ICD-10 Project Management, 15 Benchmarking And Data

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Barbara Godbey-Miller, RHIA, CCS, CHCAHIMA Approved ICD-10 CM/PCS Trainer5/29/2015New York Health InformationManagement AssociationICD-10 Project Management,Benchmarking and DataAnalytics

Agenda Project Management Process and Terms Stakeholders Project Manager Skill Set Project Roles Knowledge Areas Process Groups Risk Management Communication Management ICD-10 Implementation Project Management2

Basic Project Management Project Management coordinates a set of tools and techniques to describe,organize, and monitor the work of project activities which are performed bypeople.Process Inputs, Outputs and Tools/Techniques combined to execute a specificpurpose on the project3

Stakeholders Individuals, businesses, or communities that have a vestedinterest in the project's outcome. Project stakeholders are generallyinvolved in the project process and their expectations drive theproject requirements.Key Stakeholders Project manager Manages the project Project team The collection of individuals completing the projectwork Project Sponsor Authorizes the project work and budget4

Project Manager’s Management Skills LeadingCommunicatingNegotiatingProblem SolvingInfluencingJack of all Trades5

Project Roles Senior Management Issues Strategic plans and goals, ensures company’s projects are alignedwith company goals Maybe called upon to resolve conflicts within the organization. Functional Manager Departmental Manager, i.e Manager of Engineering, Vice President ofMarketing, Director of IT Project Office Department that supports the PM in His/Her roles. Defines best practices, defines standards, Maintains Lesson Learned6

Triple ConstraintCost or Resources7

Process Groups and Knowledge Areas47 Process organizedinto 5 Process Groups1. Initiation2. Planning3. Execution4. Control5. ClosingKnowledge Areas1.2.3.4.5.Integration ManagementScope ManagementTime ManagementCost ManagementProject QualityManagement6. Human ResourcesManagement7. CommunicationsManagement8. Risk Management9. Procurement Management10. Stakeholder Management8

Project Management Process Groups Project Authorized Planning Projectobjectives aredetermined. Executing The project Controlling ProjectPerformance Closing The project9

Risk ManagementThe process of conducting risk management planning,identification, analysis, response planning, andmonitoring and control on the project.Process NameProcess GroupKey OutputsPlan Risk Mgt, IdentifyRisks, Qualitative Risk,Quantitative Risk, Plan RisksresponsePlanningRisk Management Plan, RiskRegister, Risk registerupdatesControl RisksMonitoring and ControllingRisk register updates,Change Requests10

Plan Risk Management Risk Probability and Impact Assessment The likelihood that each specific risk will occur, level of probabilityInvestigate the potential effect on the project, Cost, Schedule, Quality,Performance, Positive or Negative Analytical Techniques Cause and AffectSystem or Process flow Charts Outputs Risk ManagementCreate a contingency plan for how each risk will be handleAvoid-eliminate the risk entirelyMitigate- reduce the probability of the risk event11

Communication ManagementThe processes required to ensure timely and appropriategeneration, collection, distribution, storage, retrieval, andultimate disposition of project information.Process NamePlan CommunicationsManagementProcess GroupManage CommunicationsExecutingChange requestControl CommunicationsMonitoring and ControllingPerformance Reports, ChangerequestPlanningKey OutputsCommunications ManagementPlan12

Planning Communications Communication Methods Informal Written Email, Memorandums Formal Written Contracts, Project Documents, Legal Notices Informal Verbal Meetings, phone calls, Water cooler, lunch rooms Formal Verbal Presentations, Speeches Push- Email Blast Meetings13

5/29/2015New York Health InformationManagement AssociationICD-10 IMPLEMENTATION PROJECTMANAGEMENTFUNCTIONS AND APPLICATIONS IMPACT

