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M Jahn Sep2011 Program Presentation

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HIMSS ICD-10 ... It\'s Closer Then You Think

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M Jahn Sep2011 Program Presentation

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  2. 2.  ICD-10 is one of the largest transformations in 30 years impacting: • Many applications • 80% of business processes • Most parts of the organization p g ICD-10 effort is large and complex The transition date is actually closer than October, 2013 If you haven’t started your ICD-10 effort, you are behind Understand the major steps involved and how the Mi Minnesota ICD 10 C ll b ICD-10 Collaborative can h l i help © Charter Solutions, Inc. 2011 2
  3. 3. Death Taxes ICD-10 ICD 10 October 1, 2013 © Charter Solutions, Inc. 2011 3
  4. 4.  ICD-10 is primarily a business problem/ opportunity You can t just give the can’t problem to a vendor Challenges exist g Opportunities to create value Key lesson learned from other countries: start early! © Charter Solutions, Inc. 2011 4
  5. 5.  10X more data options = more information to drive decisions More “appropriate” levels of reimbursement Support for new reimbursement models Streamlined claims adjudication process; eventually – fewer rejected claims Approval of new procedures Phase out legacy systems Opportunity to improve business processes Most believe ICD-10 will improve quality of care © Charter Solutions, Inc. 2011 5
  6. 6. © Charter Solutions, Inc. 2011 6
  7. 7. ICD 10 CM ICD-10-CM S72301A Unspecified fracture of shaft S72322A Displaced transverse fracture S72326A Nondisplaced transverse of right femur, initial encounter for of shaft of left femur, initial encounter for fracture of shaft of unspecified femur, closed fracture closed fracture initial encounter for closed fracture S72322G Displaced transverse fracture S72326G Nondisplaced transverse S72301G Unspecified fracture of shaft p fracture of shaft of unspecified femur, femur of shaft of lleft f f h ft f ft femur, subsequent b t of right femur, subsequent encounter subsequent encounter for closed fracture encounter for closed fracture with for closed fracture with delayed healing with delayed healing delayed healingICD-9-CM S72302A Unspecified fracture of shaft S72323A Displaced transverse fracture S72331A Displaced oblique fracture of of left femur, initial encounter for closed of shaft of unspecified femur, initial shaft of right femur, initial encounter for fracture encounter for closed fracture closed fracture S72323G Displaced transverse fracture S72331G Displaced oblique fracture of p p q S72331A Displaced oblique Di l d ofbli of unspecified femur, S72302G Unspecified fracture of shaft of left femur, subsequent encounter for shaft shaft of right femur, subsequent subsequent encounter for closed encounter for closed fracture with fracture with delayed healing right femur, healing closed fracture of shaft of fracture with delayed delayed healing821.01 initial encounter of shaftclosedof Nondisplacedfemur, initial S72309A Unspecified fracture for S72324A transverse S72332A Displaced oblique fracture ofFracture of of unverified femur, initial encounter for fracture shaft of right shaft of left femur, initial encounter for fracture closed fracture encounter for closed fracture closed fracturefemur,femur S72309G Unspecified fracture of shaft of unspecified femur, subsequent S72324G Nondisplaced transverse fracture of shaft of right femur, S72332G Displaced oblique fracture of shaft of left femur, subsequent encountershaft, closed encounter for closed fracture with delayed healing subsequent encounter for closed fracture with delayed healing for closed fracture with delayed healing S72321A Displaced transverse fracture S72325A Nondisplaced transverse S72333A Displaced oblique fracture of of shaft of right femur, initial encounter fracture of shaft of left femur, initial shaft of unspecified femur, initial for closed fracture encounter for closed fracture encounter for closed fracture S72321G Displaced transverse S72325G Nondisplaced transverse S72333G Displaced oblique fracture of fracture of shaft of right femur, fracture of shaft of left femur, shaft of unspecified femur, subsequent subsequent encounter for closed subsequent encounter for closed encounter for closed fracture with fracture with delayed healing fracture with delayed healing delayed healing © Charter Solutions, Inc. 2011 7
