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M Jahn Sep2011 Program Presentation

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The document discusses the upcoming transition to ICD-10 coding which will be a large transformation impacting many applications, business processes, and parts of organizations. It notes that the transition date of October 1, 2013 is closer than it seems and organizations that have not started preparing may fall behind. It introduces the Minnesota ICD-10 Collaborative as a resource to help with the transition and understand the major steps involved.

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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 havent 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 息 Charter Solutions, Inc. 2011 2
Death Taxes ICD-10 ICD 10 October 1, 2013 息 Charter Solutions, Inc. 2011 3
ICD-10 is primarily a business problem/ opportunity You can t just give the cant problem to a vendor Challenges exist g Opportunities to create value Key lesson learned from other countries: start early! 息 Charter Solutions, Inc. 2011 4
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 息 Charter Solutions, Inc. 2011 5
息 Charter Solutions, Inc. 2011 6
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 healing ICD-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 healing 821.01 initial encounter of shaftclosedof Nondisplacedfemur, initial S72309A Unspecified fracture for S72324A transverse S72332A Displaced oblique fracture of Fracture 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 fracture femur, 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 encounter shaft, 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 息 Charter Solutions, Inc. 2011 7
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 息 Charter Solutions, Inc. 2011 8
Get physicians involved early There wasnt enough time for training Its 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
NUMBERS BETWEEN SEPTEMBER 22, 2011 , AND OCTOBER 1, 2013: 2 years, 9 days 24 months 9 quarters q 1or 2 budget cycles 息 Charter Solutions, Inc. 2011 10
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 息 Charter Solutions, Inc. 2011 11
息 Charter Solutions, Inc. 2011 12
Computer Assisted Education and Coding (CAC) Training Clinical Business Documentation Partner/ Vendor Improvement Management Testing Application Upgrades, Remediation, Custom ICD-9 Retirement to ICD-10 Mapping B i Business P Process Assessment and Redesign Financial Modeling Analytics 息 Charter Solutions, Inc. 2011 13
EHR Clinical Documents Applicable Abstractor/ Coder Codes Encoder 1. Views documentation 2. 2 Views applicable codes 3. Selects codes to send to abstractor/encoder system Billing 息 Charter Solutions, Inc. 2011 14
Approach Outcomes/Deliverables Organization Deliverable Outcomes Departments 1 Organization Customized analysis by /Structural department, function, & Review p process Functions 2 Documented functional boundaries & accountabilities SIPOC I.D. of specific Suppliers, Process 1 Inputs, Process, Outputs Process 2 & Customers Processes Process 3 .etc. 3 Breakdown of functional High-Level processes; High Level Process Process Flow: Flow How many processes Which work streams work-streams Impacts & 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 息 Charter Solutions, Inc. 2011 15
Areas Within a Providers Business Cycle Impacted b ICD 10 I t d by ICD-10 Payer Revenue Customer Point of Care Business Finance Analytics Relations g Mgmt Service Service g Mgmt Associate Payer Claims Patient Portal Incoming Disease & Accounting Business Rule Clearing Contracting Processing Pre- Case Sets houses certifications Management Pricing Billing & Call Center Hospital Utilization Resource Predictive Third Parties Receivables Data Management Mgmt Modeling Medicare 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 息 Charter Solutions, Inc. 2011 16
ONE TO ONE COMBINATION ENTRY ICD-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-10 ICD-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
Revenue Health Cycle Hospital Mgmt System Mental Health Employers Manager PBM Claims Processing Clearing Cl i house Large TPA Radiology Clinic Health Plan Stop UM Loss RBM DME DM Benefits Small Consultant Clinic Reporting Lab 息 Charter Solutions, Inc. 2011 18
Stakeholder Group Education/Training Requirements Coders Medical terminology; anatomy and physiology; coding structure and guidelines Clinicians Documentation improvement needed Compliance ICD-10 structure and coding Financial Services Impact on grouping and payment Information Interface and internal systems impact y p Technology Researchers Impact of reporting Patient registration Documentation; impact on medication necessity Quality Management Impact on reporting and cost accounting Source: 3M 19
Begin g Raise ICD-10 Business/ Awareness Clinical and Form an Technology ICD-10 ICD 10 Impact Engage Steering Assessment Executive Committee Sponsorship S hi Assign an ICD-10 Czar 息 Charter Solutions, Inc. 2011 20
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 息 Charter Solutions, Inc. 2011 21
Business Plans Align Business and Maximize business Technology benefits Alignment IT Plans ICD-10 Reduce overall costs and timeline, coordinate upgrade schedules h d l 息 Charter Solutions, Inc. 2011 22
界看鉛揃鉛温恢揃看揃姻温岳艶 [kuh-lab-uh-reyt] Show IPA verb (used without object), - rat揃ed, -rat揃ing. 1. to work, one with another; cooperate, as on a literary work: They collaborated on a novel. 2. cooperate, 2 to cooperate usually willingly, with an enemy nation especially with an willingly nation, enemy occupying one's country 息 Charter Solutions, Inc. 2011 23
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 息 Charter Solutions, Inc. 2011 24
Operations Committee meets monthly to set overall d ll direction. Work Groups meet 1x or 2x per month 息 Charter Solutions, Inc. 2011 25
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 息 Charter Solutions, Inc. 2011 26
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 息 Charter Solutions, Inc. 2011 27
Contact information: Mark.Jahn@CharterSolutions.com 763-230-6130 (office) 612-850-9510 (cell) 息 Charter Solutions, Inc. 2011 28

