January 2015 - dignityhealthmember.org

Report
ICD-10 Workshop:
Marci Burke, Director, Program/PMO
Mark Scherling, IT Program Manager
David Theis, Project Manager
Reflection: The Storm is Coming
2
Preparing for the Storm
• Have an Emergency Plan
• Practice the Plan
• Listen for Warnings
• Recognize the Signs
• Take the Threat Seriously
3
Agenda
• ICD-10 Overview
• Provider Readiness & Workshop
• Non-Provider and Ancillary Staff Readiness
• System, Report, and Form Remediation
• Readiness Plans for Key Roles and Other Entities
• Next Steps
4
ICD-10 Overview
5
ICD-10 Leadership
Executive Program Sponsor
Tim Panks
Program
Advisors
Katie LeBlanc
Shelly Walters
IT Sponsor
Stan Martin
Clinical Sponsor
Dr. Joseph
Colorafi
Program Director
Marci Burke
Optum 360
Sponsor
Emily Rafferty
ICD-10 PMO
Marci Burke
Jonathan Weeks
Tawnya Infantino
HIM / Coding
Chair
Brian Dessoy
Provider / Clinical
Chair
Dr. Chandrasena
IT Lead
Nataiya Waller
IT Lead
Kevin Barbee-Acute
Mark Scherling-Amb
Revenue Cycle
Chair
Jennifer Igel (Acute)
Steve Scharmann (Amb)
IT Lead
Nataiya Waller-Acute
Mark Scherling-Amb
PM
MJ Murphy Gonzalez
PM
MJ Murphy Gonzalez
PM
Chris Cruise
Organizational Readiness
PM, David Theis
Home Health
Chair
Paul Giles
IT Lead
Mark Scherling
PM
Chris Cruise
6
**blue text = Optum360 employee
What Changes from ICD-9 to ICD-10?
The magnitude of ICD-10
vs. ICD-9 code sets is
significant
ICD-10 code sets:
• Represent an 800% increase over
ICD-9 code sets
• Will be alphanumeric in nature and
include an alphabetic lead character
• Logical; organized by core concepts
Structural changes will
provide specificity and
clinical detail capturing
advances in medical
technology
Changes to code sets include:
• Inclusion of a character to
indicate laterality
• More clarity around severity of
illness or injury, as well as, an
initial or secondary occurrence
7
Why does Dignity Health care about ICD-10?
Coder Productivity
Challenges
Additional
Specificity in
Physician
Documentation
Increase in
Initial (temporary)
Denial Rate
Increase in
AR Days
Payer Readiness &
Compliance
8
ICD-10 Strategies for Key Roles
Providers
Non-Provider &
Ancillary Clinical
Clinical Documentation
Specialist
Coders
Patient Financial
Services
Patient Access
(Registration)
Strategy Goals:
• Implement education to ensure
critical roles prepared to comply
• Identify strategies that minimize
productivity impacts
• Prepare systems to support
transition and minimize impact
9
Who has assisted with strategy and validated our work?
Optum
3M
Deloitte
Ernst
&Young
CHAN
10
ICD-10 Delay
11
ICD-10 Delay Response
New Deadline: October 1, 2015
Key Considerations
 11 Billion exposure if we are not ready
Mitigation Strategies
 Shift majority of work “just in time” to minimize risk of future delays
 Focus on work that benefits Dignity Health today
 Provided opportunity to look at processes and make improvements
 Additional technology: Cerner and CAC
12
Benefits of the Delay
• Technology
– 26 Facilities live on Cerner EHR
– Computer Assisted Coding (CAC) for 23 Acute Facilities &
Ambulatory
– Additional upgrades and features to existing applications
• Improved Plan
– Streamlined Activities
– Shifting more activity to centrally-led team
13
Pre-Delay Committee Structure
• Historical Structure:
– Facility Liaison (HIM Director) oversaw committees for:
• HIM/Coding, Patient Access, Patient Financial Services, Clinical, Quality
– Central ICD-10 PMs provided support to HIM Director &
committees
• Challenges:
– Complex project plan
– Duplication of effort with Optum360 transformation
– Overlap of centrally-led activities
14
New Structure
• New Structure:
– Centrally-led ICD-10 Provider/Clinical Group:
• Clinical and Quality
– Dignity Health and Optum360 management is leading:
• HIM/Coding, Patient Access, Patient Financial Services
• Benefits:
– Centralizing process and job aid development
– Leadership and roll-out from Optum360
15
Roles and Responsibilities
Centralized Program
Local Sites
• Creation & Facilitation of Education
• Joint Venture & Vendor survey,
assessment and remediation
• Business testing & Payer readiness
assessments
• Advise Managed Care Contract Team
• Create strategies, workflows and job
aids and review with centralized teams
• Provide job aid training
• Advise Optum360 and Ambulatory
leadership to identify and onboard
contractors
• Assessment and remediation for
Corporate-supported applications,
reports, and forms
• Encourage education participation &
provide logistics support
• Develop MEC Resolution
• Review/Follow-up on at-risk business
vendors (as requested)
• Job aid training participation
• Operations and logistics support for
on-boarded contractors
• Assessment and remediation for all
other* applications, reports and forms
* Other will be defined in future slides.
