[webinar] re-strategezing for a successful icd-10 / 2015 transition

© 2014 Phoenix Health Systems. All rights reserved.

RE-STRATEGIZING FOR A SUCCESSFUL ICD-10 / 2015 TRANSITION

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© 2014 Phoenix Health Systems. All rights reserved. 2

Our Presenters

D’Arcy Guerin Gue EVP Corporate Services Phoenix Health Systems

Thomas Grove Principal, ICD-‐10 Leadership Team Phoenix Health Systems

Phoenix Health Systems’ consulting services and knowledge leadership resources include a strong emphasis on ICD-10 project management and other

regulatory initiatives, such as Meaningful Use.

http://www.phoenixhealth.com


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OBJECTIVES OF THIS WEBINAR

Understand the ICD-‐10 Delay •  What we know (and don’t yet know). •  Why the delay.

Developing a strategy to go forward that •  Meets organizaDonal needs. •  EffecDvely uses personnel. •  Makes the most of the effort already expended. •  Minimizes redundant spending.


THE ICD-10 DELAY

ICD-‐10 ImplementaDon dates: •  Originally October 1, 2013 •  CMS delayed to October 1, 2014

“We have delayed it several /mes, most recently last year. There will be no change in the deadline for ICD-‐10” -‐-‐ Marilyn Tavenner, CMS Administrator

HIMSS 2014


April 1 -‐ Congress delays implementaDon of ICD-‐10 to “not prior to October 1, 2015.”

May 1 – CMS confirms the new ICD-‐10 transiDon date as October 1, 2015.

CMS also announced: §  End-‐to-‐end tesDng with providers, originally scheduled for July 21 – 25,

will be cancelled. “AddiDonal opportuniDes for end-‐to-‐end tesDng will be available in 2015.”

§  ICD-‐9 will sDll be used unDl September 30, 2015, which appears to rule out a soa phase in.


According to an April, 2014 survey performed by HFMA:

90% 58%

Most respondents were not able to predict financial impact:

71% 22%

Of hospitals > 600 beds were confident in their readiness.

Of hospitals 100 beds or less were confident in their readiness.

Of hospitals had analyzed less than half of their contracts for financial impacts.

Of hospitals had completed conDngency plans to miDgate transiDon risk.

MGMA noted in February, 2014 that only 10 percent of physician pracDces had “made significant progress” on ICD-‐10 readiness.

Why a Delay?


Edmund Billings, MD, Chief Medical Officer for Medsphere Systems CorporaDon, described healthcare providers as belonging to one of two groups:

Group One – “Have-‐a-‐lot” FaciliDes FaciliDes who are equipped with the resources to meet ICD-‐10 deadlines and feel confident of a posiDve outcome. •  For these faciliDes, the delay is an opportunity to slow their efforts, and

perhaps focus on Meaningful Use.

Group Two– “Have-‐not” FaciliDes FaciliDes (usually smaller providers) who were behind on ICD-‐10 efforts, and are breathing a collecDve sigh of relief as a result of the delay. •  For these faciliDes, the delay is an opportunity to finish ICD-‐10

preparaDons in a more raDonal way.


q Will there be addiDonal tesDng opportuniDes with CMS and other payers?

q  How much will the delay cost providers?

q When will CMS educaDon resources be updated?

q  How will the current “parDal code freeze” be handled?

What We Still Don’t Know


April 2014 October 2014 October 2015

Before the delay – with six months to go – providers

should have been:

q  Performing or finalizing coder and provider training.

q  Preparing to train their work force.

q  ExecuDng internal and payer tesDng.

q  Coding charts in ICD-‐10 for pracDce and analysis.

A@er the delay – with 18 months to go – providers should be:

q  Redefining the organizaDonal strategy for ICD-‐10, including developing a new project plan with a modified Dmeline. This new strategy must: q Meet organizaDonal regulatory

needs, e.g. Meaningful Use. q  EffecDvely uDlize personnel. q Make the most of the effort and

dollars already expended.


Ensure the Smoothest Possible ICD-10 Conversion in 2015…

Restructure your implementation strategy in at least 11 critical areas: 1.  IT 2.  Testing 3.  Revenue Analysis 4.  Cash Management 5.  Contracts 6.  Clinical Documentation Improvement (CDI) 7.  Physician Engagement 8.  Education 9.  Human Resources 10.  Practice Coding 11.  ICD-10 Coding and Back-Mapping

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IT Strategy Assess the status of major IT projects in the organization.

Some project prioriDes (those driven by mandatory upgrades to support ICD-‐10) will change. Some project end dates may shia to provide resources to projects with fast approaching deadlines, like Meaningful Use Stage 2.

