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ICD-10 Readiness & Transition Planning for HIM Professionals

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Presentation on theme: "ICD-10 Readiness & Transition Planning for HIM Professionals"— Presentation transcript:

1 ICD-10 Readiness & Transition Planning for HIM Professionals
Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS And Michele Eyler, RHIT May 11, 2012 Hotel Pennsylvania New York, NY

2 Agenda ICD-10 Update HIM Transition Planning:
Top ICD-10 Implementation Action Items ICD-10 Readiness Services Q & A

3 Industry Challenges “Business as Usual is Not an Option”
Looking Ahead… Transition to ICD-10 Meaningful Use (achieving MU Stage 2) Impact of ACOs on the HIM Practice Health information exchanges (HIEs) Identity Management Embracing Technology

4 Current State of Clinical Coding
Over the past decade, clinical coding has become more complex due to: The expansion of PPS Expanded coding rules The increased need for improved data collection Increased scrutiny for erroneous or fraudulent claims No tolerance for coding or billing errors The financial pressure to “drop” a bill Advancements in medical care vs. ICD-9 Advanced education requirements of Coders

5 Standards compliance date
HHS proposes that covered entities must be in compliance with ICD-10 on October 1, 2014. The proposed rule, CMS-0040-P, may be viewed at A news release on the proposed rule may be viewed at

6 ICD-10 Adoption: Stay the Course!
Regardless of the final compliance date. We should continue to prepare for the ICD-10 transition and keep their eyes focused on the goal of ICD-10 implementation. 

7 Transition Planning: Action Items for ICD-10 Implementation

8 Action Items for ICD-10 Ensure Organizational Awareness
Provide organization­ wide ICD­10 awareness education to key stakeholders Include senior management, information technology personnel, clinical department managers, medical staff, and all currently involved with ICD data HIM managers and coding professionals should become familiar with the format, basic structure and fundamentals of ICD­10­CM/PCS Establish and execute a communication plan for the entire healthcare organization

9 Action Items for ICD-10 Establish Executive Leadership
Develop multi­disciplinary steering committee to develop implementation strategy and oversee implementation process (provide oversight of the entire implementation timeline) Formulate transition strategies and identify goals Identify key stakeholders requiring awareness education and ensure education provided Identify key tasks and objectives and assign to appropriate departments for follow-up Prioritize concurrent projects both related and unrelated to ICD­10­CM/PCS to ensure timelines are met

10 Action Items for ICD-10 Perform Impact Assessment
Identify range of impact on every department Analyze impact on operational processes Assess impact on documentation processes and work flow Identify impacted internal and external reporting Assess the detail in clinical documentation to determine whether it is adequate to support ICD­10­CM/PCS

11 Action Items for ICD-10 CQI: Continue Impact Assessment and Initiate Resolutions Implement, test, and validate systems changes identified via impact assessment Develop and modify policies and procedures and processes for the new systems Assess the effect of the new changes on the workflow of the institution

12 Action Items for ICD-10 Conduct Systems Inventory
Inventory all databases and systems applications (including interfaces) using ICD­9­CM codes Perform detailed analysis of systems changes needed Request documentation from vendors on their plans to prepare for the transition

13 Action Items for ICD-10 Complete Gap Analysis
Perform GAP analysis on the areas of impact Develop a strategic organizational approach Identify and rank risks and identify any contingency plans

14 Action Items for ICD-10 Establish Internal Timeline
Develop internal implementation timeline Specify resources required to complete identified tasks Monitor timeline and update as needed

15 Action Items for ICD-10 Determine Plan for Training
Perform detailed assessment of current day coding staff knowledge Identify the specific groups who need training (role based) Identify at what level training needs to be provided to all categories of users Determine method and timeline for training

16 Action Items for ICD-10 Prepare Multi­year ICD­10 Budget
Perform budget assessment and procurement of needed funds to staff the transition project In this project consider: System, hardware, maintenance fee upgrades Training Outsourcing or consultant fees Temporary staffing needs Data conversion Report redesign and reprinting paper forms Additional tools or resources needed Systems testing

17 Action Items for ICD-10 Manage Contractual Changes
Review vendor and payer contracts early and collaborate with external parties to determine modifications Identify any additional fees from vendors

18 Action Items for ICD-10 Continue to Evaluate the Effect on Data Analysis Identify major areas of change between ICD-9-CM and ICD-10-CM/PCS that impact data comparison and reporting for both internally and externally reported data Determine the impact of transition on longitudinal data analysis and consider: i. Legacy data requiring conversion and how this will be accomplished ii. Application-specific mappings requiring development for coded data and whether it will be mapped between ICD-9-CM and ICD-10-CM/PCS by using the General Equivalence Mappings (GEMs) iii. Which data will be linked by using mapping applications and which data will be maintained

19 Action Items for ICD-10 Monitor Business Associate Readiness (including payers, providers, system vendors, and electronic data interchange trading partners) a. Follow up periodically on the readiness status of business associates for updates on ICD-10 transition progress b. Use the AHIMA vendor questionnaire when working with vendors c. Identify any changes to the readiness timeline