16
Our Accomplishments
• Assessed over 150 applications and hundreds of instances; Upgraded 54
applications (multiple instances) at 39 hospitals and over 125 clinics;
Remediated 84% of in-scope application reports
• Developed & implemented education plans for 40,000 learners
• Identified productivity impacts, resources, and mitigation
• Created and are implementing remediation strategies for:
Managed Care
Contracting
Business Vendors
Joint Ventures
Practice Coding
Business Testing
Payer Contingency
Cutover / Dual
Processing
Technology
Remediation
17
Workshop Goals
• Identify how local sites can increase provider engagement
• Clarify scope for systems, reports, and forms remediation
• Review readiness plans for impacted staff, vendors, and payers
• Identify any gaps in our strategies
• Work together to prepare for transition
18
Providers
ICD-10 Readiness
19
Provider Impact
• Problem/Opportunity:
– ICD-10 requires increased specificity in documentation
– Lack of specificity will result in increased queries
• Anticipated Impact: 10-20% short-term productivity loss*
• Solution:
– ICD-10 Education
– Clinical Documentation Education
– Technology (available over time)
* Helping Physicians Succeed (Alex et al., 2011)
20
Impacts Of Changing From ICD-9 To ICD-10
Additional documentation specificity may result
in:
•
Appropriate payment: accurate payment for
new and complex procedures, fewer rejected
claims and better claims adjudication
•
More detailed physician profile: detailed
representation of the complexity and quality of
care provided, which will affect pay-forperformance programs (e.g., value-based
purchasing) and risk-adjustment
methodologies (e.g., mortality rates)
•
Research opportunities: more detailed
information will enable data mining and create
research opportunities which will benefit
public health
21
Addressing Physician Engagement
Physician Champion Network
• Membership: 50 Physician Champions
–Includes Acute and Ambulatory
• Roles/responsibilities:
–Foster engagement & peer-to-peer communication
Leadership
Education
Oversight
–Reviewing education strategy & curriculum
–Coordinating training for providers
CDI Engagement
–Engaging providers in CDI program
Communication
22
Clinical Documentation Improvement
Centralized ICD-10 Program-Provided Education for Providers
• CDI Training for employed and non-employed physicians,
nurse practitioners, physician assistants, residents and
fellows:
– Acute In-Person: October–February 2015
– Acute and Ambulatory WebEx: February 2015
– Ambulatory In-Person: “Documenting Patient Acuity” (HCC)
January-March 2015 at select locations
•
HCC’s associated with Medicare Part C, Capitated contracted – managed HMOs.
Clinical Documentation Improvement is beneficial now,
regardless of when ICD-10 is implemented.
23
Education for Providers: CDI Videos
Centralized ICD-10 Program-Provided
• CDI Videos for CME credit
– 5 to 8 minute videos
– ICD-9 and ICD-10 relevant documentation guidelines on severity and acuity
– Marketed by CMOs, VPMAs, and ICD-10 Physician Champions
General
Documentation
Guidelines
Acute Blood Loss
Anemia
Acute Kidney
Injury
Acute Myocardial
Infarction
Congestive Heart
Failure
Cerebral Edema
and Brain
Compression
Deep Venous
Thrombosis and
Pulmonary
Embolism
Excisional
Debridement
Hypo/
Hypernatremia
Malnutrition/
BMI
Pathology Findings
Pneumonia
Pressure Ulcers
Sepsis
24
ICD-10 Education for Providers
Centralized ICD-10 Program-Provided
• ICD-10 Education for employed and non-employed
physicians, nurse practitioners, physician assistants,
residents and fellows:
– eLearning: May – September 2015
– In-Person ICD-10 Training: July – September 2015
Education is offered just-in-time
to ensure retention prior to ICD-10 implementation.
