ICD10PlayBook: NewToolsforSuccessfulTransformation l f f l f i

May25,2011

Thankyou tooursponsors! Thank you to our sponsors!

Today sLearningObjectives: Todays Learning Objectives:

1. Reviewhowtoaccesstheindustrysbesttoolsandtacticsfromthisfree, webbasedresourcemaintainedbyleadingICD10experts 2. ExplorethewiderangeofICD10challengesandsolutions from implementationtoriskmitigationstrategies 3. LearnhowtheICD10Playbookcanhelpyouduringeverystepof conversionprocess 4. TakeyourquestionstothispanelofICD10expertsandtopprofessionals fromhealthcareassociations,healthplans,providers,banksandfinancial from healthcare associations health plans providers banks and financial institutions.

Housekeepingitems:
YoumaysubmitaquestionorcommentatanytimebyaccessingtheQ& Aboxatthelowerbottomrightcornerofyourscreen A box at the lower bottom right corner of your screen TypeyourquestionintheQ&Atextboxandpresssend Wewillmakeeveryefforttoansweryourquestions Wewilltrytoaddressquestionseitherthroughtypedchatorontheair W ill t t dd ti ith th ht d h t th i duringthepresentationsliveQ&A

LegalDisclaimer g
Todayswebinarispresentedforinformationalpurposesonly,andnoneof itscontentshouldbeconstruedaslegaladvice.HIMSSmembersare it t t h ld b t d l l d i HIMSS b stronglyencouragedtoreadtherespectivelegislativetextsand/orconsult withlegalcounsel.Ifyouhaveanyquestionsregardingtheinformation sharedduringthiswebinar,oranyHIMSSactivities,pleasecontactus.Visit shared during this webinar or any HIMSS activities please contact us Visit ourwebsiteforthelatestdevelopments.

TodaysModerator
ToriSullivan,MHA,RHIA,PMP ICD 10 Business Solutions Professional ICD10BusinessSolutionsProfessional IBM,GlobalBusinessSolutionsDivision currentlyservesascochairfortheHIMSSRevenueCycle

TodaysPresenters y
TysonMcDowell C O f CEOofBenchmarkRevenueManagement h k currentlyservesascochairfortheHIMSSRevenueCycle ImprovementandFinancialSystemsTaskForce. Improvement and Financial Systems Task Force. hasfocusedonleveragingtheInternetfortrue interoperability,scalability,andrapidapplication development.

Today sPresenters,(cont.) Todays Presenters, (cont.)

RossLippincott Vice President of 5010 and ICD 10 deployment programs at VicePresidentof5010andICD10deploymentprogramsat UnitedHealthcare heldavarietyofrolessupporting hospitalandphysicianoperations spent13yearsasaconsultantwithAccenture'sHealthcareand t 13 lt t ith A t ' H lth d Governmentpractice holdsanMBAfromtheUniversityofKansas

ICD10PlayBookDemonstration

VantagePointSurvey
SurveylaunchedinAprilof2011andresultsincluded353Responses. Nearly1/3ofrespondentsnotedthattheinformationwouldhaveno impactontheirorganization'sprep.forconvertingtoICD10. i h i i i ' f i ICD 10 Asimilarpercentnotedtheguidelineswouldbeofuseeitherinthe conversionprocessesunderwayeitherathealthcareorganizationsorof theproductsandservicesofferedtotheindustryinthisarea. th d t d i ff d t th i d t i thi 73percentofrespondentsnotedthattheyturntoassociationsasa resourceforinformationontheirICD10conversion;72percentturnto thefederalgovernment. th f d l t

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Impactof2011CDCGuidelinesonICD10Conversion
OnethirdofrespondentsnotedthatCDC'spostingofguidelineshas hadnoimpactontheirorganization'spreparationsforconvertingto ICD10.Anotherquarternotedthatthepostingwillhelptheconversion effortsattheirhealthcarefacility,and11percentindicatedthatthis efforts at their healthcare facilit and 11 percent indicated that this informationwillbeusefulasmodificationsaremadetoproductsand servicesinadvanceoftheconversionprocess.Thegreatestconcern thatrespondentshavewithregardtotheirICD10conversionisthe that respondents have with regard to their ICD10 conversion is the revenuelosstheyfaceduetocodingissues.