§  It probably doesn’t make sense to put off upgrades for a year. •  Other improvements and fixes can be made in the soaware. •  ICD-‐10 compliant soaware supports both ICD-‐9 and ICD-‐10.

Vendors stretched for implementaDon resources will have more Dme, providing some relief. Consider new implementaDons -‐ Computer Assisted Coding may now be possible.


Testing Strategy The additional year offers more time for industry-wide testing.

§  Unit tesDng §  Integrated tesDng §  TesDng with clearinghouses §  TesDng with payers Most tesDng will be claim acceptance tesDng. Few payers have offered end-‐to-‐end tesDng. §  The lack of end-‐to-‐end tesDng means providers will

have likle insight on how their coded claims actually interact with the clinical rules in the payer’s claims processing system.

§  Based on historical experience with the HIPAA v4010 to v5010 conversion, there will be providers who “Pass” in tesDng and “Fail” in producDon.


Revenue Analysis Strategy Providers now have Dme to perform more analysis on the revenue

impacts of ICD-‐10. Four Key Steps to Revenue Impact Analysis 1.  Assess current documentaDon. 2.  Assess ICD-‐10 coding. 3.  Assess the impact of your ICD-‐10 coding on DRG

assignments. 4.  Assess the impact of proposed ICD-‐10 payer

reimbursement rates on cash flow.

Doing this analysis now provides data for revenue forecasDng, and also idenDfying areas for process improvement that will benefit your current cash flow.


Cash Management Strategy Remedy the negaDve impacts on hospital cash reserves as a result of the rush to implement upgrades for MU and ICD-‐10. Impacts of rushed implementaHon §  Limited resources used in implemenDng new

systems were unavailable for regular producDon work, resulDng in slow billing and receivables.

§  Revenue impacts from rushed implementaDon. §  Costs to perform projects have depleted ready cash.

Hospitals can use the extra 12 months to: §  Reduce unbilled inventory and unresolved claims. §  OpDmize upgraded systems and enhance workflow

processes (systems and manual). §  Retain cash prior to October 2015 to prepare for

ICD-‐10 impacts.


Contract Strategy Quickly address contracts for ICD-‐10 services.

Most computer-‐based training vendors license content using a yearly model. Extending ICD-‐10 means:

§  Changing dates of use. §  Extending the length of use → more $. §  Contract negoDaDon will be required.

for contracts without delay clauses.

Resource websites and other subscripDon services will be similarly affected. Vendors for contract coding services will be most severely impacted.

§  These vendors will likely be willing to negoDate to retain the use of their services over the next year so that they can retain the staff.


CDI Strategy Don’t let Clinical DocumentaDon Improvement efforts be

affected by the ICD-‐10 implementaDon. Training in enhanced documentaHon should not be delayed

§  Quality physician documentaDon is independent of which coding scheme is used.

§  Enhanced documentaDon will improve current case mix and revenue. §  Revenue analysis results can be used to guide training. §  Complete documentaDon provides a more realisDc foundaDon for

coders pracDcing ICD-‐10 coding, revenue analyses, and tesDng. Consider documenHng using SNOMED terminology

§  The terminology is more logical for physicians. §  Streamlines the transiDon from ICD-‐9 to ICD-‐10. §  SNOMED codes are required for Meaningful Use.


Physician Engagement Strategy

§  UnderuDlized coders can provide office coding and documentaDon services.

§  Skilled trainers,if already employed, can provide training to physician offices.

§  AddiDonal physician training in documentaDon can be provided. §  OrganizaDons with poor physician involvement in EMR and CDI

projects can use this Dme to beker engage key physicians in both efforts.

Use the extra year to provide benefits to physician offices as part of their physician engagement strategies.


Education Strategy Assess the current state of ICD-‐10 training.

Most faciliHes have already started the 80 – 120 hours of training required for coders. Hospitals have three choices on how to proceed: 1.  Complete coder training now and provide coders

the opportunity to code in ICD-‐10. 2.  Complete coder training, but plan refresher

training next year. 3.  Stop training now and plan to fully train staff in

2015. Broader workforce training that hasn’t begun should probably be delayed unDl next year.


Human Resources Strategy ProacDve hiring may have resulted in overstaffing due to the delay. §  Staffing may be reduced through akriDon. §  Planned hiring can be slowed. If providers choose NOT to reduce staff, coders can: §  PracDce coding exercises to improve ICD-‐10 accuracy and

producDvity. §  Perform documentaDon assessments as part of Clinical

DocumentaDon Improvement efforts. §  Provide quality oversight of exisDng coding acDviDes. Also consider novel approaches… §  Using coders in physician pracDces to assess and improve

coding. §  Paying coders a bonus to delay their start date. §  Offer part Dme employment.


