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Presented by: American Consultants. Darrell Jones, PMP, ITIL Director, Health Information Technology. Linda Gerber V.P. Health Information Technology. ICD-10: Anticipate the Impact. ICD-10 Agenda. Background Project Approach Training ICD-10 Impacts Project Management Readiness.

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Icd 10 anticipate the impact

Presented by:American Consultants

Darrell Jones, PMP, ITIL

Director, Health Information Technology

Linda Gerber

V.P. Health Information Technology

ICD-10: Anticipate the Impact

Icd 10 agenda
ICD-10 Agenda

  • Background

  • Project Approach

  • Training

  • ICD-10 Impacts

  • Project Management

  • Readiness

Icd 10 background
ICD-10 Background

  • ICD-10 must be used for transactions with dates of service/date of discharge on or after October 1, 2014

  • ICD-9 will no longer be accepted.

  • Deadline is firm, no further delays are expected.

Coding specificity
Coding Specificity

An Example of Structural Change




















Etiology, anatomic site, manifestation

Etiology, anatomic site, manifestation









An Example of One ICD-9 code being Represented by Multiple ICD-10 Codes

Type 1 diabetes mellitus with diabetic neuropathy, unspecified






One ICD-9 code is represented by multiple ICD-10 codes








Type 1 diabetes mellitus with diabetic mononeuropathy

Diabetes mellitus with neurological manifestations type 1 not stated as uncontrolled












Type 1 diabetes mellitus with diabetic amyotrophy

Type 1 diabetes mellitus with other diabetic neurological complication

Project approach
Project Approach

  • Governance Structure is required.

  • ICD-10 Implementation is a project, there’s a deadline.

  • Needs Executive-Level Sponsorship& Leadership

    • CEO, CFO, COO

  • Needs input from many different sources.

    • Physicians, Vendors, Payers, etc…

  • A path to Go-Live

  • Create your Implementation Plan

Governance structure
Governance Structure

  • Executive Sponsor

  • Executive Steering Committee


  • ICD-10 Program Manager

  • ICD-10 Core team

  • Education

  • Physicians

  • Coders & Billers

  • CDI

  • Revenue Cycle

  • HIM

  • Work Groups

  • Work Groups

  • Work Groups

Icd 10 implementation plan
ICD-10 Implementation Plan





  • Exec sponsors/stakeholders

  • Coding Assessment

  • Documentation review

  • Organizational readiness

  • Contract analysis

  • IT product inventory

  • Vendor readiness

  • Process readiness

  • Risk assessment

  • Roadmap assessment

  • Budget assessment

  • Exec sponsors/stakeholders

  • Establish steering committee

  • Establish PMO

  • Program Planning

  • Budget planning

  • Establish structure

  • Establish communications & reporting

  • Establish change mgmt.

  • Application/Interface

  • Workflow

  • Payer

  • Vendor coordination

  • Upgrade/Modify/replace

  • Testing

  • Coder education

  • Staff education

  • System training

  • Contract changes

  • Sensitivity analysis

  • Parallel Coding

  • Go-live planning

  • Go-live support

  • Change mgmt. & awareness

  • Risk management

  • Managing adoption

  • Reporting & analysis


  • Claims analysis

  • Process audits

  • Coding audits

  • Documentation updates

  • Systems Monitoring

  • Vendor support

  • Go-live support

  • Program closure

ICD-10 Organization Wide Education

Formal Training—Provider, Coding, Clinical Documentation, etc...

On-going Sustainment training

Who needs to be trained
Who needs to be trained?

Administrative – Basic training

Registration, Schedulers, Office Managers

Non-Physician Clinician –Moderate training

PAs, Nurses, Lab, Radiology, Support Personnel

Physician – Training by specialty or codes

Family, Specialty, Surgeons

Coder/Billing – In-depth code training

Training timeline
Training Timeline

  • Train coding professionals in high risk areas first.

    • Highest volume codes and codes with largest revenue impact.

    • Code areas with the most changes (e.g. diabetes).

  • Conduct training needs analysis, only train on codes practitioners will use.

  • Train your best coders first and early. They will become super coders to help you train the rest.

  • Plan several shorter training sessions over time rather than marathon training sessions.

  • If, however, your staff prefers workshop style training, then plan “review” sessions to reinforce learning over time.

Break it down

Icd 10 training
ICD-10 Training

Number of training hours needed:

  • The Medical Group Management Association recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff

  • Average Costs of training per doctor or coder = Provider and staff education and training, estimated between $500 to $2500 per individual.

Icd 10 impact
ICD-10 Impact

We all know ICD-10 impacts clinical documentation and coding, but what is the impact to your organization?

Technology impact
Technology Impact

  • System upgrades, replacements, testing, and go-live

  • Vendor readiness and management

  • Potential clinical department workflow process changes

  • Clinical Documentation changes

  • Interface development and testing

Processes impact
Processes Impact

Clinical Processes

  • Documentation

  • Training

  • Code Review

    Revenue Cycle

  • Coding

  • Billing

  • Denials

  • Customer Service

    Information Systems

  • System Upgrades

  • Reporting

  • Testing

  • Vendor Management

  • Project Management

People impact physicians
People ImpactPhysicians

  • Documentation: The need for specificity dramatically increases by requiring laterality, stages of healing, weeks in pregnancy, episodes of care, and much more.