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GreatestChallengeAssociatedwithICD10Conversion g
Onethirdofrespondentsnotedthatthegreatestchallenge organizationsfaceastheyundertakeICD10conversionisalackof staffingresources.Another19percentnotedthatalackof synchronizationbetweenpayersandproviderswouldpresent challenges.

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GreatestConcernRelatedtoMeetingICD10 g ImplementationGuideline
Nearlyhalfofrespondentsnotedthattheirgreatestconcernrelatedto meetingtheICD10implementationguidelineisarevenuelossduetoa bottleneckofcodingissues.Onlyfivepercentofrespondentsare concernedthattheirorganizationwillmisstheOctober2013deadline andbepenalized.

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InformationSourcesforICD10Conversion
Nearlythreequartersofrespondentsnotedthattheyturnto associationsforinformationontheirICD10conversion.Asimilar percentreportturningtothefederalgovernment.Clearinghouseswere leastlikelytoidentifyasaresource.

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IDC10:Impactonthe IDC 10 I t th RevenueCycle y

TysonMcDowell T M D ll CEO,BenchmarkRevenueManagement tmcdowell@benchmarkrevenue.com

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LearningObjectives
Clarifydefiniteareasofpotentialfinancialimpact Understandtheinvestmentsthatwillprotectyoufromtheunknown UnderstandtheanalysesthatwillbringICD10bleedtothefore IdentifyunintendedconsequencesofpoorICD10implementationand maintenance

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ThisIsntPayerVersusProvider
ICD10challengesboth payersandproviders Thereis2yearsofuncertaintyafterimplementationforeveryone There is 2 years of uncertainty after implementation for everyone But,sophisticationwillyieldrealfinancialadvantageforthosewho executewell. t ll

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PayersPerspective
ICD9toICD10isnotapplestoapples Casemixanalysiswillincludeassumptions,addinguncertaintytorisk exposure Uncertaintyinriskexposuremeansnecessaryconservatismtoprojecting risk Thistranslatesto: Higherpremiums Morediligencetoclaims Focus on re casting contracts and subscriber mix based on new Focusonrecastingcontractsandsubscribermixbasedonnew ICD10basedutilizationdata

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RisksEveryoneTalksAbout
Costofconversion ICD9 ICD9 to ICD10 ICD10mappinginconsistencies i i i i Lossestolackoftraining Thesearealldirectandthereforeavoidable.Itjusttakesdiligence.

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HiddenRisks:RealityofChange
PayerReadinessVariability NecessaryPayerConservatism InevitableLenderUncertainty ReimbursementRestructuring Theseareindirectandcomplextounderstand,butcancause irreversibledamage.

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HiddenRisk:PayerReadiness
Payershavetodoextensivemodelingthemselves,whichwillcontinue afterfirstrollout Theymaybetechnicallycompliant,butwilladjustrulesregularlyasthey learn,changingthegameontheprovider Configurationmistakescanleadtomanyrebills(cashflowdelay,higher g y ( y, g costofadmin)

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HiddenRisk:PayerConservatism
Payersmustbemorediligenttoassumemiscoding Increasedenialrate Payersmustbemorediligenttovalidateappeals Cashflowdelays Payers must be more diligent to validate appeals Cash flow delays Payersmustevaluatecontractsonassumptivetrenddata,erredonthe worstcasescenario,untilrealICD10trendstakeover Contracts negotiatedtopayerfavor negotiated to payer favor