  8. 8. Assessment/Strategy Plan and Design Implement Go live• Assign ICD-10 Czar • Engage providers & • Application, data and • Business Partner• Education/ Awareness partners business process Testing• Assess Business and • Business Decisions/ changes • Service ICD-10 Technology Impacts Model Options • Testing • Coordinate final roll-out• Corporate Strategy • Technical Decisions • Risk management• Hi-level strategy design gy & scope identification g • Design Solutions g • Baseline performance • Transition planning • Coordinate p g October 1 1,• Form Steering Committee • Financial Modeling • Establish Projects implementation & roll-out 2013 2010 2011 2012 2013 © Charter Solutions, Inc. 2011 8
  9. 9.  Get physicians involved early There wasn’t enough time for training It’s just not a systems problem Teach documentation sooner Plan for delays and cost overruns Understand that U d t d th t you will not ill t regain productivity Collaborate and share the pain Source: Gillian Price, Project Director Canada 9
  10. 10. NUMBERS BETWEEN SEPTEMBER 22, 2011 , ANDOCTOBER 1, 2013: 2 years, 9 days 24 months 9 quarters q 1or 2 budget cycles © Charter Solutions, Inc. 2011 10
  11. 11.  Several ICD-10 solutions will actually y need to be implemented well in advance of October, 2013 Organizations will begin transitioning g g g to ICD-10 months before the actual due date Recommend a 25% schedule and budget contingency be added Many not ready for the 5010 implementation; shortens the available time for ICD-10 focus 2012 – Implementation 2013 – Business Partner Testing and Go-Live © Charter Solutions, Inc. 2011 11
  12. 12. © Charter Solutions, Inc. 2011 12
  13. 13. Computer Assisted Education andCoding (CAC) TrainingClinical BusinessDocumentation Partner/ VendorImprovement Management TestingApplicationUpgrades,Remediation, Custom ICD-9Retirement to ICD-10 MappingB iBusiness P ProcessAssessment andRedesign Financial Modeling Analytics © Charter Solutions, Inc. 2011 13
  14. 14. EHR Clinical Documents Applicable Abstractor/ Coder Codes Encoder1. Views documentation2.2 Views applicable codes3. Selects codes to send to abstractor/encoder system Billing © Charter Solutions, Inc. 2011 14
  15. 15. Approach Outcomes/DeliverablesOrganization Deliverable OutcomesDepartments 1 Organization ► Customized analysis by /Structural department, function, & Review p processFunctions 2 ► Documented functional boundaries & accountabilities “SIPOC” ► I.D. of specific Suppliers, • Process 1 Inputs, Process, Outputs • Process 2 & CustomersProcesses • Process 3 • ….etc. 3 ► Breakdown of functional High-Level processes; High Level Process Process Flow: Flow ► How many processes ► Which work streams work-streamsImpacts &  Impact 1 =Magnitude High 4 ► Map to processes  Impact 2 = ► Estimate of Impacts (H, Risks & High M, L) Impacts  Impact 3 = Low ► Business Partner & …etc. Technology Touch-points gy p © Charter Solutions, Inc. 2011 15
