ICD-10 Processes: Defining Milestones

Transcription

1 ICD-10 Processes: Defining Milestones A reflection of the industry after the ICD-10 delay July 23, 2014 Betty Gomez, VP Regulatory Strategy ZirMed Penny Osmon Bahr, Director, Avestone Health Solutions Erik Newlin, VP EDI Platforms & Compliance, Xerox

2 Content Panelist Introductions Topic Discussions: High Level Milestones High Level Tasks Re-calibration activities Questions

3 Panelists Provider: Penny Osmon Bahr, Avastone Health Solutions, Director Clearinghouse: Betty Gomez, ZirMed, VP Regulatory Strategy Vendor/Payer: Erik Newlin, Xerox, VP EDI Platform & Compliance

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5 From the very beginning people have been looking for an easy button.

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8 Milestones With the recent ICD-10 delay timelines and milestones have to be reviewed and adjusted depending on where you are today in your preparations and whether you are a Provider, a Vendor or a Payer. Re-calibration of the following milestones & respective tasks will be discussed: Plan, Organize & Assess Communication & Outreach Implementation Training & Testing Transition Execute & Evaluate

9 Thoughts to consider/discuss What other critical ICD-10 activities do you have to do? How do you minimize the financial and resource impact? What are your new/deferred costs? How do you continue with new/on-going training? Are there new dependencies given new timelines? What activities to be re-evaluated or re-calibrated? Should you consider your organization type, size and culture?

10 Plan, Organize & Assess Tasks Review regulations/guidance Review ICD-10 available resources Perform an assessment of where diagnosis and procedure codes are utilized today, including current and future use of data Assess the impact to the organization on documentation, processes, systems, IT, policies, business areas, etc. Establish an ICD-10 project team with executive sponsorship (multiple ways to structure) Develop your project plan with tasks and assignments

11 Plan, Organize & Assess Tasks Conduct a risk & cost analysis strategy Identify key vendors and evaluate their tools and available resources, capabilities, and readiness. In some cases, an upgrade or change of systems may be necessary. (If an integrated system, consider multiple lines of service) Identify your critical trading partners to determine any contract, reimbursement or fee schedule changes (critical does not just mean high volume, can also mean high complexity) Determine impact on reimbursement practices Review trading partner agreements and payer contracts

12 Plan, Organize & Assess Re-calibration activities Review new CMS regulations/guidance and assess whether/if the new regulations or mandates positively or negatively impact your ICD-10 project Assess all other initiatives in the organization for impact on funding and resources Re-evaluate staffing models: retention strategies, consultants Re-visit your potential risk analysis and results Re-consider level of intensity for your vendor, payer and provider outreach Re-evaluate tools and available resources, capabilities, and readiness Re-evaluate infrastructure impact and supply pipeline Include all of the unique activities that apply to your environment

13 Communication & Outreach Tasks Develop ICD-10 communication plan for staff and business partners Ask your payers and vendors software/systems, clearinghouses, billing services about ICD-10 readiness Ask about required systems changes, timelines, available training and associated costs Ask when they will start testing, how long they will need, and how you and other clients will be involved Review trading partner agreements and contracts

14 Communication & Outreach Re-calibration activities Review communication materials and consider updated date, language, timing Evaluate outreach strategy, including timing and methodology Update communication plan Communicate often and collaborate with your business partners to understand needs Continue outreach and seek feedback

15 Implementation Tasks Create a budget Secure funding for the project (consider other projects that may benefit as well) Obtain and retain skilled resources Identify system migration strategies Implement issue tracking with mitigation strategies Work with vendors to schedule timelines for systems upgrades (PMS/EMR/coding, etc.), testing and integration Upgrade systems: Implement business processes, information systems, software applications and technical modifications Consider infrastructure/environmental changes

16 Implementation Re-calibration activities Budget has to be reviewed Obtain and retain skilled resources Reacquire funding Reconfirm testing dates, software upgrade timelines Re-evaluate internal testing and testing environments Consider impact of other system upgrades or initiatives

17 Training & Testing Tasks Determine which personnel needs to be trained on the changes (consider those that don t code but still use the codes or terms) Provide extensive ICD-10 documentation and coding education to anyone who codes now in ICD-9 (e.g. physicians, billers, or medical coders) Provide ICD-10 code set training for case managers and staff who translate coverage policies (ongoing) Create a test plan and test scripts Dual-code in ICD-9 and ICD-10 Test ICD-10 compliance across internal policies, processes, and systems to ensure compliance

18 Training & Testing Tasks Stress clinical documentation improvement for ICD-10 readiness Determine what percentage (%) of mission critical trading partners (payers, clearinghouses, billing services, and providers) you will be testing with Begin external testing (including end-to-end testing) and other transactions using ICD-10 codes with the identified critical trading partners Perform financial and operational analysis of the testing results to gauge DRG shift, changes in denial codes and other changes in test environment processing and payment

19 Training & Testing Re-calibration activities Evaluate and confirm your training retention plan to ensure code set knowledge is maintained Review your current testing plan and use the delay as an opportunity to engage additional vendors, payers and providers in testing Consider impact of any changes to your production environment since you tested. Should you re-test? Establish a dual-coding plan that allows for ICD-10 code set practice and proficiency Continue training based on learnings from testing Continue training all of the impacted workforce

20 Transition - Execute & Evaluate Tasks Identify Go-Live tasks and associated actions Complete ICD-10 transition for full compliance Create a contingency plan in the event there is a problem with moving to production Ensure you can continue to use both ICD-9 and ICD-10 based on date of service Develop a plan for post implementation data analysis focus on identifying high volume codes/code categories Monitor systems and correct errors if needed Develop post-implementation audit processes and procedures Contingency planning identify what to do if payers, vendors or providers aren t ready

21 Transition - Execute & Evaluate Re-calibration activities Define metrics for tracking code set proficiency and financial impact Create strategy or plan for auditing accuracy and proficiency of staff, software and systems Complete ICD-10 transition for full compliance

22 ICD-10 Flexible Timeline 2014 Plan Organize & Assess Implement Communication & Outreach 2015 Train & Test Transition Execute & Evaluate

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24 Milestones Resources Resources that provide more detailed checklists WEDI ICD-10 Roadmap Tool Kit CMS Timelines & Checklists Roadto10 HIMSS ICD-10 Playbook AHIMA AAPC

25 ICD-10 Milestones Questions