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HiddenRisk:LenderUncertainty
Lendersknowthattherewillbeablipincashflow Increasedpressureoncash on hand Increased pressure on cashonhand Lendersknowthattherewillbeaslipinnetrevenue Increasedscrutinyofoperatingmargin Lendersknowthathistoricaltrendswontnecessarilyapply goingforward RatingstobeMoreConservative

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HiddenRisk: RestructuredReimbursementModels
PayerswillgetgoodatICD10,andadjustreimbursementpatterns Payers will get good at ICD10 and adjust reimbursement patterns accordingly ICD10isbuiltforenhancedclarity,startinglogicallywithtightening reimbursements Easiestmeasureisreducedcostofservices,notadjustingpaymentto coverallservicesprovided Untilefficacyofserviceispartofmodel,providerscantwinbackpayer U til ffi f i i t f d l id t i b k gainsinnarrowerreimbursementmodels

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HiddenRisk:PreparationDistraction Hidden Risk: Preparation Distraction

Manycompetinginitiativesdistract EMR,MeaningfulUse,ARRA SeetheHIMSSRevenueCycleHorizonwhitepaperfordetails ICD10carriesthelargestrisktofinancialhealth g ICD10seemstobeaneglectedtopicbyProviders

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RiskMitigation g
Buildadatawarehouse Financialdatamergedwithclinicaldata a c a da a e ged c ca da a Cover3yearsofhistory ApplyGEMmaps Project per service per payer gross margins Projectperservice,perpayergrossmargins HireananalystandCrossTraininICD10codingandRevenueCycle101 Considercooperationinthisamongfriends PlanforOutsourcing Communicatewithyourlenders&ratinganalysts

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TakeAways
2013isjustthebeginning,ifyougetbehind,youwillstaybehind PayeroptimizationofICD10basedmodelsthrough2015willhavelong P ti i ti f ICD10 b d d l th h 2015 ill h l termimpact,nottheconversioncomplexities Sophisticationistheonlydefense,soinvest,partner,collaborate,ordoall three th Budgetforreducedcashflowandhigherdenialrates20132015 Getapprovedforadditionallinesofcredit,now Communicatewithfinancialinstitutionsaboutyoursophisticationsothey perceivelessrisk

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SuggestedReading gg g
MillimanWhitePaper:ICD10ImpactonProviderReimbursement h // bli i http://publications.milliman.com/publications/health illi / bli i /h l h published/pdfs/icd10impactprovider.pdf ICD10Watch:MajorICD10FactorsinProviderReimbursement http://www.icd10watch.com/blog/majoricd10factorsprovider reimbursement BenchmarkICD10ReadinessChecklist http://www.benchmarkrevenue.com/icd10

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ICD10G7RoundtableAdvisoryReport &HealthPlanPerspective
RossLippincott VicePresident5010&ICD10Programs UnitedHealthcare

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Agenda
HIMSSICD10G7RoundtableSummary ICD10Concerns/RisksDiscussed FinancialRisks PracticeRisks Work Force Risks WorkForceRisks UHCPerspectivesonImpactstoPractices HowtoContactUs UHCPlaybookContent

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HIMSSICD10G7RoundtableSummary
InteractiveinpersonsessionatVanderbiltCenterforBetterHealthin Nashville Representativesfromallindustrygroups(providers,vendors, clearinghouses,payers,banks) p p y Discussedtheconceptoftheplaybook Howtopresenttheinformation howtocollaborate Whatshouldbeincluded

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HIMSSICD10G7RoundtableSummary (Cont.)
Assignedscenariosfromdifferentperspectivesthatwereroleplayedoutto identifyrisksandmitigationthoughts DiscussedDevelopmentoftheplaybook How do we get it going Howdowegetitgoing Howdowegetthewordout Whattoincludeinversion1.0 Howtogrowtheplaybookcommunity Engagementchannels

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Concerns/RisksDiscussed Financial
Risks
Sustainabilityinthefaceofpotentialfinancialimpacts Delayed payments due to utilization of new codes Delayedpaymentsduetoutilizationofnewcodes Increaseinaccountreceivables Cashflow/lineofcreditrisksduetopossiblenegativerevenuecycle impacts Industryestimatesindicatetherecouldbeuptoafiveyearstabilizationof cashflowpostICD10cutover

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Concerns/RisksDiscussed Financial
Mitigation
Establishasolidfinancialbaseline/revenuecycleupfront WhatdoesmyICD9worldlookliketoday? WhatthingsdoIneedtothinkaboutfromamodelingstandpointgoing forward? WhatdoIneedtomonitoronthebackend?

