ICD-10 Operational and Revenue Cycle Impacts Wendy Haas, MBA, RN Dell Services Healthcare Consulting

2 Confidential Timeline Strategy/Approach/Planning ICD-10 Education 5010 Implementation 5010 Testing ICD-10 Training/Implementation -ICD-10 Audits -Mapping Tools 5010 Deadline Testing Training Change Management Internal Service Management Transition Deadline for ICD-10

3 Confidential Overview HIPAA Electronic Transactions Standards-Final Regulation Prerequisite for ICD-10 -Version 4010 (current version), lacks the means to identify the code set used on the claims -Compliance date for most updated transaction standards is January 1, 2012 IDC-10 Final Regulation 5010 IDC-10 Final Rule Compliance date of October 1, 2013 ICD-10-CM & ICD-10-PCS Includes all covered entities ICD-10-CM is the U.S. clinical modification of the World Health Organization’s ICD- 10 coding system

4 Confidential Overview ICD-10-CM –Standard code set for reporting and coding diseases, injuries, impairments, other health problems and their manifestations –Will replace ICD-9-CM volumes 1 and 2 –All covered entities ICD-10-PCS –Will replace ICD-9-CM volume 3 and official coding guidelines for the following procedures or other actions taken for diseases, injuries, and impairments on hospital inpatients reported by hospitals: ›Prevention ›Diagnosis ›Treatment ›Management MS-DRG –Will not directly correlate to ICD-10 at go-live

5 Confidential Basic Coding Differences ICD-9 CM has 14, character alphanumeric diagnosis codes with 855 code categories. ICD-9 PCS has 3, character numeric procedure codes ICD-10 CM has 68,069 codes 3-7- character alphanumeric diagnosis codes with 2,033 code categories. ICD-10 PCS has 72,589 7-character alphanumeric procedure codes.

6 Confidential Mapping Between Old And New Systems General equivalence maps (GEMs) between ICD-9-CM and ICD-10-CM/PCS have been developed GEMs do NOT equal crosswalks Reimbursement map added to CMS web site in 2009 –Intended for use by payers –Temporary mechanism –Allows claims processing by legacy systems –Allows for data collection for reimbursement changes Maps should NOT be used for coding medical records

7 Confidential Impacts to People Coders-learn new codes, increased queries Physicians-adopt new codes and ways of documenting Clinicians- clinical documentation enhancement Information Technology-more work Financial Management-learn new codes and reduced revenue cycle productivity Payer Impact-adoption and claims processing challenges Others

8 Confidential Impacts to Process Documentation practices Productivity and efficiency practices Contracts and business processes HIM practices Practice management processes Budget Payment conversions System logic and edits Claims edits Disease & Utilization management

9 Confidential Impacts to Technology IT system changes Upgrade software Modified field lengths Modified system logic Update superbills/encounter forms and databases Data reporting elements Submitting ICD-9 and ICD-10 codes Retain access to historical coded data in ICD-9 forma

10 Confidential Revenue Cycle Impacts Medium Impact to process and training Large impact to process and training IT Applications Clinical Business Process/ Patient Access Payment Posting Scheduling Patient Access ServicesCharge/Coding IntegrityPatient Financial Services Pre- Registration Financial Counseling Charge Capture Entry Coding Assignment Account Resolution Claims Processing Test Order “Optional” Clinical Doc. Clinical Intervention Scheduling Patient Accounting Registration Performance Measurement Pricing HIS (including CPOE) HIM Claims Clearinghouse Patient Accounting Case Management Utilization Management

11 Confidential POTENTIAL IMPACTS AND RISKS

12 Confidential Prepare-2010 Strategy/approach/planning ICD-10 Education 5010 Implementation Create ICD-10 Project Steering Committee Communications Download mapping tools for financial impact testing Impact Assessment and Gap Analysis IT Vendor Contract Negotiations Publish the project plan Assess outside coding vendor readiness Establish system downtime procedures

13 Confidential To Do Testing ICD-10 Training/Implementation –Train the trainer –Identify end user knowledge level/requirements Comprehensive systems audit Use “mapping tools” Partner with vendors to review contracts and develop tools Refine documentation and data capture processes Formulate clear financial plan Modify project plan

14 Confidential To Do Deadline Testing Change Management Conduct systems testing Comprehensive systems audit for “same results” Continue training/user level specific Update mapping and code sets

15 Confidential To Do-2013 Real-time training Re-check and revise all systems and processes Finalize the implementation budget Activate go-live plan

16 Confidential Education and Training C-Suite Coders Physicians Clinicians Admitting/Financial Services

17 Confidential Implementation Must have a detailed plan Provide communications Plan to mitigate increased DNFB due to coding and billing delays Plan to mitigate increased A/R due to increased denials Plan to mitigate reduced reimbursement due to documentation deficiencies Plan to mitigate increased coding error rates Plan for reimbursement changes due to code mapping to MS-DRGs

18 Confidential Evaluation Post Go Live Impact of noncompliance is no payment Coding quality reviews Billing audits Assess revenue cycle impact Assess productivity impact Ongoing operational changes Celebrate project success

19 Confidential Strategy/Approach/Planning ICD-10 Education 5010 Implementation 5010 Testing ICD-10 Training/Implementation ICD-10 Audits Mapping Tools 5010 Deadline Testing Training Change Management Internal Service Management Transition Deadline for ICD-10 Timeline

20 Confidential ICD-10 WEB RESOURCES

21 Confidential Thank You Contact Information: Wendy Haas, MBA, RN Management Consultant Dell | Healthcare Services Mobile: