Author: Jason Gottlieb

ICD-10 Project releases implementation guidance for registering recurring services

Jason Gottlieb

Recurring services (alternatively known as Therapeutic Referred Ambulatory or TRA) are generally defined as outpatient settings in which a patient is repeatedly treated over multiple visits/encounters with a set of prescribed services to address a previously diagnosed condition.  Recurring services may include but are not necessarily limited to:

  • Physical, Occupational, and Speech Therapy
  • Chemotherapy and other therapeutic infusion services
  • Radiation Therapy
  • Behavioral health and psychotherapy services

Because these encounters may likel be associated with a plan of care that crosses the September/October time frame, it is essential that proper registration procedures are followed to support ICD-10 coding and billing for recurring service encounters after October 1, 2015.  This may include creating new visit records or even entirely new registrations in the Hospital’s registration and billing system.  Operating areas may additionally be required to work with providers to convert ICD-9 diagnosis codes and re-write orders and plans of care.

For more information about registering recurring services and ensuring your ICD-10 readiness, read the full guidance document here.

ICD-10 Project releases operating guidance for transition period code conversion activities

Jason Gottlieb

Code conversion is defined as an exercise to supply, replace, and/or update ICD-9 diagnosis and/or ICD-9 procedure codes with equivalent ICD-10 codes.  Code conversion is a necessary ICD-10 transition period activity for a number of clinical, operational, and financial activities. The updating and/or conversion of ICD-9 codes to ICD-10 codes support the Hospital’s ongoing operations with an ICD-10 ready data infrastructure.  NYP’s ability to define accurate ICD-10 codes supports among other things, medical necessity, financial clearance, patient population selections, pre-registration, and myriad reporting requirements both internally and externally.

The purpose of this guidance document is to provide direction for the situations, circumstances, and vehicles by which and for which it is considered acceptable and appropriate for NYP to engage in ICD-9 to ICD-10 code conversion activities.  The ICD-10 transition across the continuum of care and multiple providers, vendors, payers, and regulatory agencies will present many complexities. As such, it is a practical reality that entities on which NYP may demonstrate varying levels of dependence for diagnosis code data and/or definition will span the spectrum of overall ICD-10 readiness. It is reasonable to assume that situations for which NYP requires ICD-10 data may in fact be presented by such upstream data providers in ICD-9 or even as narrative descriptions of patient condition and/or diagnostic criteria. Such examples demonstrate the need for NYP to engage in acceptable forms of code conversion so as to not disrupt hospital operations and patient experiences including wait times and access to care.

There are many different devices that are generally eligible for and may require code conversion activities including:

  • Reports
  • Data extracts
  • Technology application-specific tables, dictionaries, or functionality that is designed to represent or use a specific sub-set of the overall ICD-9 and ICD-10 code set.
  • Clinical orders and plans of care
  • Referrals and appointments for clinical services
  • Forms, documents, and other data capture vehicles that currently include ICD-9 diagnosis codes

Should you have such devices, please review this guidance so as to ensure timely, accurate, and appropriate code conversion.  Questions regarding the interpretation and/or implementation of this guidance may be directed to the Project Director for ICD-10 implementation or by e-mailing ICD-10Help@nyp.org. Effective September 28, 2015, employees may additionally call the ICD-10 Support center at (646) 697-9210.  Additional information will be provided on the NYP ICD-10 AnTENna website at http://nyplearningcenter.org/apps/eLearning/cms/icd10/.

ICD-10 Implementation is October 1, 2015 – NYP’s 30 day checklist for transition success

Jason Gottlieb

It is no coincidence that as we head into the Labor Day weekend, that it will take no less than a spirited and workman-like (work person-like) effort by thousands of NYP employees and clinical professionals to ensure our transition to the new ICD-10 coding system is seamless and successful. From previous updates, you are aware that much work has been done through the contributions of more than hundred core project team members and dozens of additional individuals focused on task specific activities to prepare for October 1. Many of those same individuals will be on call to support the Hospital through the ICD-10 transition period defined from September 1, 2015 through November 30, 2015. On behalf of the project and NYP, I extend my advanced appreciation and gratitude for those eventual efforts. However, as we embark on “changing the dictionary” that describes our patients’ conditions and the services we provide to treat those conditions, the ICD-10 project becomes an organization-wide opportunity to leverage an improved classification system for better data, better research, and some day – better patient care. So, with 30 days to go, here is your ICD-10 readiness checklist.

