SUMMARY OF EVENTS

Day 7 of ICD-10 yielded our first submission of inpatient billing to third party insurance carriers, a major if not most significant milestone in the implementation and an unequivocal success for the project, Support Center staff and the Organization. These cases are now being meticulously monitored for payer acceptance and eventual payment by our Patient Financial Services Staff. Our coding professionals in HIM continue to settle into an “ICD-10 production mode”, coding more than 200 additional October discharges, and continued “ICD-10 rounds” across the campuses is providing needed visibility and attention to the transition for unreached providers and staff. Outpatient encounter monitoring is mitigating risk against unintended spikes in the unbilled receivable as we prepare for our first outpatient billing and submission on October 12. An ongoing summary of the project is listed below and the full presentation can be found here.

 

OVERALL IMPACT

The impact of the ICD-10 transition on patient care/patient experience activities continues to remain minimal. Financial and operating metrics remain largely stable indicating that the transition to ICD-9 has not necessarily impacted our or the insurance industry’s ability to continue processing in ICD-9. Documentation Improvement specialists in HIM have expectedly increased the volume of provider inquiries in an effort to take advantage of the specificity available in ICD-10.

 

ITEMS BEING RESOLVED

Collaboration across the ICD-10 Support Center, Information Technology Services, and Patient Financial Services helped identify and correct a minor inpatient billing issue that prevented a subset of our eligible inpatient discharges from being successfully billed and submitted. Similarly, The Support Center and the OR Manager team continue to engage the vendor on improving the data integrity of its ICD-10 code dictionary to prevent invalid codes from being selected for surgical bookings. Implementation Alerts and reminders regarding transition specific idiosyncrasies in Allscripts SCM have aided in getting providers to clean up legacy health issues that are no longer valid in ICD-10. An updated implementation issues log can be found here.

 

SUPPORT CENTER ACTIVITY

Staff received 2 phone call and no additional e-mail inquiries while correcting approximately 400 additional outpatient encounters erroneously assigned ICD-9 codes. In total, the Support Center has logged 7 issues and 17 remain open. The monitoring and auditing effort has resulted in verifying more than 99% data integrity for inpatient, Ambulatory Surgery, and ED encounters. The ICD-10 AnTENna website recorded an additional 164 hits.

 

REMEMBER

• ICD-10 Diagnosis Codes are 3 – 7 characters, alpha-numeric, and ALWAYS begin with a letter
• ICD-10 is date of service/date of discharge sensitive
• DO NOT insert decimal points when entering ICD-10 diagnosis codes in Eagle
• Use ICDx to assist with documentation efforts in Sunrise Clinical Manager (SCM) Code conversions with multiple options presented in the NYP Code converter should prioritize the choices with bidirectional arrows
• Close open outpatient encounters as quickly as possible to ensure timely billing.

 

HELP

For continued assistance and inquiry, please call the ICD-10 Support Center at 646-NYP-9-2-10 (646-697-9210), e-mail ICD-10Help@nyp.org, or visit the ICD-10 AnTENna webiste.

SUMMARY OF EVENTS

The transition to ICD-10 continues to stabilize and its first submission of ICD-10 coded claims to insurance carriers is imminent. Daily ICD-10 rounding across the campuses has highlighted a generally informed and engaged group of staff and providers asking necessary questions, leveraging the tools and resources available, and demonstrating flexibility for the handful of operational and technical items that have popped up. Support Center staff continues to remedy batches of outpatient encounters that have been incorrectly registered and coded in an effort to effectuate smooth and seamless billing on October 12. Coding professionals in HIM continue to settle into a “business as usual” operating model. Inpatient documentation review activities are yielding increased levels of provider inquiry to ensure NYP leverages the specificity of the ICD-10 code set. An ongoing summary of the project is listed below and the full presentation can be found here.

 

OVERALL IMPACT

The impact of the ICD-10 transition on patient care/patient experience activities continues to remain minimal.  Financial and operating metrics remain largely stable indicating that the transition to ICD-9 has not necessarily impacted our or the insurance industry’s ability to continue processing in ICD-9. Documentation Improvement specialists in HIM have expectedly increased the volume of provider inquiries in an effort to take advantage of the specificity available in ICD-10.

 

ITEMS RESOLVED

There are currently no material issues of significance outstanding or that require escalated resolution across the campuses. Support Center staff continues to resolve minor end-user inquiries including proper code assignment and entry, interpretation of coding guidelines, and clarifications around recently released fixes to OR Manager and Allscripts that will now prevent selection of ICD-9 codes for dates of service on or after October 1.  An updated issues log can be found here.

 

SUPPORT CENTER ACTIVITY

Staff received 2 phone call and 3 additional e-mail inquiries while correcting approximately 1000 outpatient encounters erroneously assigned ICD-9 codes.  In total, the Support Center has logged 74 issues and 19 remain open. The monitoring and auditing effort has resulted in verifying more than 99% data integrity for inpatient, Ambulatory Surgery, and ED encounters. The ICD-10 AnTENna website recorded close to an additional 150 hits.

