Health language siemens presentation

Take the Guesswork Out

of the ICD-10 Conversion

Siemens

1

Health Language Clients and Partners

Hospitals and

Health Systems

Clinical Vendors

Content Publishers

Consultants and

System Integrators

Payers and

Governments

HIEs and HIE

Vendors

UK

http://www.nhs.uk/

http://www.nhs.uk/

Brian Levy MD

2

Biography

Brian Levy MD has years of experience in medical informatics

with development of terminologies, clinical content, and the

use of the Internet by patients and physicians to improve care

delivery. He leads a team of physicians, nurses, PhDs, and

professional medical coders in the inclusion of terminologies,

mappings, and other content in the Language Engine.

Dr. Levy is also a practicing Board Certified Internist filling in

as a hospitalist at local hospitals, and received his medical

school training at the University of Michigan. His numerous

articles and presentations in the healthcare informatics arena

detail his experience and expertise in this field.

Today’s Agenda

1 Health Language Overview

2 Financial Analytics

3 Clinical Analytics

5 Benefits to ICD-10-CM

6 Summary and QA

4

Based in Denver, Colorado

Involved with healthcare terminology for 15 years

Signed vendor partner relationship with Siemens 2012

Acquired by Wolters Kluwer Health

Working with hospital systems on the ICD-9 to 10 conversion for 10 years

(UK, Spain, and Australia)

Utilized by over 80 Payers and 50 hospitals in USA

Dedicated to healthcare terminology management and the looming

October, 2014 deadline to convert from ICD-9-CM to ICD-10-CM

Health Language

Overview of Health Language Offerings

Content: including

180+ standardized

terminologies,

mappings, and custom

content

1

Software: for

medical terminology

management and

distribution: the

Language Engine (LE)

2

Tools: for the import,

modeling, mapping,

customization, and

extension of

terminologies.

LEAP I-10/LEAP/PFT/etc.

3

Services: including

custom mapping and

modeling, terminology

consulting, and more

4

Financial Analytics

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Market Problem

Financial Uncertainty

− How does ICD-10 claims impact my revenue cycles?

− Where should I start?

− What can I do to mitigate the risk?

ICD-10 Systems Remediation

− List mappings

− System testing

Business Operations Remediation

− Clinical documentation improvement/MD ed

− Payer/provider contracting strategies

− Service line expansion or reduction

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How We Help

Claims Analytics

− Analyze DRG shifts

− Filter by greatest impact and underlying root cause

− ‘What if’ modeling based on coding attributes

Custom Mappings / Test Data Generation

− Smart GEMs and mapping tools

− Create 837 formatted ICD-10 claims

Data Driven Decisions / Communication

− Automated and exportable CDI notes

− Revenue analysis by payer/provider

− Revenue analysis by service line

LEAP I-10

Market Problem

Financial Uncertainty

− How does ICD-10 claims impact my revenue cycles?

− Where should I start?

− What can I do to mitigate the risk?

ICD-10 Systems Remediation

− List mappings

− System testing

Business Operations Remediation

− Clinical documentation improvement/MD ed

− Payer/provider contracting strategies

− Service line expansion or reduction

8

How We Help

Claims Analytics

− Analyze DRG shifts

− Filter by greatest impact and underlying root cause

− ‘What if’ modeling based on coding attributes

Custom Mappings / Test Data Generation

− Smart GEMs and mapping tools

− Create 837 formatted ICD-10 claims

Data Driven Decisions / Communication

− Automated and exportable CDI notes

− Revenue analysis by payer/provider

− Revenue analysis by service line

LEAP I-10

LEAP I-10 is intended for use by clinicians and analysts responsible for clinical

documentation and operations as well as mappers responsible for IT system

remediation.

The product benefits are also aligned well with finance, coding, and clinical

operations departmental goals across payer and provider markets.

Using Claims Analytics to Drive Your ICD-10 Strategy

DRG

2

DRG

3

DRG

4

DRG

5

DRG

1$

Identify ICD-10 Codes

Driving $ Variance

Coding Best Practice Guidelines

Clinical Documentation

Managed Care Contracting

Strategic Planning

ICD-9

Claim GEMsSimulated

ICD-10

Claims

ICD-9

ClaimCustom

Maps

Modified

GEMs Refined

Simulate

d ICD-10

Claims

ICD-9

Claim

ICD-10

Claim

DRG

GrouperMS-DRG

AP-DRG

APR-DRG

Financial Analytics Use Cases

Payer Contracting Strategies

Targeted Education Strategies

Physician/Service Line-specific CDI

Coding

Strategic Planning (Service Line Strategy)

Finance (Revenue Risk, Budget)

External ICD-10 Testing (ICD-10 Test Data Generation)

MS-DRG shift 307:229, 238, 251

Principal Procedure Driven

ICD-9 Procedure 37.36Excision, destruction, or exclusion of left atrial appendage

(LAA)

$4,784/Case

DRG: 251 (1.7992)

02Q73ZZ -- Repair Left

Atrium, Percutaneous

Approach

02B73ZZ -- Excision of

Left Atrium,

Percutaneous Approach

DRG: 238 (3.083)


Atrium, Open Approach



Endoscopic Approach

02Q73ZZ – Repair Left


Approach

DRG: 229 (4.7745)

02570ZZ -- Destruction of

Left Atrium, Open

Approach


Left Atrium, Percutaneous

Endoscopic Approach

02574ZZ -- Destruction of

Left Atrium, Percutaneous

Endoscopic Approach


Left Atrium, Open

Approach

$28,647/Case

$18,498/Case

$10,795/Case

The LEAP I-10 Story

The client loads ICD-9 claims into LEAP I-10 which simulates ICD-10 claims and generates a

dashboard that allows insights into financial implications, risks, and DRG shifts

Whoa!

We have a problem

Filter by multiple

categories – see top

increases/decreases

The LEAP I-10 Story

As we drill into the claims representing the shift, a flag indicates codes with attributes that are suspect

The LEAP I-10 Story

We can now edit the claim to identify the cause of the shift

& recommendations to normalize the shift

The LEAP I-10 Story

The shift cause is automatically documented directly in the tool (which may live alongside client

authored notes). The user classifies the clinical documentation improvement

(CDI) category as avoidable shift mitigated through effective clinical documentation

It is important to understand and differentiate between avoidable shifts that can be

mitigated through effective clinical documentation as opposed to un-avoidable shifts

which need to be mitigated through payer/provider contracting changes

The LEAP I-10 Story

Clinical documentation generated in the tools can be exported for delivery to the CDI team so that

clinicians and coders can code properly to avoid the shift.

The LEAP I-10 Story

Financial shifts can be exported into reports for delivery to the contract negotiations team

Remediation and Analysis

Business Context Applied

LEAP I-10 Workflow-Review and

Approve

Export Data

Import Data into LEAP I-10

Governance

And

Repeatability

Install and configuration1

• Financial Analysis and Impact

• Mapping and Translation

Initial training and pilots2

• Mapping Rules and Guidelines

• Consistency in Output Ensures Success

• Repeatability for All Users

Establish governance3

LEAP I-10 Key Activities

Use Case-Centric Approach

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Physician Documentation - Clinical Analytics

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Identify the Top diagnoses, referral specifics, diagnostic procedures/orders

Provide focused education at place of service for these top codes

Utilize resources:

HIM managers

Certified coders

ICD-10 champions in each setting

Clinicians

Analytics for Informing Documentation

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0

1

2

3

4

5

6

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Percent of potential I-10 Claims:

Percent of simulated claims

0

10

20

30

40

50

Outpatient Inpatient

Percent of I-10 Codes that are Unspecified:

Percent of I10 Codesthat are Unspecified

Document the Unspecified’s

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J18.9Pneumonia, unspecified organism

Typhoid A01.03

Salmonella A02.22

Tuberculous A15.0

Gonococcus A54.84

Varicella B01.2

Rubella B06.81

Candida B37.1

Pneumocystic carinii B59

Ascariasis B77.81

Influenza J11.00

Parainfluenza J12.2

Streptococcus J13

Hemophilus J14

Klebsiella J15.0

Pseudomonas J15.1

MSSA J15.211

MRSA J15.212

Staphylococcus J15.29

Streptococcus, group B J15.3

Escherichia coli J15.5

Mycoplasma J15.7

chlamydia J16.0

J45.901 Unspecified asthma

Mild intermittent

Uncomplicated J45.20

Acute exacerbation J45.21

Status asthmaticus J45.22

Mild persistent




Moderate persistent




Severe persistent




Benefits

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Benefits:

Update the terminology and disease classifications to be consistent with

current clinical practice and medical and technological advances.

Enhance coding accuracy and specificity to classify anatomic site,

etiology, and severity.

Improve operational processes across the health care industry by

classifying detail within codes to accurately process payments and

reimbursements.

Support refined reimbursement models to provide equitable payment for

more complex conditions.

Provide more detailed data to better analyze disease patterns and track

and respond to public health outbreaks.

Detect and investigate potential fraud or abuse.

Benefits to ICD-10

Why Choose Health Language?

Expertise & ExperienceMore than 13 years assisting providers with mapping & terminology projects

(Domestic & International)

Largest team of clinical informaticists, MDs, PhDs, RNs, PAs, and AHIMA-certified

ICD-10 coders at your service

Relationship with 8 out of the top 10 Payers

TechnologyWeb-based tool, easy-to-use

Scalable and repeatable

4 modules in one: List Mapping/Claims Analytics/Map Creations and Claim Test Data

Generation

Why Choose Health Language?

Healthcare Content180+ Standardized Terminologies

HL SmartGEMs

Provider Friendly Terminology

MU reporting: LOINC, RxNorm, SNOMED CT

Financial Risk AnalysisIdentify risk at DRG and code level (actionable insight)

Leverage HL Coding and Clinical attributes to improve documentation and avoid

selection of UNSPECIFIED ICD-10 codes

Edit ICD-10 claims directly within “Financial Impact Projects” to verify effect of

more specific codes on DRG assignment

Professional ServicesHL offers our expertise to facilitate ICD-10 project management, LEAP I-10 financial

analytics performed using your data by our experts, mapping and medical policy

conversions, and staff augmentation

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Now is the time to:

Start a documentation improvement program or make improvements to

your current one

Assess documentation for ICD-10 readiness

Evaluate staffing needs

Analyze the impact on claims

Implement early clinician education

Establish a concurrent documentation review program

Review coding and compliance policies and procedures

Get started

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Chris Cummins - Director of SalesHealth Language - Wolters Kluwer Health

615.739.4532 mobile (Franklin, TN)720.446.2584 office

[email protected]://www.linkedin.com/in/cumminschris

http://www.healthlanguage.com

mailto:[email protected]

http://www.linkedin.com/in/cumminschris

http://www.healthlanguage.com/

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