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Icd 10 Playbook: LF FL F I New Tools For Successful Transformation
Icd 10 Playbook: LF FL F I New Tools For Successful Transformation
May25,2011
Housekeepingitems:
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LegalDisclaimer g
Todayswebinarispresentedforinformationalpurposesonly,andnoneof itscontentshouldbeconstruedaslegaladvice.HIMSSmembersare it t t h ld b t d l l d i HIMSS b stronglyencouragedtoreadtherespectivelegislativetextsand/orconsult withlegalcounsel.Ifyouhaveanyquestionsregardingtheinformation sharedduringthiswebinar,oranyHIMSSactivities,pleasecontactus.Visit shared during this webinar or any HIMSS activities please contact us Visit ourwebsiteforthelatestdevelopments.
TodaysModerator
ToriSullivan,MHA,RHIA,PMP ICD 10 Business Solutions Professional ICD10BusinessSolutionsProfessional IBM,GlobalBusinessSolutionsDivision currentlyservesascochairfortheHIMSSRevenueCycle
TodaysPresenters y
TysonMcDowell C O f CEOofBenchmarkRevenueManagement h k currentlyservesascochairfortheHIMSSRevenueCycle ImprovementandFinancialSystemsTaskForce. Improvement and Financial Systems Task Force. hasfocusedonleveragingtheInternetfortrue interoperability,scalability,andrapidapplication development.
ICD10PlayBookDemonstration
VantagePointSurvey
SurveylaunchedinAprilof2011andresultsincluded353Responses. Nearly1/3ofrespondentsnotedthattheinformationwouldhaveno impactontheirorganization'sprep.forconvertingtoICD10. i h i i i ' f i ICD 10 Asimilarpercentnotedtheguidelineswouldbeofuseeitherinthe conversionprocessesunderwayeitherathealthcareorganizationsorof theproductsandservicesofferedtotheindustryinthisarea. th d t d i ff d t th i d t i thi 73percentofrespondentsnotedthattheyturntoassociationsasa resourceforinformationontheirICD10conversion;72percentturnto thefederalgovernment. th f d l t
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Impactof2011CDCGuidelinesonICD10Conversion
OnethirdofrespondentsnotedthatCDC'spostingofguidelineshas hadnoimpactontheirorganization'spreparationsforconvertingto ICD10.Anotherquarternotedthatthepostingwillhelptheconversion effortsattheirhealthcarefacility,and11percentindicatedthatthis efforts at their healthcare facilit and 11 percent indicated that this informationwillbeusefulasmodificationsaremadetoproductsand servicesinadvanceoftheconversionprocess.Thegreatestconcern thatrespondentshavewithregardtotheirICD10conversionisthe that respondents have with regard to their ICD10 conversion is the revenuelosstheyfaceduetocodingissues.
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GreatestChallengeAssociatedwithICD10Conversion g
Onethirdofrespondentsnotedthatthegreatestchallenge organizationsfaceastheyundertakeICD10conversionisalackof staffingresources.Another19percentnotedthatalackof synchronizationbetweenpayersandproviderswouldpresent challenges.
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GreatestConcernRelatedtoMeetingICD10 g ImplementationGuideline
Nearlyhalfofrespondentsnotedthattheirgreatestconcernrelatedto meetingtheICD10implementationguidelineisarevenuelossduetoa bottleneckofcodingissues.Onlyfivepercentofrespondentsare concernedthattheirorganizationwillmisstheOctober2013deadline andbepenalized.
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InformationSourcesforICD10Conversion
Nearlythreequartersofrespondentsnotedthattheyturnto associationsforinformationontheirICD10conversion.Asimilar percentreportturningtothefederalgovernment.Clearinghouseswere leastlikelytoidentifyasaresource.