Practice Coding Strategy

Two forms: 1.  Dual coding allows coders to pracDce ICD-‐10 coding by using

both ICD-‐9 and ICD-‐10 codes on a single chart. 2.  PracDce coding allows coders to code a specific set of charts in

ICD-‐10. Benefits §  AcDonable data for coder readiness assessments. §  Focused remedial training can be provided for trouble areas. §  ProducDvity assessments will provide management with useful

advance data on the quanDty of resources and overDme required in October 2015.

§  AcDonable data for assessing revenue impacts and provider documentaDon training efforts.

Allow coders to pracDce their ICD-‐10 coding skills.


ICD-10 Coding and Back Mapping

§  Most providers who planned to go live with ICD-‐10 before October 1, 2014 were planning to use this method.

§  Mapping from ICD-‐10 back to ICD-‐9 is considerably easier, since there is more specificity in ICD-‐10.

§  Providers would have access to a full set of ICD-‐10 data for tesDng and financial projecDons.

§  This soluDon works aaer a formal transiDon to ICD-‐10, because coders do not have to worry about which payers are not accepDng ICD-‐10 data.

Some organizaDons are planning to switch to ICD-‐10 coding and use a mapping table to map back to ICD-‐9 for billing.


2014 2015

May-‐Jun

Jul-‐Sep

Oct-‐Dec

Jan-‐Mar

Apr-‐Jun

Jul-‐Sept

Oct-‐Dec

Replanning

RenegoHate Vendor Contracts

ImplementaHon

Clinical DocumentaHon Improvement

Finish ICD-‐10 ImplementaHons Revenue and Cashflow Analysis Coder PracHce Process & System OpHmizaHon OrganizaHonal Training Post-‐Live Monitoring

Putting It All Together: Phases for ICD-10 / 2015


Takeaways q  Use the addiDonal year to refine your overall

strategy, especially where the earlier deadline was requiring rushed acDvity, short cuts, or risky gaps.

q  Leverage Dme, money and effort already spent by idenDfying the acDviDes you can sDll move forward on, but at a slower pace. Losing the momentum and buy-‐in you’ve achieved will cause unnecessary expense and duplicaDon of past work.

q  Reassess and refine your educaDon and training efforts in line with your new Dmeline.


Takeaways

q  Focus on your revenue cycle with a vengeance -- and identify as many process improvements you can make in this extra year, to benefit your cash flow and minimize post go-live disruption.

q  Continue IT and workflow redesign projects at a slower pace.

q  Continue general awareness education and communication updates across your organization.

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Summary: ICD-10 Transition on October 1, 2015

Restructure your implementation strategy in at least 11 critical areas: 1.  IT 2.  Testing 3.  Revenue Analysis 4.  Cash Management 5.  Contracts 6.  Clinical Documentation Improvement (CDI) 7.  Physician Engagement 8.  Education 9.  Human Resources 10.  Practice Coding 11.  ICD-10 Coding and Back-Mapping

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If you were not making sufficient progress on ICD-10, you are in luck. Use the extra time wisely!


Burning Questions?

Expand the “QuesDons/Chat” area Choose “Send quesDon to Staff” from the drop down

Enter your quesDon into the chat pane

Ask them now through the chat pane on the goToWebinar dashboard.


ü  Solid ICD-‐10 experDse to help you plan, implement, train and test with your own resources, as much as possible.

ü  Overall project leadership and support. ü  Strong emphasis on revenue cycle impact management. ü  Capacity to fill internal staff and experDse gaps on short term or long term project phases.

ü  A la carte services, depending on your needs and staffing.

ü  Diligent akenDon to minimizing costs.

Phoenix Health Systems ICD-10 Solutions


About Phoenix Health Systems •  Phoenix Health Systems was founded over 20 years ago to provide IT consulDng and outsourcing services to healthcare organizaDons.

•  Phoenix has always aligned its capabiliDes to key healthcare IT iniDaDves, especially regulatory mandates, such as HIPAA, HITECH, Meaningful Use and ICD-‐10. Over the years, we have been heralded as knowledge leaders in these areas.

•  ConsulDng Services: Phoenix focuses on project leadership, strategic planning, systems implementaDon, and revenue cycle opDmizaDon. We also provide consulDng and outsourcing in areas such as process changes and infrastructure issues.

•  Outsourcing Services: Phoenix provides on-‐shore Service Desk, PC support and network management outsourcing to numerous hospitals.

•  A central driver of our client relaDonships is working together to tailor highly cost-‐effecDve soluDons, without sacrificing quality, or creaDng disrupDon in hospital operaDons.


Contact Us! Email [email protected] or [email protected] Looking for more details about us or want to download one of our ICD-‐10 resources? Visit hkp://www.phoenixhealth.com

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[webinar] re-strategezing for a successful icd-10 / 2015 transition

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