30. Understand changes to enterprise and department specific computer applications and how they impact your operation.

29. Confirm that reports, forms, documents and other data capture vehicles that leverage ICD-9 codes as criteria have been updated to include equivalent ICD-10 codes.

28. Confirm with your IT colleagues that data is interfacing both to and from applications used by your department.

27. Identify equivalent ICD-10 codes for clinical orders spanning the September/October time frame.

26. Communicate and promote the documentation assistance tools available in Crown, Allscripts SCM (ICDx), and Epic (Diagnosis Calculator) with physicians and other providers.

25. Promote and provide the inclusion of additional specificity in clinical documentation including items like acuity, anatomic site, laterality, root procedures, related conditions, disease status and stage, association with medications and/or drug use, causative agents, and significance of abnormal lab values… just to name a few.

24. Encourage physicians and other providers to download the Precyse University apps, ICD10 Doc Talk and ICD10 Mobile Documentation Guide to have valuable ICD-10 information at their fingertips (yes, they’re FREE)!

23. Promote the www.roadto10.org website for physicians. This CMS website is filled with valuable information on specialty specific documentation and coding information including ICD-10 Clinical Concept “cheat sheets”.

22. Review Medicare coverage (e.g. – LCD, NCD) policies for any ICD-10 impact of department/service specific procedures, drugs, tests, and exams.

21. Reduce unbilled receivables focusing on encounters most likely to generate accelerated cash for the Hospital.

20. Ensure appropriate data is available to financially clear cases according to their date of service/date of discharge – Remember, September: 9th month – 9 codes, October: 10th month – 10 codes!

19. Coordinate with non-NYP physicians and providers to ensure ICD-10 codes are provided on referrals.

18. Recognize the visual and structural difference between and ICD-9 and an ICD-10 code.

17. DON’T become a coder – but DO become familiar with codes that are common to your service and your patients.

16. Confirm that registries and external entities with whom you may exchange ICD-10 information are ICD-10 compliant and ready to accept NYP data.

15. Keep an eye out for transition period operating guidance related to revenue cycle operating activities for recurring services (e.g. – physical therapy, behavioral health, chemotherapy, radiation oncology, etc.)

14. Visit the Hospital’s official ICD-10 website, ICD-10 AnTENna often for updates, guidance, and support.

13. Encourage all staff to watch the ICD-10 organizational awareness video, ‘ICD-10: A New Language in Healthcare” available on their transcripts in the NYP Learning Center.

12. Use ICD-10Help@nyp.org to submit inquiries, questions, and issues to the ICD-10 Support Center.

11. Call the ICD-10 Support Center Telephone number: (646) NYP-9-2-10 (or 646-697-9210) – effective September 28, 2015.

10. Leverage code conversion tools to identify potential ICD-10 options to ICD-9 codes. DO NOT use them to code encounters.

9. DO NOT INCLUDE decimal points when entering ICD-10 codes into the EAGLE registration and billing system.

8. Be prepared to dual code inpatients covered under Medicare part B benefits only that span the September/October time frame (OK – this one is pretty small).

7. Move all interfaces, functionality, and reporting, and operating contingencies into production environments.

6. Integrate ICD-10 conversation into team meetings, staff huddles, and other communication devices – Broad based awareness is our greatest asset.

5. Think through resources and coverage for potential issues that may require remediation such as new registrations, re-entry of codes, re-writing of orders, correction of billing errors, and resubmission of insurance claim denials.

4. Set up monitoring tools to ensure orders, documentation, coding, billing, and payment are producing expected outcomes in ICD-10.