25
Documentation Assessment
Centralized ICD-10 Program-Provided
• Clinical Documentation Improvement
– Physicians identified via analytics
and local leadership
– Assessment by Optum360
CDI consulting staff
– Physician-specific and specialty specific
results shared with physicians and
each facility
Clinical Documentation Improvement
benefits us today and in an ICD-10 world
26
Community Physician Outreach
Centralized ICD-10 Program-Provided
• Training and Tools for Community Physicians
– Outreach with Market Development Representatives begins January 2015
– 1 hour WebEx presentation and 5-page Guide
• Topics:
– Overview of ICD-10
– Financial Planning
– Education for Physicians and their Staff
– System, Report, and Form Readiness
– Payer and vendor Readiness
27
Job Aid for Providers: ICD-10 Virtual Codebook
Centralized ICD-10 Program-Provided
• Available May 2015
• Easy to use
• Search by code or clinical terms
• Speech Recognition
• Documentation Tips
• Favorites
• Internet access not required
• Available on Apple or Android
28
ICD-10 Virtual Codebook
Search Functions
29
ICD-10 Virtual Codebook
Results
30
Physician Engagement
The challenge of engaging physicians in ICD-10
31
Competing priorities
• Today physicians are faced with countless demands on their
time, so it is easy for ICD-10 to be pushed to the bottom on the
agenda.
• Two additional items also create complications:
– Medicare and Stark Regulations
– Competing ICD-10 Training
32
Regulations Prevent Physician Compensation for Training
• Medicare anti-kickback regulations and Stark self-referral
regulations prevent Dignity Health from providing monetary
compensation to physicians that may have a referral
relationship with Dignity Health.
• Regulations permit Dignity Health to provide compliance
programs to health care providers provided that programs are
not offered based on volume or value of referrals or other
business generated by referring physician.
33
Competing ICD-10 Training Offerings
Site Led - Physician Education Reciprocity
• Many physicians will be asked to participate in ICD-10 Training
from different medical systems:
– VPMAs and Medical Staff Leadership are in charge of working with
physicians at their facilities to determine specifics on reciprocity training
agreement.
• ICD-10 Program provided a template to ICD-10 Physician Champions.
• Reciprocity is based on MEC guidelines per facility.
– ICD-10 Program recommends and encourages all physicians take the
Dignity Health ICD-10 training.
34
Workshop Questions
1. How do local sites encourage provider participation?
–
CDI Videos
–
ICD-10 in-person training
–
ICD-10 eLearning
2. Who should Centralized ICD-10 Communications work
with at your local site?
35
Providers: ICD-10 Roles and Responsibilities
Centralized Program
• Education opportunity
selection and funding
• Facilitation of education rollout including document
assessment & ICD-10 Virtual
Codebook
• Send out master
communication
Local Sites
• Ensure participation in
Education and
Documentation Assessment
• MEC Resolution*
• Logistics Support (for inperson training)
* ICD-10 Program provided a recommended template for the MEC
resolution; however, passage of resolution is facility specific.
36
System, Report and Form Remediation
ICD-10 Readiness Corporate and Local Scope
37
System, Report and Form Impact
• Problem/Opportunity:
– ICD-10 requires updates to applications, reports, and forms that contain
ICD-9 codes
– Need to address the “gap” between what the centralized ICD-10 Team is
remediating and the remediation needed at each local site
• Solution for Addressing the “gap”:
– CFO, ICD-10 Facility Executive Champion, identifies a local leader at each
facility to lead the remaining effort. Role includes:
–
–
–
–
Bring together departmental leadership
Drive day-to-day site committee activity
Escalate issues/risks to site leadership
Manage and communicate project status to site leadership
38
Partnering for Success
ICD-10 Executive
Champion
(Site CFO)
Optum360
Leadership
(Acute
Only)
CFO-Selected
Committee Chair
Local Site
Application
Expert or
Vendor
Site Leadership
(includes IT Site
Directors and CIO)
39
What systems, reports or forms need ICD-10 remediation?