ICD-10 Provider Business Impact AreasPeopleSystems5010/ICD-10: Provider Functions/Applications ImpactPatient AccessCentral, ED, Ancillary &Ambulatory registrationClinical ncialServicesSchedulingPhysician & ng/Discharge/TransfersAncillary and supportservices r entry & resultsEncoding and groupingWorkflowwithin EMRPhysician QueryFacility & ProfessionalbillingClinical DocumentationImprovementFollow up and denialmanagementHome Care RegistrationBehavioral HealthSchedulingHospital Owned MDPracticesClinicsCase managementClinical registries andresearchCoding and abstractingCharge entryDeficiency trackingPayer/ClearinghouseeditsClaim edit work listsNCCI/LMRP editsContracting &CredentialingClaims StatusAnalyticsand ereportingPublic Health reportingFederal and state reportingData WarehouseICD-9 to ICD-10 mappingand translationStrategicInitiativesImplementation of newbusiness and/or clinicalsystemsTransition to paperlessenvironmentOpening of new facilityNarrowing of IT VendorPortfolioImplementation ofcomputer-assistedcodingWorkflow/transfersbetween clinical unitsOrganizational Support: Project Management - Education and Training - Compliance - IT15

EDUCATION AND IT SYSTEMSNew York Health InformationManagement AssociationENTERPRISE WIDE IMPACTS5/29/2015

Organizational Support – Education and Training & ITPhysician Education Phase 1 - Mandatory Phase 2 – Specialty Specific, Mandatory Consequence for non-complianceEnterprise Education Advanced Learners Intermediate Learners General Knowledge Learners17

Vendor Supported Systems - ITSystemBusiness UnitICD-10 VendorSupported*ICD-10 Readyper VendorProcess ImprovementYesBehavioral HealthYesBy 10/15PathologyNoNoNursing/OBYesRequires BuildIT Interface EngineNoManagement ServicesNo10/1ITYesYesCDIYesYesRevenue ncy PlanAlpha/Beta to ED to test18

BUSINESS UNIT IMPACTSHOSPITALNew York Health InformationManagement Association5/29/2015

ICD-10 Provider Business Impact AreasOrganizational Support: Project Management - Education and Training - Compliance - ITPatient AccessCentral, ED, Ancillary &Ambulatory registrationClinical ncialServicesSchedulingPhysician & ng/Discharge/TransfersAncillary and supportservices r entry & resultsEncoding and groupingWorkflowwithin EMRPhysician QueryFacility & ProfessionalbillingClinical DocumentationImprovementFollow up and denialmanagementHome Care RegistrationBehavioral HealthSchedulingHospital Owned MDPracticesClinicsCase managementClinical registries andresearchCoding and abstractingCharge entryDeficiency trackingPayer/ClearinghouseeditsClaim edit work listsNCCI/LMRP editsContracting &CredentialingClaims StatusAnalyticsand ereportingPublic Health reportingFederal and state reportingData WarehouseICD-9 to ICD-10 mappingand translationStrategicInitiativesImplementation of newbusiness and/or clinicalsystemsTransition to paperlessenvironmentOpening of new facilityNarrowing of IT VendorPortfolioImplementation ofcomputer-assistedcodingWorkflow/transfersbetween clinical units20

ICD-10 HIM Coding & CDIImplementation project planBusiness Unit Business Group Task # Task NameStartFinishProgressHospitalCDIS andHIM/Coding5HospitalCDIS andHIM/Coding5.1Develop Dual Coding TimelineIn ProgressHospitalCDIS andHIM/Coding5.3Identify medical records for dual coding(high dollar/high volume)In ProgressHospitalCDIS andHIM/Coding5.4Identify feedback mechanism to CDS andphysicians during dual codingIn ProgressHospitalCDIS andHIM/Coding6HospitalCDIS andHIM/Coding6.1Review current coding productivity anddetermine additional coding needsCompleteHospitalCDIS andHIM/Coding6.3Determine coder retention strategy (Bonus,education money, remote coding, etc)CompleteHospitalCDIS andHIM/Coding6.4Identify resources required to allow forremote codingIn ProgressCDIS andHIM/Coding6.5Assess impact of decreased productivity andARIn al CodingCoding Resources21