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LearningObjectives
Clarifydefiniteareasofpotentialfinancialimpact Understandtheinvestmentsthatwillprotectyoufromtheunknown UnderstandtheanalysesthatwillbringICD10bleedtothefore IdentifyunintendedconsequencesofpoorICD10implementationand maintenance
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ThisIsntPayerVersusProvider
ICD10challengesboth payersandproviders Thereis2yearsofuncertaintyafterimplementationforeveryone There is 2 years of uncertainty after implementation for everyone But,sophisticationwillyieldrealfinancialadvantageforthosewho executewell. t ll
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PayersPerspective
ICD9toICD10isnotapplestoapples Casemixanalysiswillincludeassumptions,addinguncertaintytorisk exposure Uncertaintyinriskexposuremeansnecessaryconservatismtoprojecting risk Thistranslatesto: Higherpremiums Morediligencetoclaims Focus on re casting contracts and subscriber mix based on new Focusonrecastingcontractsandsubscribermixbasedonnew ICD10basedutilizationdata
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RisksEveryoneTalksAbout
Costofconversion ICD9 ICD9 to ICD10 ICD10mappinginconsistencies i i i i Lossestolackoftraining Thesearealldirectandthereforeavoidable.Itjusttakesdiligence.
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HiddenRisks:RealityofChange
PayerReadinessVariability NecessaryPayerConservatism InevitableLenderUncertainty ReimbursementRestructuring Theseareindirectandcomplextounderstand,butcancause irreversibledamage.
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HiddenRisk:PayerReadiness
Payershavetodoextensivemodelingthemselves,whichwillcontinue afterfirstrollout Theymaybetechnicallycompliant,butwilladjustrulesregularlyasthey learn,changingthegameontheprovider Configurationmistakescanleadtomanyrebills(cashflowdelay,higher g y ( y, g costofadmin)
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HiddenRisk:PayerConservatism
Payersmustbemorediligenttoassumemiscoding Increasedenialrate Payersmustbemorediligenttovalidateappeals Cashflowdelays Payers must be more diligent to validate appeals Cash flow delays Payersmustevaluatecontractsonassumptivetrenddata,erredonthe worstcasescenario,untilrealICD10trendstakeover Contracts negotiatedtopayerfavor negotiated to payer favor
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HiddenRisk:LenderUncertainty
Lendersknowthattherewillbeablipincashflow Increasedpressureoncash on hand Increased pressure on cashonhand Lendersknowthattherewillbeaslipinnetrevenue Increasedscrutinyofoperatingmargin Lendersknowthathistoricaltrendswontnecessarilyapply goingforward RatingstobeMoreConservative
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HiddenRisk: RestructuredReimbursementModels
PayerswillgetgoodatICD10,andadjustreimbursementpatterns Payers will get good at ICD10 and adjust reimbursement patterns accordingly ICD10isbuiltforenhancedclarity,startinglogicallywithtightening reimbursements Easiestmeasureisreducedcostofservices,notadjustingpaymentto coverallservicesprovided Untilefficacyofserviceispartofmodel,providerscantwinbackpayer U til ffi f i i t f d l id t i b k gainsinnarrowerreimbursementmodels
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RiskMitigation g
Buildadatawarehouse Financialdatamergedwithclinicaldata a c a da a e ged c ca da a Cover3yearsofhistory ApplyGEMmaps Project per service per payer gross margins Projectperservice,perpayergrossmargins HireananalystandCrossTraininICD10codingandRevenueCycle101 Considercooperationinthisamongfriends PlanforOutsourcing Communicatewithyourlenders&ratinganalysts
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TakeAways
2013isjustthebeginning,ifyougetbehind,youwillstaybehind PayeroptimizationofICD10basedmodelsthrough2015willhavelong P ti i ti f ICD10 b d d l th h 2015 ill h l termimpact,nottheconversioncomplexities Sophisticationistheonlydefense,soinvest,partner,collaborate,ordoall three th Budgetforreducedcashflowandhigherdenialrates20132015 Getapprovedforadditionallinesofcredit,now Communicatewithfinancialinstitutionsaboutyoursophisticationsothey perceivelessrisk
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SuggestedReading gg g
MillimanWhitePaper:ICD10ImpactonProviderReimbursement h // bli i http://publications.milliman.com/publications/health illi / bli i /h l h published/pdfs/icd10impactprovider.pdf ICD10Watch:MajorICD10FactorsinProviderReimbursement http://www.icd10watch.com/blog/majoricd10factorsprovider reimbursement BenchmarkICD10ReadinessChecklist http://www.benchmarkrevenue.com/icd10
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ICD10G7RoundtableAdvisoryReport &HealthPlanPerspective
RossLippincott VicePresident5010&ICD10Programs UnitedHealthcare
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Agenda
HIMSSICD10G7RoundtableSummary ICD10Concerns/RisksDiscussed FinancialRisks PracticeRisks Work Force Risks WorkForceRisks UHCPerspectivesonImpactstoPractices HowtoContactUs UHCPlaybookContent
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HIMSSICD10G7RoundtableSummary
InteractiveinpersonsessionatVanderbiltCenterforBetterHealthin Nashville Representativesfromallindustrygroups(providers,vendors, clearinghouses,payers,banks) p p y Discussedtheconceptoftheplaybook Howtopresenttheinformation howtocollaborate Whatshouldbeincluded
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HIMSSICD10G7RoundtableSummary (Cont.)