3. Prepare to leverage more specific data on our patients to improve quality, safety, delivery, length of stay, patient flow, costs, meaningful use, medication management, population health, and a lot of other stuff.

2. Be Flexible – issues will arise. It’s how we communicate, triage, troubleshoot, and revolve them that counts.

1. Prepare to celebrate a successful ICD-10 implementation!

 

ICD-10 Project releases operating guidance for capturing ICD-10 diagnosis code(s) for financial clearance activities

Jason Gottlieb

In an effort to prepare NYP for the October 1, 2015 implementation of ICD-10, the ICD-10 Project Management Office will be releasing guidance documents to define various readiness activities that are likely to require some short term operating and procedural contingency during the ICD-10 transition period. The transition period is defined as September 1, 2015 through November 30, 2015. These guidance documents are intended to provide the organization with broad based instruction on how to manage these contingencies. Each department, operating area, and service should apply this guidance (as applicable) to its specific operating idiosyncrasies that only they are uniquely qualified to account for.

The purpose of this guidance document is to provide direction as to how operating owners can ensure ICD-10 codes are properly collected, determined, and assigned to encounters so as to support effective financial clearance activity during the ICD-10 transition period. Effective for calendar date September 1, 2015, it is expected that service lines and operating areas that own or otherwise bear the responsibility for scheduling, pre-registration, and financial clearance procedures work collaboratively with upstream data providers to collect, determine, and/or assign accurate ICD-10 codes as applicable and defined. Generally speaking, scheduled services for October 1, 2015 and forward shall require the provision of ICD-10 diagnosis codes to third party insurance carriers for purposes of service authorization.  Specifically, the guidance includes date of service/date of discharge sensitive protocols for the following six major categories of service:

  • Inpatient
  • Ambulatory Surgery
  • Emergency Department
  • Hospital Based Clinic (HBC)
  • Therapeutic Referred Ambulatory (TRA) or (e.g. – PT/OT, Behavioral Health, Chemotherapy, Radiation Oncology, etc.)
  • Diagnostic Referred Ambulatory (DRA) or (e.g. – Radiology, Lab, EKG, Nuclear medicine, etc.)

Operating areas may work with the ICD-10 Project Management Office and/or IT owners of specifically affected applications to ensure a smooth transition.

Organizational Awareness Video Highlights latest NYP ICD-10 Readiness Efforts

Jason Gottlieb

On Tuesday, August 11, NYP, in its ongoing efforts to create an ICD-10 informed and insulated organization, will release its ICD-10 organizational awareness video in the NYP Learning Center.  This video, assigned to all NYP employees’ transcripts, will explain the ICD-10 diagnosis and procedure coding system, its benefits, and how it may potentially affect your role at NYP.

On October 1, 2015 the United States and NYP will begin to describe the conditions of our patients and the services we provide to treat those conditions using a new healthcare language called ICD-10.  The WORK we collectively do, the CARE we collectively provide, the GOALS we collaboratively strive to achieve, and the INITIATIVES we participate in to achieve them are all impacted in some way by ICD-10.

ICD-10 IS how we communicate to the outside world the acuity, complexity, the diversity of our patients.  ICD-10 IS how we describe the SUPERIOR, HIGH QUALITY care that each of you provide every day.  ICD-10 IS how we will be rewarded for that care in the form of payment from third party.

Please enjoy this video as NYP and the healthcare industry complete the transition to ICD-10.

 

Workgroup for Electronic Data Interchange (WEDI) issues results for latest ICD-10 Readiness Survey

Jason Gottlieb

The Workgroup for Electronic & Data Interchange (WEDI) has released the results of its latest (and likely last) ICD-10 readiness survey.  The survey included responses from 621 respondents, consisting of 453 providers, 72 vendors and 96 health plans.  Overall, the survey suggests that the predominant majority of hospital providers and insurance plans are or will be ready for the implementation date on October 1, 2015, an encouraging sign for the industry as it transitions to this new healthcare language of ICD-10.  Some of the more noteworthy findings included:

