ICD10 Implementation Plan Medaille Healthcare System Presented by

ICD-10 Implementation Plan Medaille Healthcare System Presented by Edith Walker and Dalpreet Kaur

Goals of Implementation Plan • Provide a smooth transition to ICD-10 • Develop strategic plan and identify goals • Implement work flow changes • Develop training plan for transition to ICD-10 • Improve documentation practices to provide higher quality data • Improve revenue cycle management with ICD-10 training and transition • Evaluate current EHR system and identify software changes necessary for implementation • Oversee post implementation processes to evaluate for expected outcome

Benefits of ICD-10 • Increase in patient safety due to improved quality measurements and decreased medical errors • Improved strategic and operations planning • Improved clinical, financial and administration performance • Improved claims submission with fewer denials and rejections due to higher level of specificity • Increase use of automated tools to facilitate the coding process • Increase productivity • Improve resource management • Decrease labor costs over time

Comparison of ICD-9 to ICD-10 ICD-9 ICD-10 • Less than 13, 000 codes • More than 65, 000 codes • Lacks specificity • Greater specificity to improve information sharing • Unable to expand • Can expand to accommodate new procedures and diseases • Outdated with modern practice of medicine • Up to date codes for today’s practice of medicine • Incompatible with current healthcare reporting systems • Compatible with todays technology for more streamlined billing processes and healthcare reporting processes

Step in ICD implementation process • 1. Planning and Assessment • 2. Training • 3. Process Changes • 4. Transition and Quality Management • 5. Testing

Planning and Assessment • Map current workflows, identify gaps and build plan for successful implementation plan • Formulate steering committee, transition strategies and identify goals • Assess current documentation practices and coding staff knowledge and skills to determine needs and training necessary for ICD-10 transition • Identify all stakeholders and provide organizational wide awareness • Assess vendor readiness and any necessary software changes needed • Design ICD-10 project plan • Prepare budget plan

Internal and External Impact Assessments • Internal • External • Assess current coding practices • • Assess current documentation practices Evaluate current Vendor software and ICD-10 readiness • Identify ICD-9 code sets most utilized to help with ICD-10 uses Assess current billing service providers • Assess current interface software to payers • Assess current interface software to clearinghouses • • Evaluate current software and identify upgrades necessary for ICD-10

Training • Training will affect: • Senior Executives • HIM Personnel • Coding Staff • Medical Staff • Clinical Staff • Registration Department • Billing Staff • IT Personnel • Financial Management • Business Associates and other key stakeholders • (see implementation and training plan)

Process Changes • Workflow processes to be changed: • Preadmission/precertification, referrals, authorizations, inpatient/outpatient scheduling, any other process involved with diagnosis capture • Claims submission and denial management processes • Policy and procedure modifications for ICD-10 coding • Documentation processes to improve quality data for ICD-10 • Training practices: the who, where, when and how to train • Reimbursement schedules and payment policies • Coding processes and the impact of decreased productivity at onset of ICD-10 implementation • Communication plan for ICD-10 project

Transition and Quality Management • Establish feedback loops for communication progress and needed improvements • Update all stakeholders with detailed performance reports per communication plan • Evaluate and report successes against new criteria associated with ICD-10 • Reviewing processes to confirm their effectiveness and sustainability: • Clinical documentation processes • Coding practices and processes • Revenue cycle processes and changes

Testing • A complete impact assessment, planning, system upgrade, process update and internal testing must be completed before external testing is done • Internal Testing: • • Perform a ‘dry run’ to ensure practice management system can handle ICD-10 codes and claim processing • Check if documentation, diagnosis and procedure codes are aligned with new ICD-10 billing processes External testing: • Test with clearing house to ensure that ICD-10 are sent and received properly • Review results from testing • Standardize policy and procedures based on those results

References http: //www. cms. gov/Medicare/Coding/ICD 10/i ndex. html? redirect=/ICD 10/ http: //library. ahima. org/xpedio/groups/public/ documents/ahima/bok 1_049431. hcsp? d. Doc. N ame=bok 1_049431#general_mapping http: //www. ama-assn. org/ama/pub/physicianresources/solutions-managing-yourpractice/coding-billing-insurance/hipaahealthinsurance-portability-accountabilityact/transaction-code-set-standards/icd 10 -codeset. page