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Concerns/RisksDiscussed Financial
Mitigation,(Cont)
Cashflowmanagement Establishbridgeplanwithbanksinadvance Considerreservinguptosixmonthsofrevenuepriortodeployment Havetoolsandprocessestoanalyzeyourcashflow Establish a contingency plan if a drop in revenue were to occur Establishacontingencyplanifadropinrevenueweretooccur

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Concerns/RisksDiscussed Practice
Risks
Incremental effort required to support increased granularity of codes could Incrementaleffortrequiredtosupportincreasedgranularityofcodescould decreaseproductivity Moredetailedmedicalrecords M Moretimetotranslatebycoders ti t t l t b d Increaseproviderqueries Increaseddelaysinauthorizations Increasedclaimrejections Moretimetoresearch/resolvereimbursementissues

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Concerns/RisksDiscussed Practice
Risks,(Cont)
Trainingrequirements Physicians Coders OfficeStaff Possiblepatientthroughputlossduetoincrementaleffortrequired duringtransitiontoICD10

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Concerns/RisksDiscussed Practice
Mitigation
Establishasolidpracticeperformancebaselineupfront.Ifyoudont knowwhereyoustarteditshardtogaugehoweffectiveyouwerewhen finished. Collaboratewithpayerspriortoimplementationtounderstandbaseline performance. Newcodingwillchangeeveryone snumbers New coding will change everyones numbers Needawarenessofwhatyourchangeisrelativeto

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Concerns/RisksDiscussed Practice
Mitigation,(Cont.)
Performanexternalcodingaudit Blankcodingexamsandcertificationexamsforstaffduringthe projectimplementationphase project implementation phase Makesurethatyouunderstandhowtotranslatethecurrencyofyour businesscoding

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Concerns/RisksDiscussed WorkForce
Risks
Jobtransitions/Retirement Agingworkforce Shortage of ICD 10 coding skills requiring years to master ShortageofICD10codingskillsrequiringyearstomaster Timingwillhaveimpact morestress=moresearchforgreenerpastures(workenvironment, pay,etc.) ) Inexperiencedworkforcecomingintoaverydifficultclimate Training Lackoftools Competingpriorities(5010,EMR,MeaningfulUse,etc.)furtherincrease stress
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Concerns/RisksDiscussed WorkForce
Mitigation
Understand,valueandinvestinyourpeople Consideraugmentingyourstafffortheinitialtransition Help bridge initial decreased productivity Helpbridgeinitialdecreasedproductivity Betterabletoabsorbattrition Reducestress(stress=mistakes) TooearlyforfullstafftrainingonICD10now,butnotforbrushingupon anatomyandphysiology(morecriticalinICD10)

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Concerns/RisksDiscussed Practice
Mitigation
Establishasolidpracticeperformancebaselineupfront.Ifyoudontknow whereyoustarteditshardtogaugehoweffectiveyouwerewhenfinished. Collaboratewithpayerspriortoimplementationtounderstandbaseline performance. Newcodingwillchangeeveryonesnumbers Needawarenessofwhatyourchangeisrelativeto

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Concerns/RisksDiscussed Practice
Mitigation
Performanexternalcodingaudit Blankcodingexamsandcertificationexamsforstaffduringtheproject implementationphase Makesurethatyouunderstandhowtotranslatethecurrencyofyour g businesscoding

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UHCPerspectivesonImpactsto Practices

