ICD-10: Short-Term Challenges and Long-Term Gains
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ICD-10: Short-Term Challenges and Long-Term Gains
- 1. ICD-10: Short-Term Challenges and Long-Term Gains
- 2. 2 Perficient is a leading information technology consulting firm serving clients throughout North America. We help clients implement business-driven technology solutions that integrate business processes, improve worker productivity, increase customer loyalty and create a more agile enterprise to better respond to new business opportunities. About Perficient
- 3. 3 • Founded in 1997 • Public, NASDAQ: PRFT • 2012 revenue of $327 million • Major market locations throughout North America • Atlanta, Austin, Boston, Charlotte, Chicago, Cincinnati, Cleveland, Columbus, Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Los Angeles, Minneapolis, New Orleans, New York, Philadelphia, San Francisco, San Jose, Southern California, St. Louis, Toronto, and Washington, D.C. • Global delivery centers in China, Europe and India • ~2,000 colleagues • Dedicated solution practices • ~85% repeat business rate • Alliance partnerships with major technology vendors • Multiple vendor/industry technology and growth awards Perficient Profile
- 4. 4 Business Solutions • Business Intelligence • Business Process Management • Customer Experience and CRM • Enterprise Performance Management • Enterprise Resource Planning • Experience Design (XD) • Management Consulting Technology Solutions • Business Integration/SOA • Cloud Services • Commerce • Content Management • Custom Application Development • Education • Information Management • Mobile Platforms • Platform Integration • Portal & Social Our Solutions Expertise
- 5. John Bradshaw, Healthcare Industry Consultant at Perficient John is a consultant in Perficient's national healthcare practice who specializes in ICD-10 assessments. He has conducted extensive provider ICD-10 reviews and is well-versed in the challenges faced by both the provider and payer communities. Our Speaker 5
- 6. 6 • Requisite ICD-10 Background Slide! • Challenges • Myths • A Structured Approach • An Example of a Timeline • A Dance • Code Management and ICD-10 • Closing • Q&A Agenda
- 7. 7 What? • Transition form ICD-9 to ICD-10 • ICD-10 CM (diagnosis) – 3 to 7 digits instead of the 3 to 5 digits – 68,000 codes compared to 14,000 codes in ICD-9 • ICD-10 PCS (inpatient procedure) − 7 digits instead of 3 to 4 digits − 84,000 codes compared to 4,000 codes in ICD-9 When? • October 1, 2014 • NO DELAYS, NO GRACE PERIODS Who? • All HIPAA covered entities who transmit electronic transactions − Providers, payers, billing services, clearinghouses, etc. Background Why? • ICD-9 is obsolete – It is 30 years old – It has outdated terms – Doesn’t reflect current medical knowledge or advances in technology – Not descriptive enough – No room for expansion – Lack of flexibility • ICD-10 allows for: – Greater specificity • Will improve the ability to measure health care services and decrease the need to include supporting information with claims – Includes updated medical terminology and disease classification – Allows providers to better ID patients with specific conditions • Will benefit from tailored disease mgmt. programs, e.g. diabetes, asthma
- 8. 8 • Areas of Primary Impact – Clinical Documentation – Coding & Billing – Education & Training – Reporting & Analytics • HCR initiatives already underway (MUI&II,EHR) • Anecdotal information – Early experience by some Health System and Payer organizations testing the coding of bills as ICD-10 utilizing existing patient records resulted in a low (< 50%) success rate Challenges
- 9. 9 • Upgrading the systems will make us compliant • Cross-walk will solve all your problems • Revenue neutrality • CMS will delay again Myths
- 10. 10 A Structured Approach • Create initial awareness, outline effort and establish governance • Organizational readiness and capacity for change Assessment • Program management, drive communication activities, vendor engagement, Code Management, work streams to address impacts and operational preparedness Remediation • End-to-end integrated testing, include partners • Validation of Readiness activities • Training and Education begins Testing • Implementation & distribution of Cross-Walk • Business operations transition plan execution • Data & Analytics preparation Readiness • Begin use of ICD-10 in daily operations Go-Live • On-going monitoring of organizational activities impacted by the ICD-10 change, identifying and making adjustments as necessary Post Implementation
