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ICD-10: A Street View. 2 Agenda © 2013 TM Floyd & Company www.tmfloyd.com  Timelines for Compliance  Payers & Providers  Readiness Updates  Priorities.

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Presentation on theme: "ICD-10: A Street View. 2 Agenda © 2013 TM Floyd & Company www.tmfloyd.com  Timelines for Compliance  Payers & Providers  Readiness Updates  Priorities."— Presentation transcript:

1 ICD-10: A Street View

2 2 Agenda © 2013 TM Floyd & Company  Timelines for Compliance  Payers & Providers  Readiness Updates  Priorities  Budgets & Risks  Expediting the process  Solutions

3 Background on ICD-10 3 © 2013 TM Floyd & Company

4 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

5 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

6 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

7 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

8 Readiness Outreach 8 © 2013 TM Floyd & Company Others State Level Organizations Payers Vendors

9 Readiness Outreach - MGMA 9 © 2013 TM Floyd & Company

10 Readiness Outreach - MGMA 10 © 2013 TM Floyd & Company

11 Readiness Outreach - MGMA 11 © 2013 TM Floyd & Company ICD-10 Implementation Study, June 2013

12  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

13  Multi-Year Impact  Cash Flow & Revenue  Enabling Staff  Neutrality & Analytics Products  KLO Budgets & Risks 13 © 2013 TM Floyd & Company

14 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

15 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.

16 ICD-10-CM Diagnosis Code Mapping - Level of Effort 16 © 2013 TM Floyd & Company

17 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/

18 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

19 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

20 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

21  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

22 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

23  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

24 ICD-10 Compliance Date 24 © 2013 TM Floyd & Company Tuesday – September 30, 2014 Cut-Over Date Wednesday – October 1, 2014 Compliance Date

25 Wrap-up / Conclusion


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