Assignedscenariosfromdifferentperspectivesthatwereroleplayedoutto identifyrisksandmitigationthoughts DiscussedDevelopmentoftheplaybook How do we get it going Howdowegetitgoing Howdowegetthewordout Whattoincludeinversion1.0 Howtogrowtheplaybookcommunity Engagementchannels
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Concerns/RisksDiscussed Financial
Risks
Sustainabilityinthefaceofpotentialfinancialimpacts Delayed payments due to utilization of new codes Delayedpaymentsduetoutilizationofnewcodes Increaseinaccountreceivables Cashflow/lineofcreditrisksduetopossiblenegativerevenuecycle impacts Industryestimatesindicatetherecouldbeuptoafiveyearstabilizationof cashflowpostICD10cutover
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Concerns/RisksDiscussed Financial
Mitigation
Establishasolidfinancialbaseline/revenuecycleupfront WhatdoesmyICD9worldlookliketoday? WhatthingsdoIneedtothinkaboutfromamodelingstandpointgoing forward? WhatdoIneedtomonitoronthebackend?
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Concerns/RisksDiscussed Financial
Mitigation,(Cont)
Cashflowmanagement Establishbridgeplanwithbanksinadvance Considerreservinguptosixmonthsofrevenuepriortodeployment Havetoolsandprocessestoanalyzeyourcashflow Establish a contingency plan if a drop in revenue were to occur Establishacontingencyplanifadropinrevenueweretooccur
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Concerns/RisksDiscussed Practice
Risks
Incremental effort required to support increased granularity of codes could Incrementaleffortrequiredtosupportincreasedgranularityofcodescould decreaseproductivity Moredetailedmedicalrecords M Moretimetotranslatebycoders ti t t l t b d Increaseproviderqueries Increaseddelaysinauthorizations Increasedclaimrejections Moretimetoresearch/resolvereimbursementissues
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Concerns/RisksDiscussed Practice
Risks,(Cont)
Trainingrequirements Physicians Coders OfficeStaff Possiblepatientthroughputlossduetoincrementaleffortrequired duringtransitiontoICD10
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Concerns/RisksDiscussed Practice
Mitigation
Establishasolidpracticeperformancebaselineupfront.Ifyoudont knowwhereyoustarteditshardtogaugehoweffectiveyouwerewhen finished. Collaboratewithpayerspriortoimplementationtounderstandbaseline performance. Newcodingwillchangeeveryone snumbers New coding will change everyones numbers Needawarenessofwhatyourchangeisrelativeto
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Concerns/RisksDiscussed Practice
Mitigation,(Cont.)