• Any system (application), database, interface, registry, or bolton that includes ICD-9 diagnosis or procedure codes
• Any report that includes ICD-9 diagnosis or procedure codes
• Any form that includes ICD-9 diagnosis or procedure codes
40
Remediation Overview
Generally, remediation includes:
• Implementing any patches or upgrades for ICD-10 from vendor
• For custom software, reports or forms:
– Expanding ICD-9 fields to allow for alphanumeric with 3-7 characters, with
an alphabetic lead character; Decimal after the 3rd character
– Potentially mapping ICD-9 codes to new ICD-10 codes within report
selection statements
– Updating report filters if necessary
• Testing/Validation of anything adjusted for ICD-10
• Ensuring ICD-10 changes are in place prior to October 1, 2015
41
Scope Definition:
ICD-10 Program or Local Site
42
Methodology to Identify ICD-10 Program Scope
Phase 1: First draft of Impacted Applications List (IAL) finalized.
• Corporate-supported systems data collected by 5010 team; initial impact assessment
began
• Interviews conducted with support teams/vendors/local sites to add to the 5010 listing
• Priorities assigned based on ICD-9 availability and usage as outlined by business partners
• Additional interviews with support teams and managers to verify information
43
Methodology to Identify ICD-10 Program Scope
Phase 2: 2nd Assessment due to ICD-10 Implementation Date Delay, Impacted Applications List
(IAL) Updated
• Validated IAL through additional assessments and interviews with support teams, business
partners and local sites
• Consolidation explored if deployed at more than 1 facility
• IAL reviewed to identify applications previously documented as decommissioned or ready for
archive
• Reviewed applications slated for decommission due to EHR, Optum360 or other
implementations (these were removed from scope)
Continued Assessments: The centralized ICD-10 Program has governance process for assessing
and approving scope changes
• Applications slated for decommission or replacement due to EHR, Optum360, Ambulatory or
other implementations
• New scope as a result of new software implementations or acquisitions of new clinics prior to
the July 1, 2015 cutoff date
44
Example of Impacted Applications List (IAL)
45
Application Remediation Overview
Centralized ICD-10 Program Team remediation includes:
Home-grown
reporting
databases
- Corporate-supported applications with ICD-10 impacts and
functionality usage confirmed by the ICD-10 Team
- Systems not being decommissioned or replaced by another
system prior to July 1, 2015
Customized
Software or
Systems
Centralized ICD-10 Program Remediation is on-track.
Local Site remediation is required for:
Screen Scraping
Technology
- Locally supported applications, databases, interfaces, registries,
screen-scrape technology, bolt-ons or customized software with
ICD-9 codes which are not listed in the IAL (i.e. not managed by
corporate IT)
- Work with your vendor or local expert to remediate
- Leverage list of ICD-10 applications that your site identified previously located
in your packet
Locally managed application remediation efforts are anticipated to be small and low risk.
If you need help with a specific system (application) not listed within the ICD-10 IAL,
send an email to the ICD-10 Program Team at: [email protected]
Outsource
Vendors
Applications
producing files
to 3rd parties
46
Reports Remediation Overview
Centralized ICD-10 Program Team remediation includes:
• Vendor-supplied standard reports in the ICD-10 Program IAL
• Reference your packet for reports which are not standard, but have
been assessed by the ICD-10 Program Team and have potential to
be in scope
Quality reports
(QA)
Admissions
census reports
Clinical registry
reports
Local Site remediation is required for:
• Customer defined (custom) reports that include ICD-9 diagnosis or
procedure codes (which are not listed in the ICD-10 report
remediation list in your packet)
• Queries within corporate-supported systems listed in the IAL that
include ICD-9 diagnosis or procedure codes
• All reports in locally supported applications, databases, or registries
that include ICD-9 diagnosis or procedure codes
– Work with your vendor or local expert to remediate these reports. These
may be managed by Local IT or Application Experts in the Department.
Vendor reports
Daily reports
with diagnosis
Discharge
planning
reports
Risk
Management
Need help with a specific report not listed within the ICD-10 Program-remediated reports list?
47
Reports Remediation Help
Option 1: Work with your ICD-10 IT Project Manager to better
understand what ICD-10 is remediating to identify gaps and
determine your next steps.
Option 2: Open a Help Desk Ticket
 The ICD-10 Program will assess whether or not ICD-10 or Corporate IT will
be able to accommodate the request.