ICD-10 Implementation projectplanBusiness Unit Business Group Task # Task NameStartFinish ProgressHospitalCDIS andHIM/Coding6.6Determine contingency plan for decreasedproductionIn ProgressHospitalCDIS andHIM/Coding6.7Preform analysis of coder productivitydecrease (2 parts)In ProgressHospitalCDIS andHIM/Coding6.8HospitalCDIS andHIM/Coding6.9HospitalCDIS andHIM/Coding6.19Assess ICD10 accuracy & productionfollowing module educationIn ProgressHospitalCDIS andHIM/Coding6.21Review query process and forms (work withCDS to standardize)In ProgressHospitalCDIS andHIM/Coding6.22Analyize query reasons and volumecompared to CDS team for targetededucation campaignIn Progress1. Productivity decrease pre-GoLive (ICD10 training/education including dualcoding)2. Productivity decrease post-Go LiveResourceNameCommentsDependenciesIn ProgressDelayed22

5/29/2015New York Health InformationManagement AssociationIDENTIFYING & MEASURING RISKBUSINESS UNIT AND BUSINESS GROUP SPECIFIC

Contingency PlanningBusinessUnitBusiness Task # MetricGroupMeasurementHospital HIMDNFB (Discharge NotFinal Billed) - InpatientHospital HIMDNFB (Discharge Not# of daysFinal Billed) - OutpatientHospital HIMCoder Productivity (will # per day/# perfeed into DNFB value)weekHospital HIMQueries - Concurrent#; length oftime torespond;financial impactHospital CentralSchedulingLength of SchedulingTimeminutesHospital CentralSchedulingCall Abandoned Rate% of calls# daysMgmtSvcsPhysicianBillingClaim DropMgmgSvcsPhysicianBillingDenials by nagementPhaseThresholdImpactRiskProbability# of days24% billed out

Contingency Planning ntPhaseThresholdImpactRiskProbabilityE H R - CDIContentWorkflow RedesignPre-I10 MitigationNAHighMgmt SVC –Claim Drop TransactionalPatient Care/PatientSatisfactionCash flowBusiness ProcessOvertimeContract HelpNew HireEducationWorkflow RedesignTransitional (Oct-Dec2015)New Environment (JanMarch 2016)Pre-10/1/15 Mitigation5%10%15%20%25%30%HighMediumLow25

SYSTEMSBU NAME HEREENTER SYSTEMSCAUSING IMPACTS TOTHE EFFECTPEOPLEENTER PEOPLE IMPACTSTO THE EFFECT HERECAN BE INTERNAL OREXTERNALMETRICSENTER METRIC(S) BEINGCOLLECTED AND USED TODETERMINE SUCCESS HEREENTER DESIRED EFFECT HEREENTER EDUCATIONANDTRAINING HERETRAININGENTER MATERIALIMPACTS TO THE DESIREDEFFECT HEREMATERIALSENTER METHODSIMPACTING DESIREDEFFECTMETHODS26

SchedulingSystem (SS)Central Schedulingreceives Email, Fax,Phone call to scheduleFax/EmailCentral Schedulingcalls back patient orpatient representativesending FaxPhoneOffice gives CPT code andtells ICD9 code (if commonprocedure done often andoffice does not have theICD9 then CSD will lookup)Physician / Physician OfficeCentral SchedulingSchedules with individual(CSD) determines basedon receiving documents)CompletePatient is scheduledin SS and finishedRegistration in BillingSystemPatientPatient has a Script, but is itcomplete with CPT Codeand ICD9 Code?IncompleteEither step can be taken:1. CSD to ask patient or physicianoffice to fax complete script.2. Look up procedure by description in SSand then lookup the ICD9 in Billing Systemby search using diagnosisdescription on the script. Search for closestICD9 by varying internet searches or searchcode lookup (Medicare Patients only)RegistrationProcessProcess StepImpacted byICD10