 

REMEMBER

• ICD-10 Diagnosis Codes are 3 – 7 characters, alpha-numeric, and ALWAYS begin with a letter
• ICD-10 is date of service/date of discharge sensitive
• DO NOT insert decimal points when entering ICD-10 diagnosis codes in Eagle
• Use ICDx to assist with documentation efforts in Sunrise Clinical Manager (SCM)
• Code conversions with multiple options presented in the NYP Code converter should prioritize the choices with bidirectional arrows
• Close open outpatient encounters as quickly as possible to ensure timely billing.

 

HELP

For continued assistance and inquiry, please call the ICD-10 Support Center at 646-NYP-9-2-10 (646-697-9210), e-mail ICD-10Help@nyp.org, or visit the ICD-10 AnTENna webiste.

As the transition heads into the week 2, Day 5 the rewards of preparation, teamwork, dedicated effort, and responsiveness continue to pay off. Many small but nonetheless, nagging items have been remedied and a combination of fixes and workarounds for our most significant item to be resolved have been placed into production and communicated. The Support Center’s monitoring and reconciliation activities appear to have adequately prepared NYP for successful ICD-10 inpatient and outpatient billing runs on October 6 and October 12 respectively. A summary of yesterday’s events is listed below and the full presentation from yesterday’s Daily Transition Update can be found here.

 

OVERALL IMPACT

Though early in the implementation, the ICD-10 transition has generated minimal to no disruption in patient care/patient experience activities.  Financial and operating metrics remain largely stable indicating that the transition to ICD-9 has not necessarily impacted our or the insurance industry’s ability to continue processing in ICD-9.

 

ITEMS RESOLVED

Items of significance to be resolved include the application of error messaging and removal of Allscripts Health issues for which there is no applicable ICD-10 code. This will minimize if not eliminate patient encounters from NYP clinics from being coded with only ICD-9 codes. The OR Manager team has also expedited a fix to ensure our colleagues in the Cornell and Columbia Faculty Practice Organizations book surgical cases with ICD-10 codes. A minor issue with an Admitting Diagnosis field in our Eagle registration system similarly was identfieid and resolved within 30 minutes. An updated issues log can be found here.

 

SUPPORT CENTER ACTIVITY

The Support Center revised its operating hours for the week of October 5. Revised hours are now from 7:00 AM – 7:00 PM. It received 1 phone call and 4 additional e-mail inquiries while it continues a massive monitoring, auditing, and reconciliation effort at the encounter, transaction, and even data element level. In total the Support Center has logged 62 issues and 7 remain open. The ICD-10 AnTENna website recorded close to an additional 200 hits. Though, it appears as individuals stabilize in their understanding of ICD-10 and the practical idiosyncrasies of the transition, there is less need for material support. The Support Center continues to work with HIM experts to convert ICD-9 codes to ICD-10 on select population of patient encounters in advance of outpatient billing on October 12.

 

NEW & UPDATED RESOURCES

The Support Center has added an Allscripts reminder aid on adding Health Issues.

 

REMEMBER

• ICD-10 Diagnosis Codes are 3 – 7 characters, alpha-numeric, and ALWAYS begin with a letter
• ICD-10 is date of service/date of discharge sensitive
• DO NOT insert decimal points when entering ICD-10 diagnosis codes in Eagle
• Use ICDx to assist with documentation efforts in Sunrise Clinical Manager (SCM)
• Code conversions with multiple options presented in the NYP Code converter should prioritize the choices with bidirectional arrows
• Close open outpatient encounters as quickly as possible to ensure timely billing.

 

HELP

For continued assistance and inquiry, please call the ICD-10 Support Center at 646-NYP-9-2-10 (646-697-9210), e-mail ICD-10Help@nyp.org, or visit the ICD-10 AnTENna webiste.

The second day of ICD-10 came with more rain, less inquiries to the ICD-10 Support Center and the same positive sense that NYP and the rest of the industry will navigate this transition successfully. With a full day of registration activity under our belts, staff and providers are beginning to see the results of the efforts. Although some new items have been identified, NYP is prepared to address them in real time and proactively remedy situations that place patient flow, billing, and payment at risk. A summary of yesterday’s events is listed below and the full presentation from yesterday’s Daily Transition Update can be found here.

Overall Impact

Though early in the implementation, the ICD-10 transition has generated minimal to no disruption to patient care/patient experience activities. Financial and operating metrics remain stable.