20 Action Items for ICD-10 Implement the Training/Education Plan
Identified During the Impact Assessment a. Continue educating coding staff on ICD-10 code sets and guidelines, biomedical sciences, and pharmacology b. Begin educating all others based upon timelines and roles concerning: i. Characteristics of ICD-10-CM/PCS ii. ICD-10-CM Official Guidelines for Coding and Reporting and ICD-10-PCS Coding Guidelines iii. Data comparability issues iv. Quality reporting v. GEMs and their role in the transition process

21 Action Items for ICD-10 Assess Clinical Documentation Improvement (CDI) Practices a. Evaluate the detail and quality of medical record documentation b. Implement and monitor documentation improvement strategies i. Continue to collaborate with physicians ii. Provide training on CDI to providers c. Assess vendor-supported CDI tools

22 Action Items for ICD-10 Review the Potential Reimbursement Impact During Transition a. Evaluate potential diagnosis-related groups shifts and case mix index changes b. Actively establish correspondence with payers concerning possible revisions in reimbursement schedules and policies, paying careful attention to conversion policies c. Discuss individual payers’ mapping strategy d. Analyze the impact on reimbursement due to improved clinical documentation

23 Action Items for ICD-10 Develop a Strategic Plan to Prevent Decreased Coding Productivity and Accuracy Identify what steps can be taken to diminish the effects of decreased productivity Streamline processes in the coding workflow Review and determine the effect or impact of decreased coding accuracy, and develop a quality improvement plan as needed Plans for Technology Enablement

24 ICD-10 Readiness Services

25 How Quantim ICD-10 Countdown Program Helps You Prepare for ICD-10
Coding Simulator ICD-10 e-Learning Coder Training ICD-10 Readiness Assessment ICD-10 Preparation ICD-10 Data Analytics ICD-10 Impact Analysis

26 ICD-10 Readiness Assessment
Most comprehensive ICD-10 Readiness solution available today for community hospitals Readiness Assessment/ICD-10 Roadmap includes: ICD-10 Online Readiness Questionnaire ICD-10 Education Webinars for Key Stakeholders Steering Committee Charter MS-DRG Data Analytics Action Plan Analysis Report

27 ICD-10 Impact Analysis Identification of ICD-10 Impacts
Comprehensive — Facility-Wide ICD-10 Impact Analysis Identification of ICD-10 Impacts For Business, Trading Partners, Systems Determine ICD-10 Gaps, Approach, and Effort Development of ICD-10 Implementation Plan ICD-10 Data Analytics on MS-DRGs Assessment of Education and Training Needs Complete Educational Solution Includes ICD-10 eLearning curriculum with Quantim Coding Simulator

28 ICD-10 Data Analytics Enables Health Systems to know how ICD-10 will impact reimbursement Compares current payment to equivalent payment using GEMS maps identifying financial wins and losses Clinical Documentation Audit Identifies real risk due to inadequate documentation Provides education action plan and roadmap CDI specialists Physicians by specialty

29 ICD-10 eLearning Coder Training
QuadraMed & Elsevier/MC Strategies Solution eLearning courses combined with Quantim ICD-10 Simulator is a powerful learning solution available today Enables coders to practice coding in ICD-10 prior to the transition in a live environment Comprehensive and quality ICD-10 content Phased educational approach — right at your desktop The first step in the Assessment Process includes 130 multiple choice questions with rationale designed to measure knowledge in such categories as: • Anatomy and Physiology • Pathophysiology • Medical Terminology • Coding Guidelines

30 ICD-10 Coding Simulator “Our coders love using the Coding Simulator — they look forward to the time they use it — we’ve already rolled it out to 21 coders within our organization.” John Lucabaugh HIM Director

31 Designed for the e-HIM Model
AHIMA e-HIM® Model Quantim® HIM Suite HIM Computer Applications Chart Completion (e-Signature) Deficiency Management Chart Tracking Enterprise Patient Identification Release of Information Coding and Abstracting Transcription Document Scan and Management HIM Computer Applications e-Signature Chart Completion (Chart Deficiency) Chart Location (Chart Tracking) Encounter Management (Enterprise Patient Identification) Corres-pondence Management (Release of Information) Coding and Abstracting Transcription Interface EDM (Document Management)

32 Quantim

33 In Summary We are seeing a significant shift in the way healthcare is delivered. The need is NOW for HIM professionals to manage data across the continuum of care which will be critical to the future success of their organizations. HI will be used to support the industry need for clinical and business intelligence and there are critical roles for HIM to play in this changing world of health care. Developing and managing the health information resource will be a universal, mission-critical function in the shift to quality, efficient and accountable care.


35 Contact Information Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS AHIMA Approved ICD-10-CM & PCS Trainer AHIMA ICD-10 Ambassador Vice President of HIM Innovation Atlanta, GA   (office/voic )   (office)   (mobile/voic )

36 AHIMA References 1. Top 10 List: Phase 1
ICD-10-CM/PCS Implementation Plan Development and Impact Assessment Timeframe: First Quarter 2009–Second Quarter 2011 Prepared by the 2010 Clinical Terminology/Classification Practice Council Top 10 List: Phase 2 2. ICD-10-CM/PCS Implementation Preparation Time Frame: First Quarter 2011–Second Quarter 2013 Prepared by the 2011 Clinical Terminology/Classification Practice Council 3. Ten for 10 AHIMA’s Top Ten Reasons We Need ICD10 Now.

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