Performanexternalcodingaudit Blankcodingexamsandcertificationexamsforstaffduringthe projectimplementationphase project implementation phase Makesurethatyouunderstandhowtotranslatethecurrencyofyour businesscoding
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Concerns/RisksDiscussed WorkForce
Risks
Jobtransitions/Retirement Agingworkforce Shortage of ICD 10 coding skills requiring years to master ShortageofICD10codingskillsrequiringyearstomaster Timingwillhaveimpact morestress=moresearchforgreenerpastures(workenvironment, pay,etc.) ) Inexperiencedworkforcecomingintoaverydifficultclimate Training Lackoftools Competingpriorities(5010,EMR,MeaningfulUse,etc.)furtherincrease stress
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Concerns/RisksDiscussed WorkForce
Mitigation
Understand,valueandinvestinyourpeople Consideraugmentingyourstafffortheinitialtransition Help bridge initial decreased productivity Helpbridgeinitialdecreasedproductivity Betterabletoabsorbattrition Reducestress(stress=mistakes) TooearlyforfullstafftrainingonICD10now,butnotforbrushingupon anatomyandphysiology(morecriticalinICD10)
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Concerns/RisksDiscussed Practice
Mitigation
Establishasolidpracticeperformancebaselineupfront.Ifyoudontknow whereyoustarteditshardtogaugehoweffectiveyouwerewhenfinished. Collaboratewithpayerspriortoimplementationtounderstandbaseline performance. Newcodingwillchangeeveryonesnumbers Needawarenessofwhatyourchangeisrelativeto
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Concerns/RisksDiscussed Practice
Mitigation
Performanexternalcodingaudit Blankcodingexamsandcertificationexamsforstaffduringtheproject implementationphase Makesurethatyouunderstandhowtotranslatethecurrencyofyour g businesscoding
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UHCPerspectivesonImpactsto Practices
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ICD10ImpactsonPhysicians&Facilities
Differenttypesofphysicianpractices yp p y p willexperiencedifferentimpacts:
Privatepracticephysicians(solo, smallgroup) ll ) Largephysiciangroups Employed&academicphysicians (allmodels) Government,Researchersand Government, Researchers and othertypes
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ICD10Considerations People
Physician:ICD10requiresdetaileddocumentationofsurgical procedures;moretimetodocument Codingstaff: Willrequireincreasedanatomyandsurgicalprocedureknowledge; moretimetodocument more time to document Potentialincreaseincodingstafftosupporttransitionandminimize productivitylosses
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ICD10Considerations People
Entirepractice: Extensive retraining for physicians coding and revenue cycle staff Extensiveretrainingforphysicians,codingandrevenuecyclestaff
Productivitylossesshouldbeexpectedduringtheinitial36months duetosteeplearningcurveassociatedwithuseofICD10CM/PCS
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ICD10Considerations Processes
Officebilling/codingworkflow Increasedcodingqueriestophysiciansforfurtherdocumentation d d h f f h d Contractingcodecrosswalksreexamined Medicalmanagementprogramrequirements PriorAuthorization/Notificationchanges Increasedcomplexity/requirements
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ICD10Considerations Processes
Billing&ReimbursementAccounting A l i d t di b Analysisandtrendingbypayer,changesincodinganddatatrends h i di dd t t d
Previousdataanalysisobsolete Extensiveremappingrequired(i.e.comparinghealthcareoutcomes fromICD9toICD10) from ICD9 to ICD10) Developaplanformonitoringrevenueimpactandresponses
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ICD10Considerations Technology
PracticeManagementSystem Codefieldtype/sizeincreaseto3 7alphanumericcharactersinall applicationsusingICDcodes(includingallclinicalandfinancial applications using ICD codes (including all clinical and financial applicationswherecodesareentered/reported) RedesignSystemInterfaces g y
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ICD10Considerations Technology