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M Jahn Sep2011 Program Presentation

  • 1. 1
  • 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 havent 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 息 Charter Solutions, Inc. 2011 2
  • 3. Death Taxes ICD-10 ICD 10 October 1, 2013 息 Charter Solutions, Inc. 2011 3
  • 4. ICD-10 is primarily a business problem/ opportunity You can t just give the cant problem to a vendor Challenges exist g Opportunities to create value Key lesson learned from other countries: start early! 息 Charter Solutions, Inc. 2011 4
  • 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 息 Charter Solutions, Inc. 2011 5
  • 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 healing ICD-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 healing 821.01 initial encounter of shaftclosedof Nondisplacedfemur, initial S72309A Unspecified fracture for S72324A transverse S72332A Displaced oblique fracture of Fracture 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 fracture femur, 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 encounter shaft, 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 息 Charter Solutions, Inc. 2011 7
  • 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 息 Charter Solutions, Inc. 2011 8
  • 9. Get physicians involved early There wasnt enough time for training Its 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. NUMBERS BETWEEN SEPTEMBER 22, 2011 , AND OCTOBER 1, 2013: 2 years, 9 days 24 months 9 quarters q 1or 2 budget cycles 息 Charter Solutions, Inc. 2011 10
  • 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 息 Charter Solutions, Inc. 2011 11
  • 12. 息 Charter Solutions, Inc. 2011 12
  • 13. Computer Assisted Education and Coding (CAC) Training Clinical Business Documentation Partner/ Vendor Improvement Management Testing Application Upgrades, Remediation, Custom ICD-9 Retirement to ICD-10 Mapping B i Business P Process Assessment and Redesign Financial Modeling Analytics 息 Charter Solutions, Inc. 2011 13
  • 14. EHR Clinical Documents Applicable Abstractor/ Coder Codes Encoder 1. Views documentation 2. 2 Views applicable codes 3. Selects codes to send to abstractor/encoder system Billing 息 Charter Solutions, Inc. 2011 14
  • 15. Approach Outcomes/Deliverables Organization Deliverable Outcomes Departments 1 Organization Customized analysis by /Structural department, function, & Review p process Functions 2 Documented functional boundaries & accountabilities SIPOC I.D. of specific Suppliers, Process 1 Inputs, Process, Outputs Process 2 & Customers Processes Process 3 .etc. 3 Breakdown of functional High-Level processes; High Level Process Process Flow: Flow How many processes Which work streams work-streams Impacts & 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 息 Charter Solutions, Inc. 2011 15
  • 16. Areas Within a Providers Business Cycle Impacted b ICD 10 I t d by ICD-10 Payer Revenue Customer Point of Care Business Finance Analytics Relations g Mgmt Service Service g Mgmt Associate Payer Claims Patient Portal Incoming Disease & Accounting Business Rule Clearing Contracting Processing Pre- Case Sets houses certifications Management Pricing Billing & Call Center Hospital Utilization Resource Predictive Third Parties Receivables Data Management Mgmt Modeling Medicare 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 息 Charter Solutions, Inc. 2011 16
  • 17. ONE TO ONE COMBINATION ENTRY ICD-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-10 ICD-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. Revenue Health Cycle Hospital Mgmt System Mental Health Employers Manager PBM Claims Processing Clearing Cl i house Large TPA Radiology Clinic Health Plan Stop UM Loss RBM DME DM Benefits Small Consultant Clinic Reporting Lab 息 Charter Solutions, Inc. 2011 18
  • 19. Stakeholder Group Education/Training Requirements Coders Medical terminology; anatomy and physiology; coding structure and guidelines Clinicians Documentation improvement needed Compliance ICD-10 structure and coding Financial Services Impact on grouping and payment Information Interface and internal systems impact y p Technology Researchers Impact of reporting Patient registration Documentation; impact on medication necessity Quality Management Impact on reporting and cost accounting Source: 3M 19
  • 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 hi Assign an ICD-10 Czar 息 Charter Solutions, Inc. 2011 20
  • 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 息 Charter Solutions, Inc. 2011 21
  • 22. Business Plans Align Business and Maximize business Technology benefits Alignment IT Plans ICD-10 Reduce overall costs and timeline, coordinate upgrade schedules h d l 息 Charter Solutions, Inc. 2011 22
  • 23. 界看鉛揃鉛温恢揃看揃姻温岳艶 [kuh-lab-uh-reyt] Show IPA verb (used without object), - rat揃ed, -rat揃ing. 1. to work, one with another; cooperate, as on a literary work: They collaborated on a novel. 2. cooperate, 2 to cooperate usually willingly, with an enemy nation especially with an willingly nation, enemy occupying one's country 息 Charter Solutions, Inc. 2011 23
  • 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 息 Charter Solutions, Inc. 2011 24
  • 25. Operations Committee meets monthly to set overall d ll direction. Work Groups meet 1x or 2x per month 息 Charter Solutions, Inc. 2011 25
  • 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 息 Charter Solutions, Inc. 2011 26
  • 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 息 Charter Solutions, Inc. 2011 27