Again, we‘d like to thank all staff and providers who have worked collaboratively with us to make our ICD-10 implementation an overwhelming success. The ICD-10 Support Center is officially closed. In an effort to transition certain ICD-10 specific responsibilities back to the operations ownership, we held an Operational Transition webinar on Thursday, October 29^th.

During this session we provided participants with:

• A current state of implementation performance including key measures of operating and financial success
• A status on any remaining issues and items being resolved and applicable contingency procedures for those items
• A review of the various materials, resources, and tools that will continue to be available to you, your staff, and providers to leverage and support ongoing self-sufficiency in ICD-10

You can find a copy of this presentation here.

For ongoing support regarding the transition to ICD-10 you can e-mail ICD-10Help@nyp.org or visit NYP’s ICD-10 AnTENna website for updates, training aids & other useful resources. Please keep in mind, there will no longer be a telephone line for the Support Center. If you have any IT application related issues, contact the service desk at 212-746-4357 (4-HELP).

 

We Came, We Saw, We Conquered, I-10!

SUMMARY OF EVENTS

Two weeks into the transition to ICD-10 and by all indications, NYP is demonstrating a fully stable financial and clinical operating environment. Aggressive tracking of billed and submitted October discharges and dates of service suggest that payment receipt is imminent and in line with historical time frames. Providers are embracing the prospect of documentation specificity, leveraging ICDx on more than 8 out of every 10 encounters to select and update health issues and problem lists and even inserting those diagnoses into patients’ assessment and plans. Clinical Data Coordinators from HIM in conjunction with Support Center staff continue to remedy the remaining ambulatory encounters for which only ICD-9 codes were provided. An ongoing summary of the project is listed below and the full presentation can be found here.

 

OVERALL IMPACT

Financial and operating metrics continue to remain stable as Support Center efforts prevent ICD-10 related issues from funneling back to the operation.  Providers are demonstrating and uptick in their interaction with the new Allscripts documentation assistance tool, ICDx. Documentation Improvement specialists in HIM continue to generate increased volumes of provider inquiries in an effort to take advantage of the specificity available in ICD-10.  Coding production has remained solid despite the transition to the new code set.  Billing and claims submission production continues to be in line with historical volumes and time frames.

 

ITEMS TO BE RESOLVED

Efforts to remedy all outstanding and erroneously coded ambulatory encounters resulted in some future visits for recurring services being arrived in the Soarian scheduling system. IT has provided a go forward solution for Support Center staff to continue this effort without affecting scheduling status. The remaining cases related to the R4 to Eagle interface at LMH have been completed. Minor reporting glitches in EagleView were noted and either corrected or in the process of being so. IT is monitoring and quantifying a known pre-implementation item that would require dual coding for certain ambulatory encounters. Because dual coding was implemented prior to October 1, the exposure is expected to be minimal. The Allscripts team continues to research a known issue related to ICDx and the selection of behavioral health conditions and codes. An updated implementation issues log can be found here.

 

SUPPORT CENTER ACTIVITY

Staff received 3 phone calls and 0 e-mail inquiries while correcting approximately 200 additional outpatient encounters erroneously assigned ICD-9 codes. In total, the Support Center has logged 96 issues and 19 remain open. The ICD-10 AnTENna website recorded an additional 153 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)
• Correct old health issues by clicking the health issue, selecting ‘update preferred mapping, select the ICD-10 code, and clicking ‘Accept”

 

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 website.

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.

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.

 

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.

112 days to go –  So much for the sounds of silence. Last month we spoke of what, in retrospect, was the calm before the storm. This past month yielded the resurrection of one old bill and the drafting of two new pieces of legislation intended to either delay outright or enforce varying types of grace periods for our small batch of 140,000 codes. And then there is Alabama – Oh Sweet Home Alabama! In what has to be one of the great displays of bureaucratic poetry, the state legislature of Alabama has apparently passed legislation that calls for the collective state to urge Congress to delay ICD-10. I’m not exactly sure how to spell that sound you make when you shake your head back and forth with your mouth open but…WOW! Though none of this stand-alone legislation has more than a 1% chance of becoming law according to Govtrack, it remains a collective imperative to aggressively advocate for no further delay, no grace periods and a complete transition to an improved code set capable of supporting future transformation of healthcare research, delivery, and payment.

The NYP ICD-10 project comes into June at approximately 72% 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 half 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 for outpatient clinics at both campuses have been developed for Epic and Allscripts SCM with testing and implementation set to launch in the next 30 days
• Complete end-to-end claim testing with payers and clearing houses. Coordinated by our Managed Care team, testing has been completed with 10 of our largest contracted payers accounting for more than 85% of NYP’s revenue.
• 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 50% of all physicians have completed ICD-10 related documentation training. The Hospital Documentation Improvement Department continues to schedule service line specific in-services in an ongoing process to prepare and support physicians and other providers prior to and well after October 1.
• Apply applicable financial reserves. Revenue Cycle and financial leadership continue to push diligence and mitigation activities, reducing A/R days, as monitored by the ICD-10 project to another all-time low and creating a buffer against any unforeseen billing and payment delays after October 1, 2015. Leveraging our partnership with Mediquant, a prototype outpatient medical necessity impact analysis is expected in the next 30 days.
• 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 60%.

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.