ICD-10: Strategies to Keep Business Flowing · ICD-10: Strategies to Keep Business Flowing Daniel M. Flanagan, Executive Consultant, Beacon Partners ... –Focus on Clinical Documentation

VITL Summit ‘14 Track 2: Meeting Evolving Requirements

ICD-10: Strategies to Keep Business Flowing

Daniel M. Flanagan, Executive Consultant, Beacon Partners

Catherine West, ICD-10 Project Lead, Department of

Vermont Health Access

&

Jackie Graham, VT SMA Fiscal Agent HP Enterprise

September 9, 2014


Yes, There’s a Code for That!

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Agenda

ICD-9 vs. ICD-10

Readiness Statistics

Implementation Costs

Proactive Business Planning

Organizational Structure

Electronic Claims Testing

Questions

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Comparison: ICD-9 and ICD-10 Diagnosis Coding

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Industry Readiness Stats

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• 55% of physicians have not

started any implementation activities

26% of these physicians say

they don’t have the time, staff or training resources to begin preparation

Porter Research 2013, iHealthBeat 2013


Industry Readiness Stats

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Porter Research 2013, iHealthBeat 2013


Potential Implementation Costs

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Recent Legislation

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• July 31, 2014 CMS announced a final rule that established October 1, 2015 as the new compliance deadline for ICD-10.

• For organizations with readiness projects underway:

– Maintain momentum on existing projects; stopping and starting is costly and disruptive

– Focus on physician/provider education

– Focus on Clinical Documentation Improvement (CDI)

– Conduct a comprehensive gap analysis and workflow assessment to optimize revenue cycle performance

– Develop coder retention, recruitment and training strategies

– Evaluate Computer Assisted Coding (CAC)

– Implement/continue dual coding and coder training

• For those at (or near) the starting line:

– Now have a longer runway that allows planning the project with a more effective, less stressful approach

– Time to start….NOW


ICD-10 Impacts Everyone

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Larger, more complex code set requires: • Increased specificity of documentation • Greater reliance on technology (E.g., EMRs, encoders, scrubbers) • Changes in work flows to handle more complex codes (E.g., revenue

cycle).


Develop Proactive Business Plan

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Planning and Definition

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• Transition Process

– Plan

– Communicate

– Assess and measure

– Implement and test

– Transition

– Continue to measure

• Prioritize Goals:

– Catastrophic: Fatal to business, i.e., failed transition

– Critical: Significant loss of business function

– Major: Economic loss only

– Minor: Economic loss only


Financial Planning - Revenue Cycle Optimization

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It’s Not Easy…


Key Financial Dashboard Metrics

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Organizational Structure • Executive Sponsor(s)

– Overall organization project accountability

• Steering Committee and Workgroups

–Plan the strategy

–Create formal, structured project plan

–ICD-10 Steering Committee • Multi-disciplinary

• Able and willing to make decisions

• Workgroups

– What areas are affected?

– Identify current teams and committees

– Do the affected areas have a plan and timeline?

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Project Management Structure

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Program / Project Structure

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• Executive Sponsor

– Leads Steering Committee / Advisors

– Provides overall project coordination

• Administration / operations / finance

• HIM

• Quality

• Information Technology

– Support

• Training and communication

• Resources


Improve Organizational Workflow

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Meet with front-line staff to understand “current state” processes

What is happening today?

Map current system workflows

Identify code flow gaps and vulnerabilities

Design “future state” workflows that eliminate gaps and vulnerabilities


Training Guidelines • Coding/CDI/Case Management Staff: Advanced/Expert - up to

50 hours – Fully proficient in all aspects of ICD-10

• Providers: Moderate - up to 12 hours – Specialty-dependent

– Highlights changes in medical concepts

– Defines guidelines for required specificity

• Other Clinicians: Moderate - up to 10 hours – Proficiency in documentation

– Depending on role in the practice/how much they document

• Front and Back Office Staff: Low - up to 6 hours • Recognize/use codes when updating problem lists, checking eligibility,

etc.

