivity following go live. - When problems are identified, strategies should
be implemented to address workflow problems,
process problems, and resource issues. - Determine if further education and training is
needed and provide it expeditiously to prevent
future issues.
30- Monitor for opportunities to improve data
integrity through EHR enhancements, monitoring of
alerts, and communication with physicians
clinical documentation improvement staff. - Finally, monitor productivity to manage
responding to staffing needs. - Go live will be a challenging time for all and
retention of highly trained, skilled coding staff
will be essential.
31- Which of these building blocks needs more
attention in your organization? Which has been
successful?
32Share Your Views With Us atwww.thepracticebridge
.comand if you like it, kindly subscribe to our
blog updates!
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