PMO Project Update: June
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.
Five Ways ICD-10 Helps Providers Reach Care Collaboration Goals
by Ken Bradley, Vice president of Strategic Planning and Regulatory Compliance at Navicure, a provider of cloud-based healthcare billing and payment solutions (courtesy of ICD-10 Monitor). See full article here.
A coordinated experience only happens when the right people have the right data at the right time. Healthcare collaboration is crucial to our daily lives. That’s why care coordination is central to healthcare reform: it can remove the fragmentation and communication barriers that impede efficiency, collaboration, and informed decisions.
Agreeing on care coordination’s importance is easy for providers; achieving it, however, is the difficult part. That’s where ICD-10 can help. At first glance, it may not seem directly related to the success of care coordination; however, ICD-10 can be a catalyst in five key ways:
1) Providing specificity for today’s patient care and provider needs. When the U.S. healthcare system implemented ICD-9 in 1979, providers had different business and clinical data needs than they do today. On the business side, reimbursement models, patient billing, and technology have all advanced exponentially; activities such as claims submission require more detailed and complex data. On the clinical side, advances in medicine, more complex care needs, and the need for additional diagnoses to describe patient condition in greater detail have created the necessity for more breadth and depth in coding and documentation. In short, we’ve outgrown ICD-9, and ICD-10 is a good fit.
2) Laying a foundation of standardized, comprehensive patient clinical data. Lack of detail in clinical documentation can lead to miscommunication, the need for repetition of tests, and requests for clarity – all of which can be costly. ICD-9’s narrower code set contributed to these issues, but ICD-10 allows everyone to describe clinical documentation with the same, much more specific code set. The language is more specific, accurate, and comprehensive. As interoperability provides a vehicle for sharing data, ICD-10’s standardization and thoroughness can ensure that all parties who access this data are able to get what they need.
3) Promoting a better understanding of each constituent’s role in a patient’s care plan. An aging population, higher incidences of multiple chronic conditions, and a multilingual population all create more opportunities for miscues and a lack of understanding. ICD-10 allows for primary care physicians, specialists, therapists, and nurses to share the same detailed data; consequently, they don’t have to start at square one when consulting with patients for the first time. As a result, patients can have a more coordinated care experience while all parties can more effectively collaborate regarding treatment plans.
4) Including advocates, researchers, and other parties who contribute to the advancement of healthcare. With ICD-10, healthcare collaboration can expand to include researchers and other constituents who need standardized yet detailed data. These constituents may not directly interface with patients during the care continuum; however, they can make important contributions such as medical advancements and protocol enhancements.
5) Paving the way for more treatment accountability. Moving forward, one of the most challenging but important components of care delivery is patient involvement. Meaningful use (MU) has addressed patient engagement by promoting e-communications and the use of portals, but providers may need to involve patients on a deeper level. In particular, providers must find ways to improve patient adherence to care plans as value-based reimbursement becomes more prominent. In the future, the detail required by ICD-10 may assist in allowing providers to keep track of patients’ follow-up activities, follow-up results, and patient response to treatment plans to ensure that they are involved and following treatment recommendations.
Care coordination can only be achieved if healthcare’s silos and communication barriers are removed. ICD-10 plays an integral part in this by providing a data set that gives all parties the information they need. As interoperability becomes more ubiquitous, it also has the potential to create widespread variation in patient data. ICD-10’s standardization can allow us to reap the benefits of interoperability and achieve a collaborative and coordinated care continuum that promotes greater efficiency and better outcomes.
CMS: Second end-to-end testing of ICD-10 successful
by Fred Pennic of HIT Consultant
CMS has announced the results of its second ICD-10 end to end testing week conducted from April 27 through May 1, 2015 for Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types. Approximately 875 providers and billing companies participated, and testers submitted over 23,000 test claims.
Key results include:
The acceptance rate for April was higher than January, with an increase in test claims submitted and a decrease in the percentage of errors related to both ICD-9 and ICD-10 diagnosis codes.
- 23,138 test claims received • 20,306 test claims accepted
- 88% acceptance rate
- 2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
- <1% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code
Professional and Supplier Claims – No issues identified and zero rejects due to front-end CMS systems issues.
Institutional Claims – One issue identified related to system edits: Certain inpatient hospital test claims were inappropriately processed due to a systems issue with codes that are exempt from Present on Admission reporting. This issue will be resolved prior to the July end-to-end testing week, and testers will have an opportunity to re-submit these test claims.
