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Published byHaylie Shenton
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ICD-10: A Street View
2 Agenda © 2013 TM Floyd & Company Timelines for Compliance Payers & Providers Readiness Updates Priorities Budgets & Risks Expediting the process Solutions
Background on ICD-10 3 © 2013 TM Floyd & Company
A Strategically Planned ICD-10 Timeline 4 © 2013 TM Floyd & Company PROGRAM MANAGEMENT Process Reengineering Process Change Outsource ProcurementOutsource Transition Product Upgrade/Consolidation/RetirementInterface Remediation Product Procurement Product Implementation Process Reengineering Warehouse Upgrade Warehouse Remediation GAP ANALYSIS BUDGET DEVELOPMENT IMPLEMENTATION PLANNING MAJOR ICD-10 STRATEGIES Reimbursement Technology Products Analytics Provider Contracts Code Mapping Tools ICD-10 EDUCATION © 2012 TM Floyd & Company Today
Testing A Typical ICD-10 Plan 5 © 2013 TM Floyd & Company ICD-9 and ICD-10 dual processing capability 01/1201/1301/1401/15 Budget Development Strategic Planning Technology Remediation ICD-10 Compliance Date Implementation Planning Technology Audit, Reporting, and Analytics Business Process & Training Audit Business Process Remediation Dual Processing ICD-10 Gap Analysis ICD-10 Training & Clinical Documentation Improvement Today ICD-10 Compliance Timeline
A Challenged ICD-10 Compliance Plan 6 © 2013 TM Floyd & Company Today ICD-10 Compliance Period 01/1301/1401/15 Skills Assessment Business Process Assessment Technical Assessment RH Feedback and Guidance Finalize Remediation Schedules Remediation Determine Financial Neutrality Testing Training Contact Vendors Implementation Today
Payers Top 5 Blue Plans National/Regional Multi-State Regional/Single State/Specialty Medicare Medicaid Payers & Providers – Sizes and Approaches 7 © 2013 TM Floyd & Company Providers Multi-State Multi-Location/Shared State Lines Facilities with Clinics (Rural and Metro) Facilities without Clinics (Rural and Metro) Physician Groups Individual Physicians
Readiness Outreach 8 © 2013 TM Floyd & Company Others State Level Organizations Payers Vendors
Readiness Outreach - MGMA 9 © 2013 TM Floyd & Company
Readiness Outreach - MGMA 10 © 2013 TM Floyd & Company
Readiness Outreach - MGMA 11 © 2013 TM Floyd & Company ICD-10 Implementation Study, June 2013
Internal Organizational Regulatory Reporting Training & Staffing Outsourced Solutions Budgets Equipment & Infrastructure Noise Things that keep CEO’s up at night Where does compliance fit into the picture Healthcare Priorities 12 © 2013 TM Floyd & Company
Multi-Year Impact Cash Flow & Revenue Enabling Staff Neutrality & Analytics Products KLO Budgets & Risks 13 © 2013 TM Floyd & Company
Budget Shifts – DRGs 14 © 2013 TM Floyd & Company DRG Shifts DRG Analysis (Payer and Provider Software Neutrality & Analytics Tools) Maximized Clinical Documentation (Improvement) Use of Additional ICD-10 Codes for Maximum Reimbursement Additional Specificity Participation in Dual Coding / Dual Processing with Payers Training at All Levels
ICD-10 Potential DRG Shift – Case Example 15 © 2013 TM Floyd & Company ICD-9-CM Anemia in neoplastic disease ICD-9 DRG 812: Red blood cell disorders without MCC (weight.7872) National Average Payment* $5,444 ICD-10-CM C85.82 Other specific types of non-Hodgkin lymphoma, intrathoracic lymph nodes ICD-10 DRG 842: Lymphoma and non-acute leukemia without CC/MCC (weight ) National Average Payment* $11,441 Payment Difference in ICD-10 $5,997 * 2012 Example: Patient is admitted for the management of anemia associated with malignancy. Management of Anemia Associated with Malignancy ICD-9-CM guidelines require coders to code anemia followed by a malignancy when providers direct treatment at the anemia. In ICD-10-CM, coders must report the malignant neoplasm first.