 

Items to be Resolved

The ICD-10 Support Center is monitoring sporadic yet continued assignment of ICD-9 codes on October dates of service. This includes physician practices booking surgical cases in OR Manager, electronic superbill enabled areas, and paper orders and requisitions. Remedies and workarounds vary from reinforcement and education to systemic changes required in applications to prevent ICD-9 selection. One vendor fix is being applied and expected to be resolved by Monday. Research is being conducted to confirm one potential interface issue and the Support Center is working with HIM experts to convert ICD-9 codes to ICD-10 in advance of outpatient billing on October 12.  An updated implementation issues log can be found here.

 

Support Center Activity

The ICD-10 Support Center continued its 6 AM operating hours and fielded 7 additional phone calls and a 4 e-mail inquiries over the course of the day. The majority of inquiries related to code conversion activities and questions about idiosyncrasies in the Allscripts SCM electronic medical record including certain superbill presentations, health issues favorites, and its recently deployed documentation assistance widget, ICDx. In total the Support Center has logged 52 issues and 2 remain open. The ICD-10 AnTENna website recorded an additional 250 hits with many departments taking advantage of the two code conversion tools available. The Support Center team has initiated robust monitoring activities at the encounter and even the data element level to ensure the efficacy the cases prior to billing. Where necessary, code conversion activities have started to minimize the financial and operational impacts.  An updated issues log can be found here.

 

New & Updated Resources

ICD-10 AnTENna will be adding an FAQ and job aid for Allscripts problem lists and an aid for the Eagle therapy record assignment on Saturday, October 3.

 

Reminders

• ICD-10 is date of service/date of discharge sensitive.
• DO NOT enter decimal points when entering ICD-10 codes in Eagle
• ICD-10 diagnosis codes are 3 – 7 characters, alpha-numeric, and ALWAYS begin with a letter
• Remind providers of the documentation assistance tools available to them in SCM (ICDx), EPIC (Diagnosis Calculator), and Crown
• Scroll to the right of health issues in Superbill to see the corresponding ICD-10 code
• Review the match direction when reviewing code conversions with multiple options to narrow down appropriate selectionsInpatient claims for October dates of service begin to generate starting October 6, 2015
• Most outpatient claims for October dates of service begin to generate starting October 12, 2015

 

Providers and staff experiencing any issues related to ICD-10 should continue to call the ICD-10 Support Center today during the hours of 6 AM and 10 PM (subject to change) or e-mail at ICD-10Help@nyp.org.

By most definitions, the first day of ICD-10 proved to be just another rainy Thursday offering little in the way of resistance and generally angering most of the vocal critics of the transition. That being said, the true impact of ICD-10 remains several days, if not weeks away as NYP begins to submit ICD-10 claims to insurance carriers next week and awaits its rightfully due payment. A summary of yesterday’s events is listed below and the full presentation from yesterday’s Daily Transition Update can be found here.

Overall Impact

Though early in the implementation, the ICD-10 transition has generated minimal to no disruption to patient care/patient experience activities. Financial and operating metrics remain stable.

 

Items to be Resolved

There are two open items. EPIC, the Cornell managed EMR and practice management system was observed to be generating unusual output on its electronic referrals instead of the appropriate ICD-10 code and is being investigated and a single report was observed to be producing some ICD-10 codes instead of ICD-9 codes. Both issues are with their respective technical expertise and are expected to be resolved today. An updated log of implementation issues can be found here.

 

Support Center Activity

The ICD-10 Support Center opened at 6 AM and fielded 17 phone calls and a single e-mail over the course of the day. The majority of inquiries related to code conversion activities and questions about idiosyncrasies in the Allscripts SCM electronic medical record including certain superbill presentations, health issues favorites, and its recently deployed documentation assistance widget, ICDx. In total the Support Center has logged 40 issues with all but 2 being resolved within a day. The ICD-10 AnTENna website recorded more than 300 hits with many departments taking advantage of the two code conversion tools available. Close coordination with our Faculty Practice Organization counterparts resulted in the identification and sharing of two issues, one at each campus respectively.

 

New & Updated Resources

ICD-10 AnTENna now includes some additional resources including two provider reference materials related to DSM-V, the classification system for behavioral health that maps to ICD-10 and a short video aid on how to add a family history from personal favorites health issues using ICDx. A training aid on proper medical necessity screening using First Comply Mediquant is also available.

 

Reminders

• ICD-10 is date of service/date of discharge sensitive.
• DO NOT enter decimal points when entering ICD-10 codes in Eagle
• ICD-10 diagnosis codes are 3 – 7 characters, alpha-numeric, and ALWAYS begin with a letter
• Remind providers of the documentation assistance tools available to them in SCM (ICDx), EPIC (Diagnosis Calculator), and Crown
• Inpatient claims for October dates of service begin to generate starting October 6, 2015
• Most outpatient claims for October dates of service begin to generate starting October 12, 2015

 

Providers and staff experiencing any issues related to ICD-10 should continue to call the ICD-10 Support Center today during the hours of 6 AM and 10 PM (subject to change) or e-mail at ICD-10Help@nyp.org.