MPAA Conference: Planning and Executing your ICD-10 Implementation

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MPAA ConferencePlanning and Executing your
ICD-10 Implementation

• Tracey McKnight Sr. Director, Revenue Cycle,
  RN, MM
• Spectrum Health Hospitals
• Friday, November 16, 2012

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About Spectrum Health

• Spectrum Health is a not-for-profit system of
  care dedicated to improving the health of
  families and individuals. Our organization
  includes a medical center, regional community
  hospitals (7), a dedicated childrens hospital, a
  multispecialty medical group, affiliated
  physicians and a nationally recognized health
  plan, Priority Health.
• Spectrum Health has over 16,700 employees and
  1,500 physicians

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Revenue Cycle Overview
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OCTOBER 1, 2013 October 1, 2014 Go Live
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Background

• Effective October 1, 2014
• ICD-9-CM developed in 1979 ICD-10 developed by
  WHO in 1993
• Many countries have already adopted ICD-10,
  including Canada (2001), Germany (2000),
  Australia (1998), France (1997), UK (1995)
• Impact of the Transition from ICD-9 to ICD-10
• Requires process reengineering of clinical and
  business processes
• Requires replacement, remediation, upgrading, or
  outsourcing of legacy information systems

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Background continued

• Experience
• Provider experience in other countries showed an
  initial doubling of days in accounts receivable
  and an initial fifty percent reduction in coder
  productivity
• Because of the implementation of ICD-10-PCS as
  well as more advanced use of EHR systems, the US
  implementation effort will be far more complex
  and difficult than it was for other countries

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ICD-9 To ICD-10

• Largest transformation of core clinical and
  support processes in the last 30 years larger
  than Y2k
• much larger than CPOE
• from approx 16,000 codes to 155,000 codes
• Requires significant changes in
• Technology platforms (48 major IT systems)
• Clinical documentation (training for 3,500 staff
  and providers)
• All reports, dashboards, and solutions that use
  billing data

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ICD-10 Impact to Patient Billing

• There are many potential impacts to Patient
  Finance
• Payer issues on go-live
• Delayed payments
• Increased Denials
• Increase in DNFB (Discharge Not Final Billed)
• Rise in Customer Service calls due to increased
  Denials
• Payers may not be ready
• Non-HIPAA payers (i.e. Workmans Comp and Auto
  Insurance) arent required to use ICD-10

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Whats Changing
Coding system Diagnoses Procedures
ICD-9-CM Facility/Hospital Yes, will change to ICD-10-CM Yes, will change to ICD-10-PCS
ICD-9-CM Physician/Professional Yes, will change to ICD-10-CM No

• No changes regarding diagnosis and procedure
  codes apply to the following
• MS-DRGs
• APC
• HCPCS
• CPT

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ICD-10-CM (Diagnoses) Structure
ICD-9-CM ICD-10-CM
Three to five digits First digit is either alpha (V or E) or numeric All other digits numeric At least three digits in length Decimal after the third digit Three to seven characters First character is always alpha The only character off limits is U Character 2 is always numeric Characters 3 thru 7 can be either alpha or numeric Decimal after third character
X
X
X
X
X
X
X
.
.
X
X
X
X
X
307.81 Tension headache
G44.209 Tension type headache, unspecified, not
intractable
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• The basics of the ICD-10-CM change

• The ICD-10 code set is a full replacement of the
  ICD-9 code set that will provide additional
  granularity for diagnosis and procedure codes.
  This additional granularity is the primary driver
  of value.

An Example of Structural Change
ICD-9
ICD-10
.
.
.
Category
Category
Etiology, anatomic site, manifestation
Etiology, anatomic site, manifestation
Extension
.
Type 1 diabetes mellitus with diabetic
neuropathy, unspecified
An Example of One ICD-9 code being Represented by
Multiple ICD-10 Codes
E
1
0
4
0
One ICD-9 code is represented by multiple ICD-10
codes
.
Type 1 diabetes mellitus with diabetic
mononeuropathy
E
1
0
4
1
.
Type 1 diabetes mellitus with diabetic amyotrophy
E
1
0
4
4
.
Type 1 diabetes mellitus with other diabetic
neurological complication
E
1
0
4
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The industry expects that mapping ICD-9 and
ICD-10 codes will be a complex task
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Procedure Code ICD 10 Structure
Code structure in Medical and Surgical Section