ICD-10-CM Diagnosis Code Mapping - Level of Effort 16 © 2013 TM Floyd & Company
Expedite The Process – Use A Dashboard 17 © 2013 TM Floyd & Company HospitalStatus Date of Last Call Technical Assessment Business Process Assessment Skills Assessment 08/13/ /13/ /30/ /13/ /13/ /30/ /7/ /13/ /13/ /13/
Budget Shifts – Claim Denials 18 © 2013 TM Floyd & Company Pre-Authorizations Medical Necessity Coding ICD-10-CM ICD-10-PCS Manual Review Payer Contracts Payer Medical Policies Payer ICD-10 Readiness (Think Payer Software Vendors) Payer ICD-10 Coding Edits
Source: U.S. Department of Health and Human Services, Office of the National Coordinator for Health IT Office-Based Provider Adoption of Basic EHRs (Percent) 19 © 2013 TM Floyd & Company
Hospital Adoption of Basic EHRs (Percent) 20 © 2013 TM Floyd & Company Source: U.S. Department of Health and Human Services, Office of the National Coordinator for Health IT
Executive Leadership Determine the State of Your Organization [ ] Well on the way [ ] Somewhere in the middle [ ] Just getting started Schedule Compression Solutions (Risks) Fast Tracking – Overlapping Activities Crashing – More Resources (Cost) Testing Traditional Sprints Expedite The Process 21 © 2013 TM Floyd & Company Now Action Take
Expedite The Process – Define Milestones & Set Goals 22 © 2013 TM Floyd & Company TaskDate StartedDate Completed Technical Assessment Develop an Application Inventory Categorize Inventory by Type Identify Applications using Codes Identify Level of Impact Identify Remediation Approach Business Process Assessment Identify Functional Areas Develop an ICD BP Inventory Identify Level of Impact Assess the Types of Risk for BPs Identify Remediation Approach Skills Assessment Identify Employees and Position Types Group Position Types Assess Level of Impact on Job Groups Assess Training Requirements
Redefine the ICD-10 Direction for Your Organization Focus on the Impact to Readiness Preparation and Testing Applications CDI and Training Providers Opportunity for Payers End-To-End Testing with a Dual Processing Testing Component Communicate Solutions 23 © 2013 TM Floyd & Company
ICD-10 Compliance Date 24 © 2013 TM Floyd & Company Tuesday – September 30, 2014 Cut-Over Date Wednesday – October 1, 2014 Compliance Date
Wrap-up / Conclusion
ICD-10 IMPLEMENTATION – ARE YOU WHERE YOU NEED TO BE? Maureen Doherty, CPC, CPC-H EisnerAmper Healthcare Services Group June 2012.
ICD-10 Operational and Revenue Cycle Impacts Wendy Haas, MBA, RN Dell Services Healthcare Consulting.
Segment 6: Provider Communication California ICD-10 Site Visit Training segments to assist the State of California with the ICD-10 Implementation June.
ICD-10 Staff Awareness. WHAT IS THIS COURSE? This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical.
By: Heather Smith LDR 609. On January 15, 2009, the Department of Health and Human Services (HHS) released the final regulation to move from the current.
© 2009 ICD-10-CM/PCS TIP Audience: Admitting Medical Terminology/Terms need to be accurate even in the registration/admitting process. Learn the basics.
ICD 10 University of Toledo Medical Center University of Toledo Physicians, LLC Overview of ICD-10 Transition.
IHIMA ICD-10 UPDATE Insert presentation date here Presented by: Presenters name here.
Acumen insight ideas attention reach expertise depth agility talent TORCH Annual Conference Rural Hospital Finance Update April 8, 2015 Deborah Whitley.
Segment Five: Provider Communication Idaho ICD-10 Site Visit Training segments to assist the State of Idaho with the ICD-10 Implementation January 26-27,
The Business Impact of ICD-10 Jessica Williams, Greater Louisville Medical Society.
Preparing for ICD-10 Implementation WV HFMA 2012 Revenue Cycle Spring Workshop.
Overview Clinical Documentation & Revenue Management: Capturing the Services Prepared and Presented by Linda Hagen and Mae Regalado.