SoftwareChanges Codeeditingprograms(Example:Encoder)willneedtobeanalyzed, gp g ( p ) y , redesignedandtested RecalculationofDRGgroupersandcasemixindexes inpatientbilling ElectronicDataExchanges HeavyFacilityImpact Reportingtofederal,state,andotherregulatoryagencies/authorities willneedtobeanalyzed,redesignedtoaccommodatenewdataand tested Example Community/state proprietary birth and death registries Example Community/stateproprietarybirthanddeathregistries
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TheICD10transitioncanresultinsignificantvaluerealizationifimplementationisplannedforsuccess(once thedustsettles) Benefit Strategicimperative HowAchieved ICD10transitionshouldbeviewedmorebroadlythancomplyingwitha governmentregulation;itservesasanopportunitytocreate differentiationandnewandincrementalvaluefortheorganization. Morespecificdiagnosisreporting Casemixadjustments Morespecificqualitymonitoring/reporting;e.g.,StentInsertion(specific codesforopenvs.subcutaneousstentinsertions) Fewerclaimrejectionsanddenialsduetononspecificdiagnoses Fewerrequestsforclinicalinformation Expectations of fewer denials from payers could result in significant Expectationsoffewerdenialsfrompayerscouldresultinsignificant reductionofrework/administrativeexpenseforbothphysiciansand payers Morespecificdiseasemanagementprograms Targetedreimbursementbasedonreviseddiagnosesandprocedure 52 coding
BenefitsofICD10Implementation
PositiveimpacttoCaseMix /QualityReporting
ICD10andtheHealthCareIndustry
Practitioners will look to specialty societies/state medical associations Practitionerswilllooktospecialtysocieties/statemedicalassociations forleadershipinareasof: Codecomprehensionofspecialtyspecificchanges Documentationguidancetosatisfymedicalnecessityrequirements andincreasedgranularityoftheICD10codeset Training/Educationthatisspecialtyspecific Communicationofregulations,guidelinesandupdates PracticeManagementissues S i l Specialtysocietieshaveauniqueopportunitytostrengthentheir i i h i i h h i presenceintheindustryandleadanICD10calltoactionwithinthe medicalcommunity
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ICD10andtheHealthCareIndustry
PractitionersshouldengageinICD10readinessdiscussionswith: Vendors EMR/EHR PMIS Financial Clearinghouses HealthPlans TradingPartners ProvidersmustknowiftheirbusinesspartnerswillbereadyforICD10. EarlyengagementisthekeytosuccessfulICD10implementation!
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ICD10Communications
ICD10Communication/Outreachwillbeanimportant / p toolinstrengtheningthepayerproviderpartnership
CommunicationMaterial/PathwaySuggestions: / y gg FreeOnDemandTraining Webinars InpersonProviderTownHalls/Educationsessions FreeIndustryInformativeMaterials FAQs Bl Blogs Newsletters,Bulletins Takeadvantageofexistingprovidercommunicationvehicles
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ICD10Communications
ICD10Communication/Outreachwillbeanimportant / p toolinstrengtheningthepayerproviderpartnership
WebSite ForexampletheUHCpublicICD10Websitelocatedat: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?cha nnelId=6fa2600ae29fb210VgnVCM1000002f10b10a GeneralQuestionsMailbox: ICD10Questions@uhc.com GeneralQuestionsTelephoneline/Hotline
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UnitedHealthcareICD10Playbook Content
PlaybookcontentisformattedinMicrosoftPowerPoint,anddividedinto5 sections: 1. ICD10Challenges&Benefits 2. ICD10ReadinessatUnitedHealthcare 3. ICD10Strategy:CostNeutralityatUnitedHealthcare 4. Physician,Hospital,andMedicalSocietyReadiness 5. HowtoContactUnitedHealthcare AsaCharterSponsoroftheHIMSSICD10Playbook,UnitedHealthcarewill alsoofferadditionalFAQsdocumentsandaprovider/facilityfocusedICD 10ReadinesswhitepaperwhichwillbeavailableontheHIMSSICD10 y Playbooksite.
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Q&APanel
RhondaBuckholtz,VPofICD10EducationandTraining,AAPC VincentMarzula,ManagingDirector,BNYMellon g y DeniseHall,Shareholder,PershingYoakley&Associates,P.C. W.JamesLloyd,Shareholder,PershingYoakley&Associates,P.C. JulietSantos,SeniorDirector,BusinessCenteredSystems,HIMSS
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ICD10Playbook
Locatedat:http://www.himss.org/ASP/topics_ICD10Playbook.asp Ifyouhavecontentthatyoufeelwouldbevaluabletoanytabswithinthe y ,p j g ICD10Playbook,pleaseemailJulietSantosatjasantos@himss.org.
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