  • Code Training: Code increases from 17,000 to 140,000. Physicians must be trained.

  • Code Review: A practice of using coders to review physician diagnosis’ can drastically improve your denials and reimbursement.

People impact clinical
People ImpactClinical

  • Patient Coverage: Health plan policies, payment limitations, and new ABN forms.

  • Superbills: Revisions required and paper super-bills may be impossible.

  • ABNs: Health plans will revise all policies linked to LCDs or NCDs, etc., ABN forms must be reformatted, and patients will require education.

People impact managers
People ImpactManagers

  • New Policies and Procedures: Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRI must be revised.

  • Vendors and Payer Contracts: All contracts must be evaluated and updated.

  • Budgets: Changes to software, training, new contracts, and new paperwork will have to be paid for.

  • Training Plan: Everyone in the practice will need training on the changes.

People impact billing
People ImpactBilling

  • Policies and Procedures: All payer reimbursement policies may be revised.

  • Training: Billing department must be trained on new policies and procedures and the ICD-10-CM code set.

People impact coding
People ImpactCoding

  • Code Set: Codes will increase from 17,000 to 140,000. As a result, code books and styles will completely change.

  • Clinical Knowledge: More detailed knowledge of anatomy and medical terminology will be required with increased specificity and more codes.

  • Concurrent Use: Coders may need to use ICD-9- CM and ICD-10-CM concurrently

People impact technology
People ImpactTechnology

  • Systems: Updates to systems may impact patient encounters. Testing of interfaces and documentation will take time away from operational work.

  • Vendor Management: Projects should be underway to upgrade outdated systems.

  • Project Management: Competing priorities with other projects, e.g. Meaningful Use

Financial impact

  • An Increase in Discharged Not Final Bill (DNFB) as more claims will be denied with the lack of specificity of codes.

  • Productivity in the Coding and Billing Departments will decrease during the adjustment to the new codes sets.

  • Beyond Coding and Billing, a decrease in productivity will occur for anyone else involved in coding: Physicians, Revenue Cycle, Case Management, Clinical Documentation. NEED TO GET SPECIFICS - unspecified means unpaid!

  • Payers and Vendors will also experience delays since they are going through this same transition for the first time.

  • Dual coding will bring a need for additional coders, as the work load will be doubled.

  • Payer contract management & Payer readiness

Financial impact cont
Financial ImpactCont.

  • Many IT systems will have to be updated, upgraded, or replaced.

  • The transition will bring new Workflows that will need to be monitored, adjusted, and documented. Think continuous improvement

  • Many reporting systems will need to be adjusted or replaced.

  • Backfilling for work hours used for employee training. A good percentage of the employees will need to complete some level of education.

  • Backfilling for Physician training will be difficult, which will have a direct effect on patient volumes.

Gap analysis
Gap Analysis

Identify processes, people and technology gaps between the current state and desired target state:

  • Work flow issues

  • System Issues

  • Revenue Cycle/Charge Master

  • Other issues that were not evident

Roadmap work plans
Roadmap / Work Plans

  • Develop roadmap / work plan that includes all tasks required to ensure all people, processes, training, and technology are ICD-10 ready.

  • Plan for modifying systems to accommodate code structure in all functional systems.

  • Plan for modifying business process to manage revised components of the value chain.

  • Determine approach and timing for updating analytics and reporting to support effort.

  • Plan for testing, go-live, and contingencies.



Readiness are you ready
ReadinessAre you ready?

Readiness assessment areas
Readiness:Assessment Areas

Readiness internal

  • What applications, databases, interoperability feeds, and reporting are impacted by ICD-10?

  • Are your people/process/technology analyzed and assessed?

  • Will the ICD-10 change be vendor-supported or require in-house changes?

  • For vendor-supported systems, is there an acceptable upgrade/remediation path, or will the systems need to be replaced?

Readiness vendors

  • What are the vendor-related and internal actions required to prepare for and conduct the migration?

  • What is the estimated timeline, level of effort and anticipated costs?

  • What staffing resources are needed to support multiple replacements/upgrades?

  • How will the IT department sequence system replacements/upgrades and conduct unit and integration testing?

Readiness external partners
Readiness:External Partners

  • When can you begin testing ICD-10 transactions? When will your clearinghouses/billing services, payers begin testing?

  • Do they have any upgrades that need to be completed?

  • Are your payer contract negotiations/medical policies completed to accommodate the ICD-10 code set?

    Ask them about:

    • Review, auditing, coverage, and medical policy changes

    • Impact on coverage decisions and reporting requirements

This phase can take 2-3 months to complete and needs to be completed during the assessment phase

Especially if you start late!

Technology alternatives
Technology Alternatives

  • Evaluate the options for implementation and compliance.

  • Focus on competitive advantage and strategic imperatives to support evaluation.

  • Select future-state solution that best meets the objectives and constraints.

  • Develop more detail on the technology, operations and people impacts of the solution.

  • Include a bucket for unplanned hurdles in the budget (10% of budget).

Be prepared to change direction if needed:

The Healthcare People



Q & A

Play Offense not Defense – Start Now

Let us help you determine your game plan

Contact information
Contact Information

Darrell Jones, PMP, ITIL

Director, Health Information Technology

(O) 866-319-6795

(C) 303-956-5716

Linda Gerber

V.P., Health Information Technology

(O) 866-319-6795

(C) 913-515-0290