- 11. 11 Assessment Project Initiation Charter Governance Stakeholders Organizational Background Collection & Review Operational Baseline Interviews Investigations Discovery Impact & Gap Analysis Review & Collection of Activities Master List of Findings Determine Impacts & Gaps Roadmap & Next Steps Identify Projects & Initiatives Complete Findings & Observations Roadmap Recommendation Plan Project Review Resources & Dependencies Staffing Kickoff Communication Plan Steering Committee/Senior Management Roadshow
- 12. 12 • Method – Understand Organization and Current State – Collect and inventory those activities and items that currently involve/utilize ICD-9 – Develop a portfolio of projects to address the identified impacts and gaps – Assess the organization’s readiness for change • Artifacts – Assessment Document – Inventories Workbook – High-level Project Plan – Project Portfolio – Strategic Roadmap Assessment
- 13. 13 Inventory Categories Section Description Organization Structure List of departments, department managers and who they report to Customers Organizations, individuals and other entities that are serviced by TCHP Business Process List of major, minor and other key business processes that support a service provided by TCHP to it's customers Business Requirements Those things that, when met or satisfied, enable the organization to meet its goals and objectives. Business Partners Organizations, individuals and other entities contracted by TCHP to augment its services and/or provide other services to TCHPs customers Vendors Organizations, individuals and other entities contracted to provide products and support services to TCHP that enable it to meet its business requirements Applications Technology/systems that enable TCHP to execute certain tasks and activities Interfaces A service that enables an exchange of data to occur between an application, vendor, business partner or other entity Reports Compilation of information specifically arranged as to communicate the results of activities or events to the viewer Documents Any of a variety of business documents that describe the services to be delivered and the manner in which delivery is to be handled, such as fee schedule contracts, plan documents and standard operating procedures
- 14. 14 Remediation Program Management Governance Standards Roles & Responsibilities PMO Communication Communication Strategy Awareness Culture & Change Management Team Building Employee Education & Training Operational Planning Code Management Cross-walk Analytics Distribution Testing Vendor Management Readiness Upgrades Deployment Reporting & Analytics Risk Management Data Warehousing & Marts Clinical Operations Financial Clinical Documentation Policies & Procedures Records Patient Care Team Coding Processes & Applications EHR Revenue Ancillary & Support Inter- operability Foundational
- 16. 16 • What you need to do – Establish a governance structure and provide for oversight – Provide for/enable participation of SMEs and operational leadership during Assessment – Assign responsibility/accountability for the completion of the many Remediation initiatives to the appropriate business & technology leads – Manage the operational transition to support the 10/1/2014 implementation – Coordinate the Education and Training of impacted employees – Stakeholder Awareness • How you can leverage others – Program management, trusted advisor, able to look across the entire organization and unencumbered by any organizational norms – Bring other key partners to the table to help – Point assistance with the remediation of transactional platforms, service solutions and analytics – Visibility to how peer organizations are addressing various issues – Drive your Code Management effort Choreographed Dance
- 17. 17 • Code Management comprises: – Cross-walk development – Analytics – Distribution – Testing and validation • The experience and knowledge gained from developing the Cross-walk and leveraging it to analyze the impact to the organization, serves as an important input to the overall Remediation effort Code Management and ICD-10
- 18. 18 Code Management Benefits & Impact Code Management Partner Management Risk Management Corporate Communication Processes & Operations Clinical Documentation Program Management
- 19. 19 • Business Intelligence (BI), Reporting & Analytics based upon a mix of ICD-9 and ICD-10 originated encounters and billings • Greater granularity will provide for a much richer set of data to drive analytics • Impact of more detailed patient records • Risk Stratification • Case Mix Index Analysis • Introspection Long-term Benefits of ICD-10
- 20. 20 • Organization-wide impact • While others can assist you, the breadth of the impact requires long-term engagement in the effort by many from across the organization • The scope and effort demand structure, coordination and collaboration to ensure the maintaining of on-going service levels and the managed introduction of change • Code Management drives prioritization of efforts, risk mitigation and focus Closing
- 21. Questions?