Transcript IHIMA DELEGATE UPDATE Summer 2006

IHIMA
ICD-10 UPDATE
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Presented by:
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Background
 ICD-9-CM
 Current coding classification system
 Introduced 30 years ago
 No longer fits with 21st century health system
 ICD-10-CM & ICD-10-PCS
 International standard - diagnostic classification for all general
epidemiological and many health management purposes
 Track, report and compare morbidity and mortality
 Supports achievement of EHR benefits
 Transition to ICD-10 required by federal regulation
Global Use of ICD-10
Background
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ICD-10
 Available
since 1992
 Approximately 100 countries use ICD-10 including
Canada, Australia, and the United Kingdom
 United States: Only industrialized nation not using
ICD-10
 United States: ICD-10 go-live date is October 1, 2013
Background (continued)
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Comparison of the two systems:
Expansion of codes
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13,000 diagnosis codes in ICD-9-CM / 69,000 unique diagnosis
codes in ICD-10-CM
4,000 procedure codes in ICD-9-CM/ 72,000 procedure codes in
ICD-10-PCS
Different code structure, diagnoses for example:
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ICD-9-CM:
ICD-10-CM:
3 - 5 digits / limited alpha characters
3 -7 digits / additional alpha characters
Benefits
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Higher quality information for measuring healthcare
service quality, safety, and efficacy
More accurate payment for new procedures
Fewer miscoded, rejected, and improperly
reimbursed claims
Better understanding of the value of new procedures
and healthcare outcomes
Improved disease management
Data comparability internationally
Impacts
More than Just a Larger Coding Inventory of Systems
According to the Healthcare Information Management Systems Society (HIMSS)
Registration
Registration and scheduling
systems
Advance Beneficiary software
Performance management systems
Medical necessity edits
Clinical Systems
Clinical systems
Clinical protocols
Test ordering systems
Clinical reminder systems
Medical necessity software
Disease management
systems
Decision support systems
Pharmacy systems
HIM
DRG grouper
Encoding software
Abstract systems
Compliance software
Medical record
abstracting
Billing/Financial
DRG grouper
Conversion of other payment
methodologies
National and local coverage
determinations
System logic and edits
Billing systems
Financial systems
Claim submission systems
Compliance checking systems
Support Systems
Case Mix systems
Utilization management
Quality management
Case Management
Reporting
Provider profiling
Quality measurement
Utilization management
Disease management registries
Other registries
State reporting systems
Fraud management
Aggregate data reporting
Clinical systems
Patient assessment data sets (e.g. MDS,
RAI, OASIS)
Impacts
Impact Assessment – Next Steps
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Continue to investigate systems for potential impact
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Determine impact (if any) to pharmacy systems
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Continue vendor/system support analysis meetings
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Finalize overall plan/timeline
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Finalize budget impact
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Obtain Project Charter approval
Costs
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Training
Lost
productivity
during
implementation & training
System upgrades/changes
Contract re-negotiation
Additional resources to support
and manage implementation
Costs – System Implementation
Costs - Additional
Preparation
Early Preparation
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A well-planned, well-managed implementation process will increase the
chances of a smooth, successful transition
Experience in other countries has shown that early preparation is the key to
success.
An early start allows for resource allocation, such as costs for systems
changes and education, process evaluation and change, as well as staff
time devoted to implementation processes, to be spread over several years.
Potential Consequences of Inadequate Preparation:
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Decreased coding accuracy
Decreased coding productivity
Increased compliance risks
Increased claims rejection
An adverse impact on patient care and administrative decision-making
HIPAA 5010 Background
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HIPAA legislation mandates that the healthcare industry use
standard formats for electronic claims and related transactions
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The formats currently used must be upgraded from X12 Version 4010A1 to
5010 and from NCPDP 5.1 to D.0
Version 5010 includes changes to the following transactions:
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270/271, Eligibility Benefit Inquiry and Response
276/277, Claim Status Request and Response
278, Health Care Services – Request for Review and Response
820, Premium Payment for Insurance Products
834, Benefit Enrollment and Maintenance
835, Claim Payment/Advice
837, Claim including Coordination of Benefits (COB) and subrogation
claims
 NCPDP D.0, Pharmacy Claim
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Required to prepare the infrastructure needed to support ICD-10
HIPAA 5010 Background cont’d
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Level I Compliance by: December 31, 2010
Level II Compliance by: December 31, 2011
All covered entities have to be fully compliant on:
January 1, 2012
Level I compliance means "that a covered entity can
demonstrably create and receive compliant transactions,
resulting from the compliance of all design/build activities
and internal testing."
Level II compliance means "that a covered entity has
completed end-to-end testing with each of its trading
partners, and is able to operate in production mode with
the new versions of the standards."
Compliance Timeline per Federal Rule
Progress
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Interviewed potential project managers
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Steering Committee
members as needed
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Capturing IT costs as they become known (software,
resources)
continues
to meet
and
add
Next Steps
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Continue to investigate systems for potential impact
Incorporate ICD10 in system inventory
Secure project manager for ICD10
Determine official project sponsorship
Identify point of contact for all facilities and organizations
Formal collaboration between HIPAA 5010 and ICD10 teams
Continue and expand leadership education efforts
Bring further information and decision points to ITGC
Questions?
Resources
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American Health Information Management Association (AHIMA)
Hay Group, Inc.
Healthcare Information Management Systems Society (HIMSS)
RAND
Robert E. Nolan Company
Pricewaterhouse Coopers
http://www.cms.hhs.gov/TransactionCodeSetsStands/02_Transa
ctionsandCodeSetsRegulations.asp
http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp