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Transcript of WEBINAR: Low-Cost, High- Impact ICD-10 Action Steps · PDF fileWEBINAR: Low-Cost, High-Impact...

  • WEBINAR: Low-Cost, High-

    Impact ICD-10 Action Steps

    for Providers

    Your free participation has been made possible by:

  • ICD-10: Low Cost, High Impact Action Steps for Providers

    Rhonda Buckholtz, VP, ICD-10, AAPC

    Robert Tennant, Senior Policy Advisor, Medical Group Management Association

    Mandy Willis, ICD-10 Consultant, Healthcare IS, Group Health Cooperative

  • Now with the Delay-Consider These Low Impact, Low Cost Implementation Steps

    1.Organize Internally and conduct an Internal Assessment

    2.Evaluate and Chart Readiness

    3.Clinical Documentation Improvement

    4. Documentation Exercises

    5.Trading Partner Monitoring/Outreach

    6.Identify Testing Opportunities

    7.Explore automation

  • 1. Organize Internally and Conduct an Internal Assessment

  • Organize and Assess

    Review changes to compliance timeframes

    ID leaders who represent impacted functions from coding to technology

    Establish WGs to execute revised implementation plan

    Present ICD-10 overview to staff explain the date changes as well as the importance and scope of this new code set

    Communicate regular updates and alerts

    Dates, contacts, staff responsibility, progress

    ID vulnerabilities (ie, clinical trials, workers comp)

  • Organize and Assess

    Who assigns your codes? Clinicians themselves?

    In house professional coders?

    Professional coders outside the practice?

    Each requires an assessment and may require training

    When should you train internal staff? Too early, another delay. Too late, may not be ready

    Consider 3-6 months out

    Require proof that your external coders have been retrained (re-certified)

  • Output




    Review Your Revenue Management Cycle Processes


    WARNING! Inaccurate

    documentation/ coding will cause:

    Productivity loss Increased denial/

    rejections Increased




    Capitation Payments

    Fee-for-Service Payments

    Cash Payments


    Claims submission

  • Points of Code Contact


    Lab/ Imaging Orders

    Labs and Imaging providers rely on accurate codes from providers


    Referrals/ Prior Authorizations

    Referrals to specialists and prior authorizations for

    procedures/services and/or drugs require accurate diagnostic information

    Medical Record

    Remittance / Denials / Appeals

    Inaccurate coding will result in claims denials and appeals

    Coding/ Billing/ Claims


  • Manual & Automated Processes: Improvement Opportunities


  • Identify Your Manual Processes

    Clinician Clinical Documentation Improvement (CDI) Legibility Clarity

    Clinical Staff Medical record documentation support Lab orders Referrals Prior authorizations

    Billing Staff Coding and billing Claims submission AR Aging

  • Identify Your Automated Processes

    Clinician Clinical Documentation Improvement (CDI)



    Clinical Staff Medical record documentation support

    Lab orders


    Prior authorizations

    Billing Staff Coding and billing

    Claims submission

    AR Aging

  • Identify Critical Relationships


    Physician Practice

    Imaging Centers

    Clinical Labs






    Practice Management


  • Carpe Diem

    Improvements made in preparation for ICD-10 are investments in improving the overall efficiency of the physician practice.

  • 2. Evaluate and Chart Readiness

    Create an ICD-10 Action Steps spreadsheet that


    Dept, division or impacted area of the practice Software product Software needs to be upgraded (yes/no) Software needs to be replaced (yes/no) Vendor contact info (not just the sales rep) Vendor contacted (yes/no) Vendor responded (yes/no) Date indicated for upgrade/replacement Estimated cost (including training and hardware) Workflow change required (yes/no) Practice staff assigned/responsible Notes/resolution

  • 3. Clinical Documentation Improvement

  • Documentation is only good if the next physician who treats the patient can pick up your record and know exactly what happened


  • Supporting Medical Necessity

    Justification of care depends on information found in the medical record

    Diagnosis codes identify circumstances of patient encounter

    Medical record documentation must be supportive

  • Does documentation support code?

    Are there policies in play?


    Does documentation support reporting requirements

    Are disease processes well documented

    Quality reporting Are operative notes

    complete in information

    Have all areas of risk been identified and covered by documentation?


  • Criteria for Documentation


    Past and present diagnoses easily accessible

    Appropriate health risk factors identified

    If not documented, easily inferred

    Patient progress and response to any changes in treatment or revisions of diagnosis should be documented


  • Criteria for Documentation


    Each patient encounter should include:

    Reason for the encounter with relevant history

    Examination findings

    Diagnostic test results


    Clinical impressions

    Plan of care


  • Criteria for Documentation



    Patient is seen for shortness of breath, chest pain, fever and cough; chest xray indicates aspiration pneumonia-physicians assessment states pneumonia

    Complete, precise documentation would indicate in the assessment that the patient has aspiration pneumonia- further query of the patient should be done to determine the cause of the aspiration, such as food, milk, solids, microorganisms, etc


  • Severity


    Temporal factors




    Associated with


    Pregnancy related





    Time parameters

    Infectious agent

    Remission status

    Associated conditions

    Contributing factors

    History of

    ICD-10-CM Documentation


  • How CDI Can Improve Your Practice

    More complete documentation can assist your RCM staff more accurately bill for services

    Additional (legal) protection in the case of an audit (old adageif it wasnt written down, it didnt happen)

    Improved information flow to the patient (more and more gaining access)

    Improved information flow for transitions of care (i.e., to PC, specialist, skilled-nursing, long-term care)

    Improved research and education

  • 4. Documentation Exercises

  • Documentation Audits

    Analysis of documentation for content and validity/medical necessity relationship

    Analysis of documentation in relationship to coding and billing

    Identification of patterns and trends in documentation

  • Your CDI (Clinical Documentation Improvement) department can start now conducting ICD-10 documentation audits or hire a consultant

    Identify your top 25 most frequently billed codes using ICD-9-CM principal diagnosis codes using previously and successfully adjudicated claims and map to ICD-10-CM codes

    Determine whether the records contain the necessary clinical information to support the ICD-10-CM principal diagnosis

    Teaching opportunity

    Utilize peer-to-peer dialogue

    Example: Documentation Audits

  • Again with your top 25 ICD-9-CM principal diagnosis codes, practice dual coding live claims by mapping to ICD-10-CM codes

    Begin auditing to determine whether the records contain the necessary information to support the ICD-10-CM principal diagnosis code

    Consider this exercise with multiple payers (especially once they release payment policies)

    Example: Dual Coding

  • 5. Trading Partner Monitoring/Outreach

  • Trading Partner Outreach-Software Vendors

    Ascertain what systems need to be upgraded or replaced. Then ask vendors:

    Upgrade or replacement?

    Which version(s) will be upgraded?

    Costs covered under maintenance agreement?

    Timeline for installation / testing

    Hardware upgrades required?

    Utilize 4010 or 5010?

    Will software permit both ICD-9/10 codes?

    Are they offering any training?

  • Trading Partner Outreach-Clearinghouses

    Questions to ask:

    What ICD-10 services will you provide?

    What if we are on 4010 (workarounds)?

    What will be the cost of your I-10 services?

    When can you accept test claims?

    Will you publish a listing of payer readiness and payer testing schedules?

  • Ask Your CH for the Following Reports

    List of your top claims:

    Paid (volume, amount)

    Rejected (payment policy/documentation)

    Pended (payment policy/documentation)

    Where unspecified codes were used

    Leverage these reports during your CDI exercises

  • 6. Identify Testing Oppor