Revenue Cycle Management Medical Technology Acquisition and Assessment Team Members: Joseph Dixon, Michael Morotti, Mari Pirie-St. Pierre, David Robbins.
ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012.
Steps for Success in EHR Planning Bill French, VP eHealth Strategies Wisconsin Office of Rural Health HIT Implementation Workshop Stevens Point, WI August.
The Transition to ICD-10 November 8, 2013 Dickon Chan Health Insurance Specialist Centers for Medicare & Medicaid Services 1.
0 Presentation to: Providers, Trading Partners & Billing Firms Presented by: Sheldia Evans-Maddox Department of Community Health (DCH) Medical Assistance.
© 2015 TriZetto Corporation ICD-10: Ready, Set, Go! August 27, 2015.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
ICD-10 Transition Community Physician Impacts and Risks.
An Eye for ICD-10s Jaye Benson Marketing Manager MEDITECH.
0 Presentation to: Medical Associations and Societies - Group Meeting Presented by: Department of Community Health (DCH) Medicaid Division June 12, 2013.
Lessons Learned from ICD-10 and Challenges in the Future Deborah Grider, CCS-P, CDIP, CPC, COC, CPC-I, CPC-P, CPMA, CEMC American Medical Association Author.
ICD -10 STAFF AWARENESS WHAT IS THIS COURSE? This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical.
ICD-10 What’s Ahead. What is it? A renovation of coding, requiring field size expansion, change to alphanumeric digits, and complete redefinition of code.
The Healthcare People The Healthcare People
Transitioning to ICD-10-CM/PCS. Agenda Overview Implementation Team Organization Awareness Impact Analysis Financial Impact Training Plan Timeline.
Preparing for ICD-10 Transition Teleconference Hosted by Community Health Association of Mountain/ Plains States (CHAMPS) January 30, 2013, 12:00 PM –
Segment Two: Business Requirements Drive the Technical Updates January 26-27, 2012 Idaho ICD-10 Site Visit Training segments to assist the State of Idaho.
October 2015 Integrating Data Analytics Technology and Services to Maximize Quality-Based Payments for Hospitals.
Click to edit Master title style Status of ICD-10 Challenges and Successes 2014 Infian User Group Meeting September 17-18, 2014 Presented by: Robin Heath.
Facilitators: Kit Cairns, Dean Health Greg Margrett, Netwerkes/Ingenix.
ICD-10 Transition September Modern History of ICD-10 The World Health Organization’s (WHO) International Classification of Diseases has served.
© 2014 By Katherine Downing, MA, RHIA, CHPS, PMP.
Know.Right.Now Presented by: Rayellen Kishbach 2015 ICD-10 Tools on MediRegs.
Assessing The Value of Web 2.0 on Knowledge Management A HEALTH CARE REIMBURSEMENT STUDY ICELW CONFERENCE JUNE 2013.
ROCHESTER HEALTH INFORMATION MANAGEMENT ICD-10 WAS ALMOST HERE !!! Amy M. Crowfoot, MSHA, RHIA, C-CDI April 23, 2014.
Nurse Executive Case Management Workshop Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton.
2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara.
High Value Revenue Cycle Audits AHIA 2009 Annual Conference September 1, 2009.
ICD- 10 READY OR NOT ! Terrance Govender, MD, MBBCh, C-CDI, CHBC.
Imagine that. Ingenious. Surviving and Thriving in the ICD-10 Transition Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS February 2014.
Shelly Guffey PREPARING FOR ICD-10 IMPLEMENTATION
Draft Transition Plan for the Transfer of the Drug Medi-Cal Treatment Program Fourth Series: Stakeholder Meetings Department of Health Care Services Department.
1 HSCRC ICD-10 Hospital Survey Information Exchange II May 28, 2015.
Preparing for ICD-10 Department of Vermont Health Access in cooperation with Vermont Office of Rural Health and Primary Care, Blue Cross Blue Shield of.
WILL YOUR PRACTICE BE READY? THE CLOCK IS TICKING ON THE TRANSITION TO ICD-10 Entire Presentation Copyright All Rights Reserved. Presentation will.
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Reducing Compliance Risk- Strategies for Medicare Consultation Billing 2010 AAHAM Keystone Educational Meeting February 18, 2010.
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