• Other Staff: Minimal - 1 hour – Focus on awareness and impact

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Recruit & Retain Certified Coders

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Certified coders in high demand

Develop retention program

Invest in staff training


Develop a Transition Finance Plan

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Decrease existing A/R balances

Closely manage claims rejections and denials

Reduce coding errors and backlogs

Budget cash reserves for post-transition reality

Anticipate 25% reduced cash flow for at least 6 months

Increased denials, disputes and appeals

Consider costs related to:

Increased staffing

Hardware and software upgrades or purchases


Consequences of Poor Preparation

• Increased claims rejections and denials

• Increased delays in processing authorizations and reimbursement claims

• Improper/incorrect reimbursement

• Dollars “left on the table”

• Coding backlogs

• Compliance issues

• Decisions based on inaccurate data

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Take-Aways The time to start/continue planning is NOW

• Communicate, communicate, communicate

– Apply project management processes and principles

– Eliminate redundant processes

• Keep senior leadership informed to remove roadblocks and gain support

– ICD-10 impacts the entire organization – not just an IT project

• Work with industry associations for support and resources

• Leverage everything you can to increase productivity – people, processes, and technology

• Standardize and centralize to increase efficiency

• There are no shortcuts, just opportunities

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VITL Summit ‘14 Track 2: Meeting Evolving Requirements VITL Summit ‘14 Track 4: Patient and Provider Engagement

ICD-10 Electronic Claims Testing

Department of Vermont Health Access

September 2014

For more information - Please visit our website to access a wide-range of ICD-10 resources and information at http://dvha.vermont.gov/for-providers/icd-10 or email please email [email protected]

http://dvha.vermont.gov/for-providers/icd-10







mailto:[email protected]






Why Test with VT SMA?

The benefit to testing is to confirm you are ready and able to submit payable claims. This is an important step in your ICD-10 preparation.

Confirm your claims include valid ICD-10 diagnosis and inpatient procedure codes (as appropriate)

Validate your software can successfully deliver electronic claims to VT Medicaid

Enable you to determine if your practice requires additional training

VITL Summit ‘14 Track 4: Patient and Provider Engagement


Why Test with VT SMA?



How Do I Test w/VT SMA?

1. Login to PES, VT Medicaid ‘Provider Electronic Solutions’ (PES)

No PES, go to www.vtmedicaid.com

2. Create the Test Claim, (use a recent paid claim) – cross code from ICD-9-CM diagnosis to ICD-10-CM diagnosis & ICD-9-CM (Volume 3) inpatient procedure to ICD-10-PCS inpatient procedure coding system


http://www.vtmedicaid.com/


How Do I Test w/VT SMA?

1. Once in PES, enter cross codes into test claim.

Please note: Only ICD-10-CM diagnosis, not ICD-10-PCS inpatient procedure, will affect physicians. ICD-10-PCS will only be implemented for facility inpatient reporting of procedures – it will not be used for physician reporting. There is no impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

2. Submit your claim, test results next day!

3. Results, Return to the Medicaid portal the next business day and logon to your web account. Look for the claim under Claim Status.



VT SMA

Test Results and Next Steps

Review the RA for each submitted test claim

If the test claim paid – you’re all set*.

If the test claim denied, review the EOB, correct the error and re-submit.

Questions or Confusion - DVHA will provide additional support resources for the testing period.

* Please note; that DRG pricing may vary between ICD-9 and equivalent ICD-10 claims due to the greater diagnosis specificity.



When Can I Test

w/VT SMA?

Providers will begin testing in May 2015 through August 2015.

We encourage all provider types and specialties to participate.

There is no cost for testing.

Look for more information in the near future.



Q&A

Questions?



Thank You

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For more information please contact:

Beacon Partners

Craig Greenberg

[email protected]

VT Medicaid – Department of Vermont Health Access

Catherine West

[email protected]

[email protected] VT Medicaid website -> to access a wide-range of ICD-10 resources and information http://dvha.vermont.gov/for-providers/icd-10
















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ICD-10: Strategies to Keep Business Flowing · ICD-10: Strategies to Keep Business Flowing Daniel M. Flanagan, Executive Consultant, Beacon Partners ... –Focus on Clinical Documentation