ICD-10 Time is running out

Transcription

1 ICD-10 Time is running out 1

2 Agenda Introductions What caused the implementation delay? 3 major areas of ICD-10 impact Financial Key performance indicators to monitor Operations Coding strategy Training and education Information Technology Vendor readiness Planning for system and interface remediation What the added time can do for your organization Toolkit Questions 2 2

3 Introductions today s speaker Keith Fulmer, MHSA, PMP Directed and participated in over 30 ICD-10 assessments and implementation projects Over 20 years of senior leadership experience in information technology, working in many different industries including healthcare, pharmaceutical, financial, and manufacturing. As the senior leader of Hielix healthcare advisory practice, Mr. Fulmer brings significant healthcare regulatory subject matter expertise related to the impacts on technology, finance, and revenue cycle operations in healthcare providers and payers and oversees the Firm s ICD-10 Implementation consultancy 3

4 What caused the implementation delay? Act of Congress Congress embedded the ICD-10 delay into a bill related to Medicare reimbursement Stated that ICD-10 could not be implemented before October 1 st, 2015 CMS Came out with a rule to establish new ICD-10 go live date 4

5 Q1 Q2 ICD-10 Impact Assessment IT Solution Definition Q3 Q4 We Are Here Q1 Business Process Improvement (Revenue Cycle, HIM) Coder Education Financial Sensitivity Analysis Contract Analysis Physician Education Documentation Reviews Clinical Documentation Improvement Vendor Monitoring Vendor System Upgrades IT Remediation Financial Planning Q2 Q3 Q4 Q1 Q2 Q3 Q4 Parallel Coding Software Quality Assurance Deployment Coding Audits Financial Monitoring and Control Stabilization / Optimization Stabilization / Optimization Cash Flow Management Gap Assessment Operations Technology Finance Program Planning Program Management Program Communication Risk Management Organizational Change Management Go-Live Planning Program Management Stabilization / Optimization 5

6 Why delay may have been considered About 80% of healthcare providers will not complete their business changes and begin testing before 2014 Over 20% of vendor respondents indicated that they were halfway or less complete with ICD-10 product development and 40 % indicated they would not have products available to customers until 2014 About 40% of health plan respondents had not fully completed their impact assessment Based on the survey results, all industry segments appear to have made some progress since February 2013, but have not gained sufficient ground to remove concern over meeting the October 1, 2014 compliance deadline. - Jim Daley, Chairman, WEDI. 6

7 Where are you in preparing for ICD-10? A. Assessment started B. Assessment complete C. Implementation planning D. Implementation underway E. Live with ICD-10 within your organization 7

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9 Implications for finance 9

10 Key performance indicators to monitor xx 10

11 Impacts to accounts receivable Workgroup for Electronic Data Interchange (WEDI) Based on studies authorized by CMS, account receivable days may increase by 20% to 40% post implementation and CMS reject / denial rates may increase by % post implementation at least through a transition period ICD10 ACCOUNTS RECEIVABLE IMPACT ESTIMATOR Net revenue Average AR days Estimated Accounts Receivable Impact Est. 20% increase AR days Est. 40% increase A/R days WEDI impact assumptions Net revenue per day 20% 40% Hospital 77,464, $212,231 $2,135,046 $4,270,092 Physicians 3,929, $10,765 $127,028 $254,056 Grand Total $2,262,074 $4,524,148 11

12 Implications for operations 12

13 Develop dual coding strategy Coding productivity will be impacted by ICD-10 50% initial to 25% permanent Dual coding now will help coders become proficient Should consider CDI changes to support ICD-10 now Laterality, specificity, etc. ICD 9 standard ICD 10 double code ICD 10 dual code Outpatient surgery 12 minutes 33 minutes 22 minutes Diagnostic 2 minutes 7 minutes 6 minutes Inpatient 20 minutes 46 minutes 38 minutes 13

14 Timing of training efforts Timing of training efforts will be audience dependent: HIM should be complete Job specific early 2015 Clinical documentation improvement should be complete Physicians and advanced practitioners can start via queries and documentation tips now with specialty specific training starting in late summer

15 Implications for information technology 15

16 Planning for IT system remediation If it originates, stores or transmits an ICD-9 code today, make sure it is on the list to be reviewed Inventory and document your impacted IT systems Include systems that are not directly under IT control like cloud based systems Need to understand all system dependences for effective testing Reserve plenty of time for individual and integrated system testing Make sure new codes can be utilized and are generating the appropriate transactions 16

17 Vendor readiness Make sure your vendors are staying on schedule Vendor delays will impact your ability to stay on track Trust but verify just because a vendor says they are ready doesn t mean your version will be Staying the course will allow you to test transactions sooner and have more time to correct any problems 17

18 Understand System Dependencies LTC 6 18

19 Testing 19

20 What should you do with the additional time? 20

21 Review operational processes Revenue cycle Scheduling/ registration Insurance verification Medical records Charge master/charge capture Managed care contracting Business office Scheduling Registration ABN LCDs/NCDs Physician DX and referral Insurance verification Eligibility Outsource vendors Encoder Abstracting DRG grouper Computer assisted coding Charge master (embedded ICD-9 codes) Superbills Contract management system(s) Contract language Billing Claims submission/checks Clearinghouse Denial management Outsource vendors Processes impacted: CDI, Quality measures, Patient intake, Productivity coding/abstraction, Cash flow, Denials, etc. Patient care/finance Ancillary departments Care management Financial management Medical necessity checks Pharmacy Laboratory Radiology PT/OT/Speech/rehab Clinical research Electronic health records Utilization /Case management Quality management/reporting Clinical protocols Clinical reminders/cpoe Disease management Documentation requirements Decision support Cost accounting Provider profiling External data reporting Registries state/internal 21

22 Review and validate IT Impacts Revenue cycle Scheduling/ registration Scheduling Registration ABN LCDs/NCDs Physician DX and referral Insurance verification Insurance verification Eligibility Outsource vendors Medical records Encoder Abstracting Computer assisted coding Charge master/charge capture Charge master (embedded ICD-9 codes) Superbills Managed care contracting Contract management system(s) Contract language Business office Billing Claims submission/checks Clearinghouse Denial management Outsource vendors IT Systems Impacted: Inpatient EMR, Radiology, Lab, CPOE, Reporting, Interfaces, Ambulatory EMR, Encoders, etc. Patient care/finance Ancillary departments Care management Financial management Medical necessity checks Pharmacy Laboratory Radiology PT/OT/Speech/rehab Clinical research Electronic health records Utilization /Case management Quality management/reporting Clinical protocols Clinical reminders/cpoe Disease management Documentation requirements Decision support Cost accounting Provider profiling External data reporting Registries state/internal 22

23 Available toolkit If you haven t started yet We have a toolkit to get you started that contains templates and tools you can use: Leadership Tools Preparation Checklists Impact Diagram and Overview ICD-10 Activity Timeline Sample Project Plan Template Sample Budget Template Cash Flow Calculator Template Project Controls Templates Vendor/Payor Surveys If you would like a copy, me after the webinar 23

24 Questions? Contact Information Keith Fulmer Vice President Healthcare Advisory/CTO