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MPAA Conference: Planning and Executing your ICD-10 Implementation. Tracey McKnight – Sr. Director, Revenue Cycle, RN, MM Spectrum Health Hospitals Friday, November 16 , 2012. About Spectrum Health.

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mpaa conference planning and executing your icd 10 implementation

MPAA Conference:Planning and Executing your ICD-10 Implementation

Tracey McKnight – Sr. Director, Revenue Cycle, RN, MM

Spectrum Health Hospitals

Friday, November 16, 2012

about spectrum health
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 children’s 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
slide5

ICD-10

It’s Coming. Are You Ready?

OCTOBER 1, 2013 October 1, 2014

Go Live

background
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
background continued
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
icd 9 to icd 10
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 to155,000codes
  • 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
icd 10 impact to patient billing
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. Workman’s Comp and Auto Insurance) aren’t required to use ICD-10
what s changing
What’s Changing
  • No changes regarding diagnosis and procedure codes apply to the following:
    • MS-DRGs
    • APC
    • HCPCS
    • CPT

10

icd 10 cm diagnoses structure
ICD-10-CM (Diagnoses) Structure

.

.

X

X

X

X

X

X

X

X

X

X

X

X

307.81 – Tension headache

G44.209 – Tension type headache, unspecified, not intractable

slide12
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.

The basics of the ICD-10-CM change

An Example of Structural Change

ICD-9

ICD-10

.

.

.

Category

Etiology, anatomic site, manifestation

Category

Etiology, anatomic site, manifestation

X

X

X

X

X

X

X

X

X

X

X

X

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

Diabetes mellitus with neurological manifestations type I not stated as uncontrolled

E

1

0

4

4

2

5

0

6

1

.

Type 1 diabetes mellitus with other diabetic neurological complication

E

1

0

4

9

The industry expects that mapping ICD-9 and ICD-10 codes will be a complex task

icd 10 program
ICD-10 Program

ICD-10 Program

Business & Clinical Workflows Project

Human Resources Retention and Recruitment

Business Technology Project

guiding principles
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
guiding principles continued
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
approved program objectives
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
icd 10 program1
ICD-10 Program

ICD-10 Program

Business & Clinical Workflows Project

Human Resources Retention and Recruitment

Business Technology Project

spectrum health s icd 10 transition project structure
Spectrum Health’s 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

icd 10 business clinical workflows project
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)

process flow workgroup
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
education workgroup
Education Workgroup
  • Accomplishments:
      • 31 Coders were trained by AHIMA to be certified trainers
        • AHIMA material such as PowerPoint’s 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
coding workgroup
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
communications workgroup
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
physician champions workgroup
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    
physician champion workgroup
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
spectrum health s icd 10 transition project structure1
Spectrum Health’s ICD-10 Transition Project Structure

Business Technology Project

Reports and Data Warehouse

Workgroup

Forms Workgroup

Application and Interface Workgroup

slide30

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

applications and interfaces workgroup
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
application and interfaces workgroup
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
forms workgroup
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)
data warehouse and reports workgroup
Data Warehouse and Reports Workgroup
  • Accomplishments:
      • GEM’s Mapping Tool vendor presentations reviewed
      • Recommendation document completed for GEM’s Mapping Tool selection
  • Next Steps:
      • Select and Implement GEM’s Mapping tool
      • Determine report analysts and generators
spectrum health s icd 10 transition project structure2
Spectrum Health’s ICD-10 Transition Project Structure

Human Resources Project

Career Development

Leadership Development

Recruiting

Resource Planning

career development workgroup
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
leadership development workgroup
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
recruiting workgroup
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
resource planning workgroup
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
program next steps
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
reminder patient finance is impacted
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
high level timeline
High Level Timeline

Progress to-date

OCTOBER 1, 2013 October 1, 2014

Non-negotiable

slide44

ICD-10

It’s Coming. Are You Ready?

10.01.2014

Jim Anderson, Program Manager & Business & Clinical Workflows PM james.anderson@spectrumhealth.org

Derek Mazurek, Business Technology Manager- derek.mazurek@spectrumhealth.org