Practice Manager toolkit General Overview Folder AAFP ICD-10 Timeline AAFP ICD-10 FAQ ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 Diagnosis 10 AAFP Superbill ICD-10 Form Resources available for a fee ICD-10 Resources Document Optum ICD-10 GEM Mapping Book AAPC practice Mgmt ICD-10 specialty cards codes28

DUAL CODINGNew York Health InformationManagement Association5/29/2015

ICD10 Dual Coding – PopulationHospital Inpatients Bedded Outpatients Invasive/Interventional Outpatients Emergency RoomBehavioral Health Inpatients30

Dual Coding – Sample Selection Coders are directed to take 5 records of their daily work assignment per dayto code in ICD9 and ICD10. Emergency Room coders are directed to take 10 records of their daily workassignment per day to code in ICD9 and ICD10. Criteria provided on service selection approach.31

ICD10 Dual Coding - Methodology Industry models for dual coding: Simultaneous Dual Coding by an Individual Coder Dual Coding of One Record by Two Coders Dual Coding and Inter-rater Reliability (several coders, onerecord) Use of Temporary Staff for Dual Coding32Care Communications Inc.,“Dual Coding in Preparation for ICD10 Emerging Best Practice”

ICD10 Dual Coding – Data CollectionEach coder maintains a spreadsheet of their ICD10 coded cases, updated daily.Data Elements Collected: Coder NameMRNAccount #Service/Discharge DateAttending MDCoding DateServiceLOSICD9 DRGICD10 DRGProcedure Performed Total Minutes to Code ICD9 Total Minutes to Code ICD10 ICD10 DX - Missing Documentation:CANNOT COMPLETE CODING ICD10 DX - Missing Documentation:RESULTED IN AN UNSPECIFIED CODE ICD10 PX - Missing Documentation:CANNOT COMPLETE CODING Coder Commentary (Feedback)33

Logging dual coding effortsLOSICD9DRGICD10DRGProcedurePerformedICD10 PX MissingTotalTotalICD10 DX - MissingDocumentatioMinutes Minutes toDocumentation:ICD10 DX - Missingn: CANNOTto CodeCodeCANNOT COMPLETE Documentation: RESULTED IN AN COMPLETE(ICD9)(ICD10)CODINGUNSPECIFIED CODECODING2470470TKR10254460460Spinal fusion30303475476BKA, RemovalHardware2745Not specified the type of OA (erosive,primary, post-traumatic, etc.) Notspecified for laterality of OA (ingeneral, not just regarding the kneebeing operated on). Missing detailsof knee subluxation (chronic, acute,traumatic, etc.) Not specified type ofHTN. Missing cause of CAD (lipidplaque, calcified lesion)Missing details of work-related injuryto vertebral column preventsaccurate choice of external cause ofinjury codesHardware removal doesnot specify what bone it BKA does not give level sowas removed from.unspecifiedHardwareremoval doesnot specifywhat bone itwas removedfrom34

Findings - Next StepProductivityDocumentation Feedback to Clinical Documentation Specialist Feedback to Physician Financial Impact - FTE and DRG Shifts Comparison of ICD9 DRG to ICD10 DRG35

THE GOOD, THE BAD, AND THE UGLYNew York Health InformationManagement AssociationCOMMUNICATING RESULTS5/29/2015

Meetings Executive Sponsor and Oversight – Monthly – PM Leads Power Point Deck with any ASKS Sponsor - Bi Weekly – group discussion More Informal – Discuss project status, issues, escalations Business Unit Lead – Monthly – PM leads Review Status and Executive Sponsor initiatives – ContingencyPlanning Education Status and Communication - Bi Weekly – support role IT Functional and Integrated Testing – Bi Weekly – support role andstatus tracking Ad Hoc - Lead or support all business units with activities andneeds37

QUESTIONSNew York Health InformationManagement Association5/29/2015

ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .

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