The home health issue discovered during the January end-to-end testing week was resolved prior to the April testing. January testers had the opportunity to re-submit these test claims, and they were processed correctly.
There’s a code for that: V55.42
ICD-10 Project Update: May
142 days to go – Shhhh. Hear that? Well, if you don’t, you needn’t worry. It’s not as if you have a case of H91.23 (Sudden idiopathic hearing loss, bilateral). It is the sounds of silence. And with less than five months to go before October 1, 2015, no news is good news as the journey towards ICD-10 continues. On an eventful sports weekend that saw record books updated, a plethora of overtime victories, and three buzzer beating performances in three days, NYP and the rest of the industry will do its best to protect the lead, play aggressive defense, and hold on for ICD-10 victory come October 1.
The NYP ICD-10 project comes into May more than 70% 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. The collaboration across the Hospital and our school-based partners continues as both Cornell and NYP develop and implement physician friendly documentation assistance tools into Epic and Allscripts Sunrise Clinical Manager (SCM). You can read about Epic’s Diagnosis Calculator here and NYP’s ICDx widget here.
- Operationalize dual coding.Nearly half of all Health Information Management (HIM) coding professionals are now coding in ICD-10 for inpatient, ambulatory surgery, and Emergency Department cases.
- 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 an all-time low and creating a buffer against any unforeseen billing and payment delays after October 1, 2015.
- 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 50%. New York State Medicaid SPARCS testing, a vitally important regulatory requirement that aids in determining the Hospital’s rates has begun.
- New York Presbyterian Healthcare System Readiness. Under our healthcare system leadership, we have recently implemented a bi-weekly scorecard for system hospitals to ensure we are all ready for October 1.
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.
There’s a code for that: V47.52
Weill Cornell Faculty Practice Organization (FPO) Launches Epic-based ICD-10 readiness tools
Tomorrow May 7th (Thursday), we will introduce changes in Epic to help transition to the ICD-10 coding scheme. HHS mandated us to switch to ICD-10-CM on October 1, 2015.
Changes you will notice in Epic:
- A “Diagnosis Calculator” will appear for diagnoses when a visit diagnosis requires additional specificity such as laterality, chronicity, care timing (initial, follow-up) etc. After you provide the necessary information, the appropriate code will be added to the system.
- A “Problem Calculator” will appear when you enter a new problem allowing you to select additional specificity (optional). E.g. when you search for ‘heart failure’ you will see options such ‘systolic’, ‘diastolic’, ‘chronic’ show up in the calculator options. You may choose to use these for additional specificity or continue to add ‘Heart failure’ as it is to the problem list.
To familiarize yourself with these ICD 10 changes prior to May 7th, please refer to the job aid and complete the video training and assessment at https://survey2.med.cornell.edu/perseus/wcmc/select/index.aspx
NOTE: Please complete the training even if you had taken it last year in 2014. After you log in using the link above, you will see a link labelled ”recertify” under the “completed on” column in case you have done this last year. Please click on this “recertify” hyperlink to get to the training video.
Why we are making this change: All healthcare organizations in the United States must start using the ICD-10-CM diagnosis code set on October 1, 2015. These changes are being made to increase your familiarity with more specific diagnosis ICD-10 codes to help ease the transition later this year. Payors will still continue to receive ICD 9 codes till the transition date based on our internal mappings of ICD 10 to ICD 9.
How this will affect you: Tomorrow you will start seeing ICD 10 terms when searching for diagnoses in places such as problem list, visit diagnoses and see the diagnosis calculator appear where a more detailed description of a disease is necessary.
Who to contact with Questions/Feedback: Send a message to the Epic Support Team by clicking on the “Epic Help” button in the top-right of Epic, or contact ITS Support at x64878 or email support@med.cornell.edu.
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Physician Organization Information Services
Helpdesk: 746-4878
Log a HelpDesk case: http://myhelpdesk.med.cornell.edu
The argument against ICD-11
Authored by the Coalition for ICD-10 on January 13, 2015
In what at times feels like an unending barrage of excuses why the U.S. should further delay moving to ICD-10, one of the frequently repeated reasons is that we should wait until ICD-11 is ready for implementation.
This excuse is reminiscent of Samuel Beckett’s play Waiting for Godot:
“Let’s go.” “We can’t.” “Why not?” “We’re waiting for Godot.”
Based on the World Health Organization’s (WHO) current timeline, ICD-11 is expected to be finalized and released in 2017. For the U.S., however, that date is the beginning, not the end. As with every WHO version of the ICD codes, ICD-11 would need to be adapted to meet the detailed payment policy, quality assessment and other regulatory requirements of U.S. stakeholders.
The modification of the WHO version of ICD-10 for use in the U.S. took eight years. It was another eleven years before the regulatory process of proposed rules and comment periods was completed and the issuance of a final rule establishing ICD-10 as the HIPAA standard code set. The ICD-10 final rule gave the industry three years to get ready for ICD-10 implementation. Two one-year delays have now pushed the time allotted for preparation to five years. Based on the ICD-10 timeline, ICD-11 would not be implemented until 2041.
It’s now 16 years since the U.S. version of ICD-10 was completed, five years since publication of the ICD-10 final rule, and the U.S. still has not implemented ICD-10. For the many healthcare organizations that worked diligently and in good faith to prepare for ICD-10, the lament in Waiting for Godot is all too true:
“Nothing happens. Nobody comes, nobody goes. It’s awful.”
The U.S. simply cannot wait decades to replace ICD-9, a code set that was developed nearly 40 years ago. U.S. healthcare data is deteriorating while at the same time demand is increasing for high-quality data to support healthcare initiatives such as the Meaningful Use EHR Incentive Program, value-based purchasing, and other initiatives aimed at improving quality and patient safety and decreasing costs.
Moreover, implementing ICD-10 is an important step on the pathway to ICD-11. ICD-11 is built on ICD-10 and benefits from the clinical knowledge and additional detail that have been incorporated into the U.S. version of ICD-10. Transitioning to ICD-10 in 2015 will provide an easier and smoother transition to ICD-11 at some point in the future.
Indeed, a 2013 report[1] on the feasibility of skipping ICD-10 and going right to ICD-11, published by the American Medical Association Board of Trustees, recommended against waiting for ICD-11 and called it fraught with pitfalls. The AMA report concluded that overall implementation and training efforts for ICD-11 will be more challenging if ICD-10 is not implemented first, and the U.S. would miss out on improvements in the ICD-10 codes that better align with today’s data needs.
Waiting for ICD-11 is simply not a viable option. The absurdity of the endless waiting in Waiting for Godot culminates in frustration:
“Let us not waste our time in idle discourse! Let us do something, while we have the chance!”
Yes, the wait needs to be over. It’s time to stop wasting time. It’s time to get ICD-10 implemented.
[1] American Medical Association. “Evaluation of ICD-11 as a New Diagnostic Coding System.” Report of the Board of Trustees. 2013. http://www.ama-assn.org/assets/meeting/2013a/a13-bot-25.pdf.
ICD-10 Readiness Spotlight: ICDx – A widget to support ICD-10 documentation
Enabling physician support of ICD-10 documentation requirements is one of the most important milestones in NYP’s ICD-10 project. In order for NYP to be compliant with ICD-10, our physicians need to incorporate additional details into the documentation that they enter into their patients’ charts. For example, proper ICD-10 coding requires information about the cause of a patient’s condition, the severity of that condition, and how long the patient has experienced it – details that are not necessary for ICD-9 coding.
NYP is supporting physicians in providing this additional documentation through several avenues. The Documentation Improvement team has been training physicians on the additional ICD-10 documentation requirements for their specialty. Documentation Nurses are also beginning to incorporate ICD-10 documentation requirements into their chart reviews, sending queries to physicians whose documentation is missing details that are needed for ICD-10 coding.
Additionally, the ICD-10 Provider Education and Adoption workgroup has collaborated with the IT department to develop a tool that is embedded in the Allscripts Sunrise Clinical Manager (SCM)Electronic Medical Record that helps guide physicians to provide ICD-10 required documentation while they are in the patient’s chart. Called ICDx, this tool will launch automatically when a provider opens certain types of notes. The tool helps providers maintain an accurate ICD-10 problem list which drives documentation that can be readily coded in ICD-10. By guiding physicians to include ICD-10-compliant documentation while they are in the patient’s chart, the tool should reduce the need for subsequent queries from Documentation Improvement nurses.
The ICDx tool is currently being piloted with twelve physicians, who have provided mainly positive feedback. The team is incorporating some requested changes into the tool, and plans to launch the tool institution-wide for the ten most frequently used notes on each campus later in the spring. The tool will be incorporated into additional notes over time in order to ensure that our physicians can easily provide the required documentation for ICD-10 coding.