1 2 3 4 5 6 7
Name of Section Body System Root Operation Body Part Approach Device Qualifier
ICD-9 Dx/Px ICD-10 Dx/Px Description
47.01 0DTJ422 Laparoscopic Appendectomy
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This is what specificity looks like
ICD-10
ICD-9
T18100A Unspecified foreign body in esophagus causing compression of trachea, initial encounter T18.100D Unspecified foreign body in esophagus causing compression of trachea, subsequent encounter T18.108A Unspecified foreign body in esophagus causing other injury, initial encounter T18.108D Unspecified foreign body in esophagus causing other injury, subsequent encounter
T18.110A Gastric contents in esophagus causing compression of trachea, initial encounter T18.110D Gastric contents in esophagus causing compression of trachea, subsequent encounter T18.118A Gastric contents in esophagus causing other injury, initial encounter T18.118D Gastric contents in esophagus causing other injury, subsequent encounter
T18.120A Food in esophagus causing compression of trachea, initial encounter T18.120D Food in esophagus causing compression of trachea, subsequent encounter T18.128A Food in esophagus causing other injury, initial encounter T18.128D Food in esophagus causing other injury, subsequent encounter
T18.190A Other foreign object in esophagus causing compression of trachea, initial encounter T18.190D Other foreign object in esophagus causing compression of trachea, subsequent encounter T18.198A Other foreign object in esophagus causing other injury, initial encounter T18.198D Other foreign object in esophagus causing other injury, subsequent encounter
935.1 Foreign body in esophagus
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ICD-10 Program
ICD-10 Program
Business Clinical Workflows Project
Human Resources Retention and Recruitment
Business Technology Project
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Guiding Principles

• The ICD-10 Transition Program is not a series of
  technology projects within a program technology
  is only a small part of the solution
• Dedicated Core Program Management Team focused on
  ICD-10 Transition
• Make use of Project Management Methodology and
  Business Analysis processes

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Guiding Principles continued

• Program includes SHHG/SHMG partnership with PH
• Recognize and seize opportunities for Business
  Clinical Process Improvement
• Focus on managing and mitigating all risks and
  issues related to Financial Readiness
• Baseline Program Planning assumptions are best
  estimates with information to date

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Project Organizational Structure
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Approved Program Objectives

• Coding
• Coder productivity will be at 80 after six
  months
• Coder accuracy will be at 95 after six months
• Financial
• Cash, AR, Denials will return to July 2011 levels
• Technical
• Core applications will be upgraded by April 2013
• Inventory of all applications were identified by
  12/31/11 with a 5 margin of error
• Testing will have only a 5 margin of error

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ICD-10 Program
ICD-10 Program
Business Clinical Workflows Project
Human Resources Retention and Recruitment
Business Technology Project
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Spectrum Healths ICD-10 Transition Project
Structure
Business and Clinical Workflows Project
Business and Clinical Workflows Workgroup
Coding Workgroup
Communication Workgroup
Education and Training Workgroup
Physician Champions Workgroup
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ICD-10 Business Clinical Workflows Project

• Dedicated Project Manager and Analyst
• Goal
• Ensure enterprise wide ICD-10 compliant
  workflows and processes.
• Plan
• 1) Who/What process flow analysis
• 2) Coding, Training Communication Processes
• 3) Validate Process Readiness
• 4) Validate Final Readiness (A Week in the
  Life)

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Process Flow Workgroup

• Accomplishments
• Completed Impact Analysis of organization.
  Currently beginning in-depth review highly
  impacted departments
• Developing a Financial dashboard to report daily
  or weekly metrics such as of denials, claims
  submitted, of accounts in work queues etc.
  This dashboard will help identify problems early
  by closely monitoring these items
• Next Steps
• Continue work with highly impacted departments
  and modify current processes as needed to be
  ICD-10 compliant
• Continue to engage the Central Billing Office to
  ensure financial readiness. This will involve
  working closely with payers and clearinghouses as
  well

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Education Workgroup

• Accomplishments
• 31 Coders were trained by AHIMA to be certified
  trainers
• AHIMA material such as PowerPoints and lesson
  plans will be utilized to create curriculum for
  staff
• Coding staff who select diagnosis codes will be
  trained the same (Medical group and Hospital
  group)
• Completed the Basic ICD-10 Education module
• Next activities
• Develop Intermediate Training lesson plan
• Select Online Education Software vendor for
  ICD-10 content

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Coding Workgroup

• Accomplishments
• Completed a case review in 10 highly impacted
  areas identified by a 3M audit
• Began in depth analysis of the top selected
  diagnosis and procedure codes. Review will be
  done by chapter of the current ICD-9 book to
  represent each specialty
• Next Steps
• Continue analysis of top diagnosis and procedure
  codes
• Work with the Education Workgroup as they develop
  Physician Education content to incorporate
  findings of analysis
• Update any forms or electronic templates with
  ICD-10 codes

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Communications Workgroup

• Accomplishments
• Created an ICD-10 Video which can be used to
  create awareness
• Developed content for Physician awareness
• Continue providing monthly documentation topics
  outlining the changes needed for ICD-10
• Next Steps
• Begin Physician awareness campaign
• Focus on marketing the benefits of ICD-10 to ease
  any fears and gain a positive perspective
  throughout the organization

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Physician Champions Workgroup