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ICD10ImpactsonPhysicians&Facilities
Differenttypesofphysicianpractices yp p y p willexperiencedifferentimpacts:
Privatepracticephysicians(solo, smallgroup) ll ) Largephysiciangroups Employed&academicphysicians (allmodels) Government,Researchersand Government, Researchers and othertypes

Physicianpracticesarehighlycost sensitive,andarealreadycontending with:

HIPAAChanges AmericanRecoveryand ReinvestmentAct(ARRA)/Health InformationTechnologyfor EconomicandClinicalHealth (HITECH)meaningfuluseincentive (HITECH) meaningful use incentive driversandpenaltyavoidance ePrescribingincentives/penalties PhysicianQualityReporting Initiative(PQRI)Incentives& Initiative (PQRI) Incentives & penalties

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Bottomline:physicianswillhavetoincrease Bottom line: physicians will have to increase levelofmedicalrecorddocumentation acrossallplacesofservice 45

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ICD10Considerations People
Physician:ICD10requiresdetaileddocumentationofsurgical procedures;moretimetodocument Codingstaff: Willrequireincreasedanatomyandsurgicalprocedureknowledge; moretimetodocument more time to document Potentialincreaseincodingstafftosupporttransitionandminimize productivitylosses

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ICD10Considerations People
Entirepractice: Extensive retraining for physicians coding and revenue cycle staff Extensiveretrainingforphysicians,codingandrevenuecyclestaff
Productivitylossesshouldbeexpectedduringtheinitial36months duetosteeplearningcurveassociatedwithuseofICD10CM/PCS

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ICD10Considerations Processes
Officebilling/codingworkflow Increasedcodingqueriestophysiciansforfurtherdocumentation d d h f f h d Contractingcodecrosswalksreexamined Medicalmanagementprogramrequirements PriorAuthorization/Notificationchanges Increasedcomplexity/requirements

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ICD10Considerations Processes
Billing&ReimbursementAccounting A l i d t di b Analysisandtrendingbypayer,changesincodinganddatatrends h i di dd t t d
Previousdataanalysisobsolete Extensiveremappingrequired(i.e.comparinghealthcareoutcomes fromICD9toICD10) from ICD9 to ICD10) Developaplanformonitoringrevenueimpactandresponses

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ICD10Considerations Technology
PracticeManagementSystem Codefieldtype/sizeincreaseto3 7alphanumericcharactersinall applicationsusingICDcodes(includingallclinicalandfinancial applications using ICD codes (including all clinical and financial applicationswherecodesareentered/reported) RedesignSystemInterfaces g y

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ICD10Considerations Technology
SoftwareChanges Codeeditingprograms(Example:Encoder)willneedtobeanalyzed, gp g ( p ) y , redesignedandtested RecalculationofDRGgroupersandcasemixindexes inpatientbilling ElectronicDataExchanges HeavyFacilityImpact Reportingtofederal,state,andotherregulatoryagencies/authorities willneedtobeanalyzed,redesignedtoaccommodatenewdataand tested Example Community/state proprietary birth and death registries Example Community/stateproprietarybirthanddeathregistries

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TheICD10transitioncanresultinsignificantvaluerealizationifimplementationisplannedforsuccess(once thedustsettles) Benefit Strategicimperative HowAchieved ICD10transitionshouldbeviewedmorebroadlythancomplyingwitha governmentregulation;itservesasanopportunitytocreate differentiationandnewandincrementalvaluefortheorganization. Morespecificdiagnosisreporting Casemixadjustments Morespecificqualitymonitoring/reporting;e.g.,StentInsertion(specific codesforopenvs.subcutaneousstentinsertions) Fewerclaimrejectionsanddenialsduetononspecificdiagnoses Fewerrequestsforclinicalinformation Expectations of fewer denials from payers could result in significant Expectationsoffewerdenialsfrompayerscouldresultinsignificant reductionofrework/administrativeexpenseforbothphysiciansand payers Morespecificdiseasemanagementprograms Targetedreimbursementbasedonreviseddiagnosesandprocedure 52 coding

