implementing icd-10 in five simple steps
TRANSCRIPT
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Implementing ICD-10 in5 Simple Steps
Presented by
Ms. Sirisha Bommireddipalli, CPC, CPC-H, ICD-10
Director - Operations
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M-Scribe’s 5-Step Plan for ICD-10 Implementation
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Step 1: Planning and Assessment
Step 2: Training
Step 3: Process Changes
Step 4: Transition and Quality Management
Step 5: Testing
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Step 1: Planning and Assessment
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• Map current workflows, identify gaps and build plan for successful ICD-10 implementation
• Support renewal of coverage policies, medical reviews and reimbursement schedules
• Coordinate ICD-10 transition across key impacted areas
• Update practices on all relevant rules pertaining to ICD-10
• Design an ICD-10 action plan
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• Isolate where and by whom diagnosis codes are used in your practice today.
• Record the processes, forms, and systems where your practice uses diagnosis codes
• Pinpoint the ICD-9 codes you use most frequently use by reviewing superbills, encounter forms, practice management system reports, and the common codes.
• Utilize the list of your most frequent ICD-9 codes to help identify the ICD-10 codes relevant to your practice
• Make a special note of those conditions where the available number of diagnosis codes in ICD-10 is noticeably larger.
Internal Impact Assessment
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You will need to engage your vendors and payers for effective ICD-10 transition:
Examples:
• Billing Service Provider
• Technology Vendor
• Clearing House
• Payer
External Impact Assessment
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Step 2: Training
In-depth training for cross-functional areas of practice
Training
Clinical Documentation
Training
ICD-10-CM/ PCS CODE SET General ICD-10-
CM/ PCS and change from
ICD-9 -CM
Medical Staff
Medical Coders
Non Medical Staff
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• Who will need training?
• What type and level of training will be needed?
• How will training be delivered?
• Online?
• Face to face?
• Additional training may be needed to refresh or expand knowledge in the biomedical sciences
• Use assessment tools to identify areas of strengths/weaknesses
Training Strategy
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Determine the type and source of training for each practice staff member based on the following general guidelines:
• Documentation training for physicians, NPs, PAs, and other staff who document in the patient medical record.
• Coding training for staff members who work with codes on a regular basis.
• Overview training for staff members engaged in administrative functions.
• User training on the ICD-10 functionality included with system upgrades.
Training Strategy (cont.)
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Step 3: Process Changes
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Specific workflow activities have to be updated for an effective ICD-10 Transition:
Revise paper forms and templates
• Preadmission/Precertification
• Referrals
• Authorizations
• Superbills/Patient Encounters
• Inpatient and Outpatient Scheduling
• Other paper forms and tools used to capture diagnosis code information
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Modify policies and procedures
• Identify most common services that trigger reviews or denials, due to medical necessity, incomplete or inadequate documentation
• Adopt procedures to isolate ICD-10 DX codes to determine coverage prior to claim submission
• Establish proactive denial management processes
• Track patient complaints and payment delays to help address any problems quickly
Step 3: Process Changes (cont.)
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Documentation ChangesClinical documentation has to improve to support new coding requirements. Better clinical documentation promotes better patient care and more accurate capture of acuity and severity
• Quality measures
• Reimbursement
• Severity-level profiles
• Risk adjustment profiles
• Present on admission reporting
• Hospital-acquired conditions
Process Changes (cont.)
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High-quality documentation can help to:
• Avoid misinterpretation by third parties (auditors, payers, attorneys, etc.)
• Justify medical necessity
Documentation Changes (cont.)
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M-Scribe’s clinical documentation improvement strategies determine best solutions for addressing each documentation gap – we realize that one size doesn’t fit all.
Examples: • Modifications to form or template
• EHR documentation template
• System prompts
• Education
• Workflow or operational process changes
How can M-Scribe Help?
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Assess quality of medical record documentation to identify improvement opportunities
Medical record sampling techniques could include: • Random samples
• Sampling by clinical specialty
• Top diagnoses
• Top service lines
• High volume diagnoses
• Diagnoses historically known to cause documentation problems
Documentation Gap Analysis
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Examples of ICD-10 details that could be added to electronic health record (EHR) templates:
• Laterality
• Encounter type (initial, subsequent, sequela, routine healing, delayed healing)
• Anatomic details
• Severity
• Disease relationships
Some Details We Could Add
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Step 4: Transition Management
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• Dual-submission of workflow during the migration
• Evaluate and report success against new criteria
• Establish feedback loops, communicate progress and needed improvements
• Provide detailed performance reports to staff
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After the ICD-10 implementation, your practice should review processes to confirm their effectiveness and sustainability
These include:
• Clinical documentation processes
• Coding practices and processes
• Revenue cycle processes and changes
Remember: Transition goes hand in hand with testing
Step 4: Transition Management (cont.)
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Step 5: Testing and Verification
• “Dry run" to ensure practice management is capable of handling the ICD-10 codes and claim processing
• Check if documentation, diagnosis and procedure codes are aligned for new ICD-10 Billing
Internal Testing
• Conduct external testing with clearinghouse to ensure the ICD-10 codes are sent and received properly
• Review results from testing
• Standardize policies and procedures based on the result
External Testing
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• Perform eligibility & benefits verification
• Process a referral
• Process an authorization
• Update a patient’s history & problems
• Enter and process an order
• Verify that diagnosis-dependent clinical decision support rules issue alerts
• Prepare clinical notes for an encounter
• Code an encounter
• Generate and process a claim
• Perform a claim status inquiry
• Reconcile and post a payment
• Run frequently used reports
• Perform other key tests as needed
Examples: Key Transition & Testing Areas
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• Review test results for the data you submitted to your clearinghouse, billing service, and/or payer(s)
• Verify test results for each type of test transaction which was processed
• Document your test results. Investigate the cause (data entry, process, system, other) for tests that failed unexpectedly
• Report potential system issues to the applicable technology vendors
• Test fixes installed and changes made to address the problems you identified
Transition and Testing (cont.)
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It is VERY crucial to complete impact assessment, planning, system upgrade, process update, and internal testing activities as soon as possible to maximize the time you have remaining for external testing and overall preparation!!
Complete transition and full compliance is achievable by October 1, 2015 with timely and efficient implementation of our 5-step plan
Transition & Compliance
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• Free initial consultation of internal processes of your practice
• A report provided by M-Scribe’s ICD-10 coders with recommendations for ICD-10 implementation
M-Scribe’s Special Offer
Contact [email protected] call her at 888-727-4234 for more information on
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