 IMPORTANT: We recommend all requests be submitted as soon as
possible, but no later than March 1, 2015. Start your assessments now.
 How to open a ticket:
 Effective February, you may call the help desk to open a ticket.
 The ability to open a ticket via the help desk web portal will be
available in early February. Further communication to follow when
this method is available.
 There is quite a bit of information you will need to have on hand
when opening a help desk ticket….
48
Opening a Report Remediation HD Ticket - Required
 Requestor Name
 Facility Name
 Phone Number
 Service Area
 Email Address
 Department
Report Specifics
• Application Name
• Report Name
• Report Type (Standard, Custom, Ad-hoc, User created)
• Report Distribution Method (Email, Web, File Share)
• Frequency of use (How often the report is ran – daily, weekly, bi-weekly etc.)
• Report Description (Description that explains the purpose of the report, audience and
risk of not remediating for ICD-10)
• Will ICD-9 to ICD-10 code mapping be needed to complete remediation of this report?
Yes or No
• Does the report include ICD-9 Diagnosis or Procedure Codes? Yes or No
• Attach additional supporting information (Ex. Report filters, criteria, output etc.)
• Additional Comments
49
Forms Remediation Overview
Centralized ICD-10 Program Team remediation includes: None
ABN forms
Local Site remediation is required for:
– Paper Forms: Update Paper Forms that include ICD-9 diagnosis or
procedure codes via your vendor or Microsoft Word.
• Paper forms cannot be submitted to local IT or corporate IT for
remediation.
– Electronic Forms: Update Electronic Forms that include ICD-9
diagnosis or procedure codes via FormFast or similar software.
• FormFast form update requests should be submitted directly to vendor.
IT does not support FormFast forms outside of EHR armbands and labels.
– Optum360 is centrally remediating PFS, PAS and HIM forms.
– Forms Committees or Clinic Directors should identify and update any
forms that include ICD-9 diagnosis or procedure codes
– Third Parties remediate their own forms. Your packet includes a 1page instruction sheet on form remediation to return to third parties.
Medicare forms
Hospital Face Sheet
Charge
tickets/Encounter
forms/Super Bills
Referral forms
Order forms – Lab,
Diagnostic Imaging,
Physical Therapy
Physician orders
(Admission orders)
50
ICD-9 to ICD-10 Mapping Assistance
Identify
Identify any ICD-9
codes that need to
be translated to
ICD-10 in systems,
forms, or reports
Submit
Submit mapping
request form no later
than May 1st to:
[email protected]
Map
Remediate
ICD-10 Program
maps ICD-9 codes to
ICD-10 codes, and
returns to requestor
Local Site
remediates the
systems, forms, or
reports using the
ICD-10 mapping
Depending on volume and site capability the program may also provide a license to the software
and train the users on the tool.
51
ICD-10 Local Remediation – Suggested Timeline
ICD-10 Go Live | October 1, 2015
February
January
- ICD-10 Workshop
- Identify Facility Lead
- Establish meeting
cadence and
responsibilities
March – June
- Finalize identification of
ICD-10 non-assessed
locally supported
systems, reports or forms
- Update identified
systems, reports and
forms
- Identify remediation
resources
- Request mapping
assistance by May 1st.
- Request mapping
assistance if needed
- ICD-10 Program
Check Point (March)
July-September
- Test systems,
validate reports,
obtain form approval
- Plan to put in place
for October 1, 2015
-Plan for October 1,
2015 go-live support
52
Reference Information: Provided after Workshop
Systems (Applications)
• Impacted Application List (IAL): List of corporate-supported systems which will
be remediated by the centralized ICD-10 Program IT Team. Includes assessment
results.
• List of ICD-10 impacted systems that your site identified previously
Reports
• List of reports from larger corporate systems which have been assessed for
remediation by the ICD-10 Program
Forms
• ICD-9 to ICD-10 Mapping request form
• 1 page instruction sheet on form remediation to return to third parties
Tools
• Tracking tools to use to manage your application, forms and report remediation
• List of Questions for IT Vendors and Application Subject Matter Experts
53
Reference Information Examples
54
Roles and Responsibilities – Systems, Reports and Forms
Centralized Program
Local Sites
• Assessment and remediation for
• corporate-supported
applications on the Impacted
Applications List (IAL)
• reports for Corporatesupported applications on the
Impacted Applications List
(IAL) – standard reports only
• Assessment and remediation for
• local applications not
supported by Corporate (not
on IAL)
• reports not supported by
Corporate (not on IAL) –
nonstandard or custom
reports or queries
• All electronic or paper forms
• PFS, PAS, and HIM acute
forms will be centrally
remediated by Optum360
55
Our Ask of You
1.