  • Hospital/health system testing and readiness: Almost 75 percent of hospitals and health systems have started or completed external testing. Additionally, nearly 90 percent responded that they were ready or would be ready by the compliance date, while a few were unsure if they would be ready.
  • Health plan testing and readiness: Nearly 75 percent of health plans have begun or completed external testing. 40 percent responded that they were already prepared and the remaining 60 percent said they would be ready by October 1.
  • Vendor product development and availability: 75 percent of vendor respondents have fully completed product development and no one responded that their products would not be ready by the compliance date.
  • Physician practice testing and readiness: Only about 20 percent of physician practices have started or completed external testing and less than 50 percent responded that they were ready or would be ready for Oct. 1. This is cause for concern.

The full survey results and letter to the Department of Health & Human Services Secretary, Sylvia Matthews Burwell can be viewed here.

 

PMO Project Update: August

Jason Gottlieb

52 days to go –  This is what I believe they call in the ICD-10 world – PLAYOFF TIME! The NCAA has March Madness and NYP and the rest of the industry are making their way through August Absurdity with September Insanity on the horizon. Our playoff beards are in full effect and no ingrown hair (ICD-10 Code L73.1 – Pseudofolliculitis barbae) is going to get in our way to the ICD-10 Champion ship on October 1.

Much of the industry also appears ready for life in a new healthcare language. As you can read in our industry and regulatory update, the most recent readiness survey issued by the Workgroup for Electronic Data Interchange (WEDI) seems to suggest that the majority of hospital providers and payers are or will be ready for October.

The NYP ICD-10 project comes into July at approximately 79% complete. A list of NYP’s most recent and cumulative accomplishments continues to move the organization closer to realizing the benefits of ICD-10 and much more.

  • Enabling physician support of ICD-10 documentation requirements. ICDx, the Allscripts SCM customized documentation assistance tool has been embedded into the first two waves of document templates covering an average of more than 300,000 instances of documentation. The final phases will be implemented by the end of August. Faculty Practice Organizations (FPO) at both the Cornell and Columbia Campus continue to work cooperatively with the NYP Documentation Improvement Group as approximately 62% of all physicians have completed ICD-10 related documentation training. Finally, the ongoing implementation of electronic Superbill yielded its landmark milestone with the AIM practice at Columbia going live.
  • Operationalize Dual Coding. Nearly 40,000 inpatient and outpatient cases have been coded in both ICD-9 and ICD-10 ensuring coders are getting adequate practice coding in ICD-10 and providing inventories for a multitude of financial and operational analyses as well as claim testing.
  • Supporting Hospital operations with an ICD-10 ready technology and data infrastructure. Project governance has removed several barriers to identifying the affected report inventories and the organization has identified nearly 60 additional reports and successfully converted the first 9 reports. Continued efforts to successfully test all affected system-to-system interfaces is ongoing.
  • Apply applicable financial reserves. Our Finance, Managed Care, and Decision Support groups have completed evaluating several solutions to monitor payer-specific reimbursement after October 1 with decision and implementation to be completed in the next 30 days.
  • Create an ICD-10 informed and insulated organization. On Tuesday, August 11, a short 5-minute organizational awareness video will be placed on NYP employees transcripts in the NYP Learning Center. We encourage everyone to watch this video to understand ICD-10, its benefits and how its implementation can potentially affect different roles at NYP. The beginnings of operational readiness including guidance on ICD-10 specific financial clearance and the design of an ICD-10 Support Center will be defined and drafted in the next 30 days.

Other activities will continue to progress and expand under the assumption that no further delays shall occur. For a complete overview of the project status, click here to view the Project Scorecard.

Should you have questions about what you can be doing to get your department ready for ICD-10 or would like to request an in person presentation from the ICD-10 project team, please e-mail ICD10Help@nyp.org.

CMA and AMA Collaborate on ICD-10 Readiness

Jason Gottlieb

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) jointly announced efforts to ready the physician community for the transition to ICD-10.  Part of this effort includes CMS’ claim processing flexibility and guidance that will prevent Medicare part B claims from being denied due to lack of specificity as well as eliminating potential penalties associated with its various quality reporting initiatives.  Though not the most desirable of arrangements, this agreement should clear an unabated path to October 1,2015 and the implementation of the new ICD-10 code set.  As part of the ICD-10 project, we here at NYP should be reminded as to what this announcement means.

