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.