• Accomplishments
• Reviewed documentation templates with Physician
  Champions. Workgroup selected summary format
• Example Total Hip Replacement (ICD-9 code
  81.51)
• Documentation Considerations   
• Laterality    
• Device Type Ceramic, Autologous Tissue,
  Nonautologous Tissue, Synthetic
• Cement Need to specify whether it is cemented
  or uncemented (where applicable)
• Approach Open    

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Physician Champion Workgroup

• Accomplishments
• Physician and provider networks identified for
  ICD-10 awareness communications for SHGR, SHMG
• Next Steps
• Identify other physician and provider groups that
  need communication
• Refine Physician and provider awareness plan for
  2012

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Spectrum Healths ICD-10 Transition Project
Structure
Business Technology Project
Reports and Data Warehouse Workgroup
Forms Workgroup
Application and Interface Workgroup
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ICD-10 Business Technology Project

• Dedicated Project Manager and Analyst
• Goal
• Ensure enterprise wide ICD-10 compliant
  applications, databases, forms, reports, and FTP
  sites while maintaining ICD-9 capabilities
• Plan
• Prepare and validate application readiness
• Clinical and Business form identification and
  standardization
• GEMs Mapping tool implementation
• Determine report analysts/generators

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ICD-10 Application Status Dashboard
As of 1/9/2012
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Applications and Interfaces Workgroup

• Accomplishments
• Continued discussions regarding coordination of
  concurrent coding within 3M for Spectrum Health
  Coding department in 3M
• Continued discussions regarding testing
  coordination and timeframes for core systems
• 3M platform upgrade in October 2012 will provide
  preliminary ICD-10 grouping capabilities
• HealthQuest upgrade in March 2013 will provide
  PROD grouping capabilities
• Finalized detailed ICD-10 application data map

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Application and Interfaces Workgroup

• Next Steps
• Continue to obtain vendor certification
  documentation from analysts
• Continue to obtain outstanding analyst responses,
  estimate of hours and cost associated with
  upgrade of application
• Continue to configure work estimator for Core
  application customizations

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Forms Workgroup

• Accomplishments
• Document Approval Team (DAT) continues to meet
  twice monthly for clinical form review and
  consolidation
• Clinical forms standardization
• Identification of all business forms
• Next Steps
• Continue forms work group meetings (clinical and
  business)
• Formulating a business form approval/ICD-10
  compliance committee to match DAT (but for
  business forms)

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Data Warehouse and Reports Workgroup

• Accomplishments
• GEMs Mapping Tool vendor presentations reviewed
• Recommendation document completed for GEMs
  Mapping Tool selection
• Next Steps
• Select and Implement GEMs Mapping tool
• Determine report analysts and generators

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Spectrum Healths ICD-10 Transition Project
Structure
Human Resources Project
Career Development
Leadership Development
Recruiting
Resource Planning
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Career Development Workgroup

• Accomplishments
• Researched employee preferences related to growth
  and development
• Gathered data on existing jobs and informal
  career paths
• Next Steps
• Plan an internal recruitment program for future
  medical coders based on estimated needs and
  timing
• Develop a career path framework to outline
  opportunities within the organization

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Leadership Development Workgroup

• Accomplishments
• Surveyed employees and leaders on factors
  influencing retention
• Designed learning tracks at Spectrum Health
  University to focus on leadership development at
  multiple levels
• Next Steps
• Launch leadership development curriculum with
  leaders of medical coding groups
• Implement additional leadership development
  activities that help leaders improve levels of
  engagement and retention

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Recruiting Workgroup

• Accomplishments
• Launched new talent acquisition software to
  streamline selection of candidates
• Revised strategies and tools for selection
  assessments
• Next Steps
• Enhance our employment brand and relationships
  with educational institutions in our region
• Follow through on hiring plans and monitor
  process effectiveness

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Resource Planning Workgroup

• Accomplishments
• Developed a three-year employee supply and demand
  forecast based on anticipated workforce needs
• Next Steps
• Monitor and update workforce forecast based on
  actual data and plan changes
• Develop recruitment and hiring plans aligned with
  the forecast
• Assess options for internal resource pool
  management

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Program - Next Steps

• Partner with clinical documentation strategy
• Identify appropriate collaboration for quality
  metrics
• Implementation of Computer Assisted Coding
  Software
• Develop future state process flows for highly
  impacted areas
• Kickoff awareness campaign throughout Spectrum
  Health
• Complete training plans for all staff
• Coding workgroup to complete analysis of the top
  diagnosis codes by body system, ICD chapter and
  specialty
• Finalize vendor decisions for translation tool
  and online education

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Reminder Patient Finance is Impacted!

• Key Tasks
• Begin Payer readiness assessment
• Plan for Payer testing
• Develop post go-live dashboard to capture key
  metrics
• Create staff education plan by role
• Assess risk and plan for how to mitigate delayed
  payments

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High Level Timeline
Progress to-date
OCTOBER 1, 2013 October 1, 2014 Non-negotiable
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