Establish leadership at the local site to drive work which is out-of-scope for
the centralized ICD-10 Program
2.
Identify “gray areas” and contact [email protected]
• If you have questions regarding a system (application) not on the IAL (Impacted
Applications List)
• To submit request form for ICD-10 mapping assistance by May 1, 2015
• For all other ICD-10 questions
3. If you have questions regarding a report not on the ICD-10 Program list for
remediation, work with your ICD-10 Project Manager or submit a remedy
help desk ticket.
56
Readiness Plans for Key Roles
Understanding productivity & education for impacted key non-provider roles
57
Readiness: Coders
Centralized ICD-10 Program-Led
Impact
• Inadequate clinical
documentation and
coding errors
• 50% initial coder
productivity impact
and 20% long-term
impact
Coder Education
Acute & Ambulatory
• eLearning
December 2014
• Practice coding:
Jan – Sept 2015
• Weekly Review:
Jan – Sept 2015
• Assessments &
Refresher Training
Coder Productivity
• CAC implementation
for Acute and
Ambulatory
• Preferred vendors to
provide 50%
additional contract
staff to offset initial
loss
58
Readiness: CDI Specialists (CDS)
Centralized ICD-10 Program-Led
Impact
• Additional
specificity requires
greater number of
queries
CDS Education for
Acute
• eLearning through
January 2015
• In Person Education:
Aug – Oct 2014
• Clinical
Rotation/On-unit
Rounding:
Jun-Sept 2015
CDS Productivity
• Short-term
productivity loss
• Adding CDS Staff
• 33 temporary
• 22 permanent
• Streamlined
Query/Clarification
Forms
59
Readiness: Non Provider Clinicians & Ancillary Staff
Centralized ICD-10 Program-Led
Impact
Education
Productivity
• limited impact
anticipated
• nursing notes are
not used for coding
• eLearning:
June – Sept 2015
• Job Aid* Pilot
April – May 2015
• Job Aid* Training
June – Sept 2015
• Rounding Flyer for
Bedside Nursing
Sept 2015
• Negligible impact
* Job
Aids for roles involving registration, scheduling, and
orders
60
Readiness: Patient Financial Services (PFS)
Centralized ICD-10 Program-Led
Impact
• Cash flow impacts
• Up to 100% increase
in initial (temporary)
denials
• Increase in A/R days
• Increase in billing
edits
• Timeframe: 12-18
months
PFS Education for
Acute & Ambulatory
• eLearning:
Jun – Sept 2015
• Job Aid Pilot: April
2015
• Job Aid & Workflow
Training*:
Aug – Sept 2015
PFS Productivity
• Preferred vendors to
provide additional
contract staff to
offset initial loss of
100%
* Includes: Cutover, Dual Processing and Payer Contingency
61
Readiness: Patient Access, Registration, Scheduling (PAS)
Centralized ICD-10 Program-Led
Impact
• ICD-10 remediation
for Patient Access
functions
PAS Education for
Acute & Ambulatory
• eLearning:
May – Sept 2015
• Job Aid Pilot
April – May 2015
• Job Aid & Workflow
Training*
June – Sept 2015
PAS Productivity
• Negligible impact, if
prepared
*Includes Advanced Beneficiary Notices (ABNs), Prior Authorizations, Referrals,
Pre-registration, Registration, Pre-certifications, Scheduling**
**High impact area spanning both Optum360 and Dignity Health.
62
Roles and Responsibilities – Key Roles
Centralized Program
Local Sites
• Facilitation of education roll-out
• Create payer contingency &
cutover strategies, workflows and
job aids
• Lead centralized committees to vet
strategies for acute & ambulatory
• Provide job aid training
• Advise Optum360 and Ambulatory
leadership to identify and onboard
contractors to off-set productivity
loss
• Validate learners
• Ensure Education participation
• Ensure Job Aid & workflow training
participation
• Operations and logistics support
for onboarding and managing
contractors
63
Readiness Plans for Other Entities
Remediation for Vendors, Joint Ventures, and Payers
64
Readiness: Business Vendor* and Joint Venture
Centralized Program
• Survey entities for readiness
• Escalate any expected noncompliant entities
• At risk vendor remediation:
• Add contract addendums to
protect Dignity Health
• Identify vendors requiring
replacement consideration
Local Sites
• Review/Follow-up on at-risk
vendors as requested
* Your packet will include a list of all Business Vendors being reviewed by the ICD-10 team. 65
Readiness: Payers
Centralized Program
• Survey entities for readiness
• Payer Contingency Plan set for
non-compliant entities
• Business Testing with
participating Payers
• Aetna, Mercy Care, Blue Cross
Blue Shield, United
HealthCare, CMS (Noridian),
Medi-Cal
• Advise Managed Care
Contracting team to ensure
contract readiness
Local Sites
• Ensure PFS participation in
Payer Contingency Job Aid /
Workflow Training
66
Next Steps
67
Workshop Goal Review
• Identified how local sites can increase provider engagement
• Clarified scope for systems, reports, and forms remediation
• Reviewed readiness plans for impacted staff, vendors, and
payers
• Identify any gaps in our strategies
• Work together to prepare for transition
– How would you like us to communicate with you going forward?
68
Remaining Activities: Centralized ICD-10 Team
• Email ICD-10 Workshop packet and copy of deck
• Facilitation of education and job aid roll-out
• Continue to assess business vendors, joint ventures, and
payers and make at-risk recommendations
• Continue to business test with interested payers
• Complete remediation for in-scope systems and reports
• Implement Command Center for go-live support
• Finalize payer contingency and cutover strategies, workflows
and job aids with centrally-led acute & ambulatory committees
• Roll-out ICD-10 key performance indicators (KPIs)
69
Remaining Activities: Local Sites
1. Set up local-leadership to remediate out of scope systems, forms,
and reports
•
If you have questions regarding a report not on the ICD-10 Program list for
remediation, submit a remedy help desk ticket.
•
Contact [email protected] for gray area questions about an application not
on the IAL (Impacted Applications List) or to submit request form for ICD-10
mapping assistance by May 1, 2015.
2. Encourage participation in ICD-10 education opportunities
•
Provide other education support: learner validation, logistics support for in-person
training and MEC resolutions.
3. Participate in job aid training
4. Follow-up on at-risk business vendors (as requested)
5. Operations and logistics support for on-boarded contractors
70
Questions?
[email protected]
71
Appendices: HomeCare
Additional information
72
Home Care—What’s Different?
Educational offerings are specific to Home Care
coders (OASIS)
Home Care Patient Access and Business Office
(PFS) Committees are being formed from the
different sites and services
Committees will address: Impacted Workflows,
Job Aids for PFS and PAS, Payer Contingency and
Cutover/Dual Processing Plans
Home Care will need to be ICD-10 compliant in
August due to CMS guidelines
73
Appendices: ICD-10 Analytics
74
ICD-10 Analytics
Optum Analytics
• Provided insight into DRG and MDC shifts by facility and payer,
and potential best and worst case reimbursement scenarios
• 2012 data complied in 2013
PwC Know Your
Numbers
• Examined DRG and MDC shift down to the Provider (Physician)
level
• 2012 data complied in 2013
HBI Analytics
Managed Care
Contracting Analytics
• Pulled claims volume and reimbursement information by
Physician to be used for the Documentation Assessment
• Current data complied in 2014
• Combined Optum Analytics DRG shift data with actual Dignity
Health contract rates to review expected financial impacts for
DRG based contracts
• Pairs data from 2012-2014, compiled in 2014
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ICD-10: Top Areas Impacted by
Clinical Documentation
Diabetes Mellitus
Injuries
Drug Underdosing
Cerebral
Infarctions
Acute Myocardial
Infarctions
Neoplasms
Musculoskeletal
conditions
Pregnancy
Respiratory/vents
Source: 3M Health Information Systems, 2013
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ICD-10: Common Themes
by Body Systems Disease Processes
PwC
• Signs and
Symptoms
•
•
•
•
•
•
•
Bowel
Infection
Neurosurgery
Cardiovascular
Orthopedic
Respiratory
Skin &
subcutaneous
tissue
• Renal
Optum
• Injuries
• OB
• Complications
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