  16. 16. Areas Within a Provider’s Business Cycle Impacted b ICD 10 I t d by ICD-10 Payer Revenue Customer Point of Care Business Finance AnalyticsRelations g Mgmt Service Service g Mgmt Associate Payer Claims Patient Portal Incoming Disease & Accounting Business Rule ClearingContracting Processing Pre- Case Sets houses certifications Management Pricing Billing & Call Center Hospital Utilization Resource Predictive Third Parties Receivables Data Management Mgmt ModelingMedicare Reimburse- Procedure, Disease Financial Comparative Vendors ment Review Diagnosis and Management Extracts Effectiveness Drug C di D Coding Medicaid Patient Gaps in Care Population Supply Chain Outcomes Hospitals, Collection Management Analysis Clinics, Labs Policies and Operational Other Procedures Reporting Treatment Modalities © Charter Solutions, Inc. 2011 16
  17. 17. ONE TO ONE COMBINATION ENTRYICD-9 ICD-10 ICD-9 One code in source to ICD-10 One code in source to only one in target 3,458 multiple in target 629 codes or 24.5% of all codes or 4.46% of all ICD-9 DX codes ICD-9 DX codes ICD-9 NO MATCH ICD-10ICD-9 SINGLE ENTRY ICD-10 One code in source – One code in source to new code in target 416 only one of many in target 9,600 codes or codes or 2.95% of all 68.07% of all ICD-9 DX codes ICD-9 DX codes Cerner 5/24/11 17
  18. 18. Revenue Health Cycle Hospital Mgmt System Mental HealthEmployers Manager PBM Claims Processing Clearing Cl i house LargeTPA Radiology Clinic Health Plan Stop UM Loss RBM DME DM Benefits Small Consultant Clinic Reporting Lab © Charter Solutions, Inc. 2011 18
  19. 19. Stakeholder Group Education/Training RequirementsCoders Medical terminology; anatomy and physiology; coding structure and guidelinesClinicians Documentation improvement neededCompliance ICD-10 structure and codingFinancial Services Impact on grouping and paymentInformation Interface and internal systems impact y pTechnologyResearchers Impact of reportingPatient registration Documentation; impact on medication necessityQuality Management Impact on reporting and cost accounting Source: 3M 19
  20. 20. Begin g Raise ICD-10 Business/ Awareness Clinical and Form an Technology ICD-10 ICD 10 Impact Engage Steering Assessment Executive Committee Sponsorship S hiAssign anICD-10 Czar © Charter Solutions, Inc. 2011 20
  21. 21.  Overall Strategy Major Initiatives Timeline/Schedule/Milestones Budget/Costs g / Resource Requirements Organization Structure g Key Risk Mitigation Strategies An ICD-10 Roadmap is critical for leading the organization through the ICD-10 effort © Charter Solutions, Inc. 2011 21
  22. 22. Business PlansAlign Business and Maximize business Technology benefits Alignment IT Plans ICD-10 Reduce overall costs and timeline, coordinate upgrade schedules h d l © Charter Solutions, Inc. 2011 22
  23. 23. col·lab·o·rate [kuh-lab-uh-reyt] Show IPA verb (used without object), -rat·ed, -rat·ing.1. to work, one with another; cooperate, as on a literary work: They collaboratedon a novel.2. cooperate,2 to cooperate usually willingly, with an enemy nation especially with an willingly nation,enemy occupying ones country © Charter Solutions, Inc. 2011 23
  24. 24. To identify and evaluate opportunities to minimize the disruption in health care billing, reporting, and related processes for a variety of stakeholders in the health care industry in connection with the ICD-10 conversion.25 major health plans, providers, state agencies and associations participate in the Minnesota ICD-10 Collaborative © Charter Solutions, Inc. 2011 24
  25. 25. Operations Committee meets monthly to set overall d ll direction.Work Groups meet 1x or 2x per month © Charter Solutions, Inc. 2011 25
  26. 26.  Communications and Outreach C i ti dO t h • Webinar - November 8, 2011 • S i Spring 2012 S Summit i • Other events Work Group d li W kG deliverables bl Website for sharing information Best Practices © Charter Solutions, Inc. 2011 26
  27. 27.  ICD-10 is closer than you think! Large and complex (i e many rocks) (i.e. Jump start your ICD-10 effort, time is not on your side y Minnesota ICD-10 Collaborative can help © Charter Solutions, Inc. 2011 27
  28. 28. Contact information:Mark.Jahn@CharterSolutions.com763-230-6130 (office)612-850-9510 (cell) © Charter Solutions, Inc. 2011 28

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