  • This announcement is only applicable to claims being submitted by physicians and other providers for professional services.
  • Hospital based encounters and their associated (technical) claims are not affected by this announcement.  Clinical documentation activities performed by our physicians and other providers will continue to require the most specific representation of care provided to our patients.  This has been the case prior to ICD-10 and will continue to be the case after the implementation of ICD-10 on October 1.
  • There is no indication that commercial insurance carriers to which physicians and other providers may be submitting professional claims will follow CMS’ lead in relaxing its own and respective medical policies and coverage guidelines.

The NYP ICD-10 Project PMO, in conjunction with its various workgroups and in cooperation with the Cornell and Columbia Faculty Practice Organizations will continue to work to ensure consistent understanding of this announcement as well as all other impacts to affected parties.  Questions can be directed to ICD-10Help@nyp.org.

 

PMO Project Update: July

Jason Gottlieb

80 days to go –  We have all at one point become familiar with the value of compromise. In both our professional and personal endeavors, the art of giving a little to get a little (or a little more) has become an endemic commodity in a complex society governed by postulations and opinions and where the short term currency of stagnation is sometimes seen as more profitable that the long term currency of transformation. Such compromise was center stage earlier this month when the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) agreed to collaborate on ICD-10 implementation. This collaboration includes CMS’ concession that claims for Part B services (i.e. – physician and other provider claims for professional services) will not be denied for lack of specificity for a period of one year. While this concession has its drawbacks, it is certainly hopeful that any future adversarial rhetoric from the AMA has finally been quelled, clearing an unabated path to October 1, 2015 and a new code set to define the healthcare we provide to our patients. The NYP ICD-10 project, in continued cooperation with our respective Faculty Practice partners, will work to ensure there is clear understanding as to what this latest news means for all affected parties communicating a singular message to aid the ongoing transition.

The NYP ICD-10 project comes into July at approximately 74% complete. A list of NYP’s most recent and cumulative accomplishments continues to move the organization closer to realizing the benefits of ICD-10 and much more.

  • Operationalize dual coding.More than 90% of all Health Information Management (HIM) coding professionals are now coding in ICD-10 for inpatient, ambulatory surgery, and Emergency Department cases. Dual coding interfaces from Epic to our ICD-10 environment are complete and implemented.
  • Enabling physician support of ICD-10 documentation requirements. Faculty Practice Organizations (FPO) at both the Cornell and Columbia Campus continue to work cooperatively with the NYP as approximately 60% of all physicians have completed ICD-10 related documentation training. ICDx, the Allscripts SCM customized documentation assistance tool is complete and being embedded into its first wave of high volume document template in the next 7 days.
  • Apply applicable financial reserves. Our Revenue Cycle, Finance & Reimbursement workgroup has moved its primary initiatives of dual coding and claim testing into monitoring states and will transition to defining and developing the appropriate operational readiness protocols and associated post-implementation support models.
  • Supporting Hospital operations with an ICD-10 ready technology and data infrastructure. Tremendous work by the IT workgroup continues to pay dividends as the number of system-to-system interfaces successfully tested increases to nearly 70%. Leadership has lent assistance by assigning specific delegates to inventory a spectrum of reports requiring conversion to ICD-10 prior to October 1.
  • Create an ICD-10 informed and insulated organization. Our first draft of an organization-wide training module has been developed and is expected to be available in the next 30 days. A broader communication plan to cover the more than 13,000 NYP employees who are affected by ICD-10, large and small; has been defined with collaboration from internal communications.

Other activities will continue to progress and expand under the assumption that no further delays shall occur. For a complete overview of the project status, click here to view the Project Scorecard.

Should you have questions about what you can be doing to get your department ready for ICD-10 or would like to request an in person presentation from the ICD-10 project team, please e-mail ICD10Help@nyp.org.