BenefitsofICD10Implementation

PositiveimpacttoCaseMix /QualityReporting

Reducedcycletime Increasedthroughput Reduced administrative Reducedadministrative expense Positivelyaffectpatient/ communityhealth Enhancedreimbursement

ICD10andtheHealthCareIndustry
Practitioners will look to specialty societies/state medical associations Practitionerswilllooktospecialtysocieties/statemedicalassociations forleadershipinareasof: Codecomprehensionofspecialtyspecificchanges Documentationguidancetosatisfymedicalnecessityrequirements andincreasedgranularityoftheICD10codeset Training/Educationthatisspecialtyspecific Communicationofregulations,guidelinesandupdates PracticeManagementissues S i l Specialtysocietieshaveauniqueopportunitytostrengthentheir i i h i i h h i presenceintheindustryandleadanICD10calltoactionwithinthe medicalcommunity

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ICD10andtheHealthCareIndustry
PractitionersshouldengageinICD10readinessdiscussionswith: Vendors EMR/EHR PMIS Financial Clearinghouses HealthPlans TradingPartners ProvidersmustknowiftheirbusinesspartnerswillbereadyforICD10. EarlyengagementisthekeytosuccessfulICD10implementation!
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ICD10Communications
ICD10Communication/Outreachwillbeanimportant / p toolinstrengtheningthepayerproviderpartnership
CommunicationMaterial/PathwaySuggestions: / y gg FreeOnDemandTraining Webinars InpersonProviderTownHalls/Educationsessions FreeIndustryInformativeMaterials FAQs Bl Blogs Newsletters,Bulletins Takeadvantageofexistingprovidercommunicationvehicles

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ICD10Communications
ICD10Communication/Outreachwillbeanimportant / p toolinstrengtheningthepayerproviderpartnership
WebSite ForexampletheUHCpublicICD10Websitelocatedat: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?cha nnelId=6fa2600ae29fb210VgnVCM1000002f10b10a GeneralQuestionsMailbox: ICD10Questions@uhc.com GeneralQuestionsTelephoneline/Hotline

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UnitedHealthcareICD10Playbook Content
PlaybookcontentisformattedinMicrosoftPowerPoint,anddividedinto5 sections: 1. ICD10Challenges&Benefits 2. ICD10ReadinessatUnitedHealthcare 3. ICD10Strategy:CostNeutralityatUnitedHealthcare 4. Physician,Hospital,andMedicalSocietyReadiness 5. HowtoContactUnitedHealthcare AsaCharterSponsoroftheHIMSSICD10Playbook,UnitedHealthcarewill alsoofferadditionalFAQsdocumentsandaprovider/facilityfocusedICD 10ReadinesswhitepaperwhichwillbeavailableontheHIMSSICD10 y Playbooksite.
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Q&APanel
RhondaBuckholtz,VPofICD10EducationandTraining,AAPC VincentMarzula,ManagingDirector,BNYMellon g y DeniseHall,Shareholder,PershingYoakley&Associates,P.C. W.JamesLloyd,Shareholder,PershingYoakley&Associates,P.C. JulietSantos,SeniorDirector,BusinessCenteredSystems,HIMSS

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Q&Aprocess Q&A process

TypeyourquestionintheQ&Atextboxandpresssend
Wewillmakeeveryefforttoansweryourquestions WewilltrytoaddressQuestionseitherthroughtypedchatorontheair duringthepresentationsliveQ&A d i h i li Q&A

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ICD10Playbook
Locatedat:http://www.himss.org/ASP/topics_ICD10Playbook.asp Ifyouhavecontentthatyoufeelwouldbevaluabletoanytabswithinthe y ,p j g ICD10Playbook,pleaseemailJulietSantosatjasantos@himss.org.

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Again,Thankyou tooursponsors! Again Thank you to our sponsors!

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