Friday, April 27, 2012

Top 5 Posts on ICD-10 Impact to Payers & Providers

Here are the top 5 posts, as measured by page views by unique visitors, for this blog in 2012. Each of these have been viewed over 150. The topics are not surprising:
  1. ICD-10 Benefits
  2. Recruiting Resources
  3. Operational Neutrality
  4. Testing
  5. Project Planning

Who says ICD-10 doesn't have any benefits? These guys do...

Thoughts on Recruiting ICD-10 Resources

Playing the ICD-10 Who, What, Where Game

6 Considerations for Verifying ICD-10 Operational Neutrality

11 Areas to Consider When Testing ICD-10 Impact to Payer Business Processes


Tuesday, April 24, 2012

Building an Inventory of Assets for Your ICD-10 Assessment and Other Projects

One of the first steps to take in your ICD-10 assessment project is to create a laundry list of the business-related assets that are potentially impacted by ICD-10 and gather some key attributes for each item on the list. Identifying these core assets and collecting their attributes is a critical foundational component for driving and sustaining the gap, impact and SWOT analyses required to kick start your ICD-10 project and improve the chances of a timely and successful outcome.
Additionally, with a little extra planning and by expending some additional effort as you progress through your ICD-10 project, you can collect some additional information to address not only your ICD-10 project but also other projects undertaken in the future.  The following is a list of information to consider when building an inventory of your business assets:
Note: Many of these attributes are typically collected for other purposes like configuration management and application portfolio management projects and may exist in some form to facilitate your initial efforts.
General Information – Regardless of Potential ICD-10 Impact
Sample Values
Major asset category

Business Process, Reporting, Software/System, Training
Business Domain
What is the business domain in which this artifact is used?
Actuarial, Claims, Configuration, Customer Service, Fraud & Abuse, Finance, Care Management, Pharmacy, EDI, Member/Provider Appeals, Contracts, Legal, Marketing, Medicare, Membership, OPL, Underwriting, Data mart, Other
Artifact Common Name
What is the most commonly used name for this asset?

How critical is this artifact to the day to day operation of the business?
Minor, Medium, Great
Artifact Alias or AKA’s
What short names are used to refer to this asset? Are there any variances by end user?

Artifact Acronym(s)
What acronyms are used to refer to this asset?

Type of Component
What type of asset classification?
Datastore, Interface, COTS, Function, User interface, Report, Batch process, MS Office file, Export, Process, Subscription, Tool, Staff
Assessment Area
What is the primary assessment area?
Data Conversion, Interfaces, Letters & Collateral, New Hardware, COTS products, Data products, Vendor, Data Stores,
Artifact Owner
Who is the person most knowledgeable about the location and value of this specific asset?

Primary Business Contact
Who makes primary decisions regarding the asset?

Business SME
Who is the business process owner?

Technical SME
Who is the person with the most knowledge of the technical nature of this asset?

What is a general level of complexity for this asset?
Simple, Low, Medium, High
How stable is this asset? How often does it require attention and support?
None, Low, Medium, High, Pain in the Ass

Source of Asset Information
Where was the information for this asset obtained?
Assessment Process, Business Unit, Data Models, Vendor Documentation, report inventory, Technical Documentation, User Guide,

ICD-10 Specific Attributes
Sample Values
ICD-10 Element Type
What type of diagnosis-related element is involved?
ICD-10 Diag, ICD-10 PCS, DRG, HCC, Case Rates, etc.
Component Impacted
What portion of the asset is impacted?
Documentation, User Interface, DB Schema, Interface, Logic, Data Mapping
Remediation Effort
What type of effort is involved?
Remediate, Migrate to Other, Unknown, Retire, No remediation required, Configuration, Test
Responsible for Remediation
Who owns responsibility for remediation?
Internal or External
Remediation Priority
What is the priority for remediating this asset?
Low, Medium, High, Urgent
Estimated Remediation Complexity
How complex is the remediation approach?
Easy, Moderate, Difficult, Extreme, Unknown
Remediation Owner
Who is responsible for remediating the asset?
IT, User/Dept, Vendor, Other, Unknown
Impact Level to Other Assets
What impact or dependency does this asset have on remediation of other assets?
None, Minor, Medium, High
Estimated Effort Size
What is the estimate size of the remediation effort?
Tiny, Small, Medium, Large, Huge
Dual Use Required?
Does the remediation approach require ability to support dual usage?

Needed by Date
When is the asset required to be remediated?
During run-up to cut-over date, On Cut-over Date,

Technical Information – Regardless of Potential ICD-10 Impact
Sample Values
What type of hardware and operating system?
Mainframe, Unix, Windows, Hosted,
What is the primary language used in this asset?
Java, COBOL, C/C++/C#,
File Type
What type of file system(s) does the asset utilize?
Database, flat file, MS Office, paper, etc.
Database Type
For assets using a database system, what database platform is used?
Oracle, Sybase, MS SQL Server, Access
Software Version
What is the most current version in use and what is the next logical version?

Vendor & Miscellaneous Information
Sample Values
Vendor Name
Name of the Vendor

Vendor Service Category
What type of “product” does the vendor provide?
Licensed COTS Software, Licensed Custom Software, Hosted Software, Trading Partner, Service
Vendor Contact
Primary Contact at Vendor

Licensing Information
What are key licensing terms?

Annual Maintenance Contract
Is the application covered under an annual maintenance contract?

Renewal Date
When is the license/maintenance contract up for renewal?

Is Source Code Available?
Can usable source code be obtained if necessary?

Is Technical Documentation Available?
Is current technical documentation available?

Is User Documentation Available?
Is current user documentation available?

Age of App
How long has this application been used?

End of Life Target Date
When might this particular application be retired?

Next Major Upgrade Date
What is the next major software version upgrade planned?

# of local users
Number of local users

# of WAN users
Number of users on WAN

Est # of Interfaces
Number of interfaces

Est # Lines of Code
Metric to estimate size of the software

Friday, April 20, 2012

Top Tweets from AHIMA's 2012 ICD-10 Summit

This week the AHIMA held their ICD-10 Summit Conference in Baltimore, MD.  Conference Info
From what I heard and read there were a lot of good presentations and information shared.  Being able to glean a few ideas and highlights from attendees who tweeted was the next best thing to being there – or getting the handouts from someone who was there! :’)
Here are some of what I felt were the top tweets – sorted by general category.  Special thanks to Beth Friedman @HealthITPR (!/HealthITPR) who tweeted the lion’s share.

Note: Sorry for not recognizing the actual Tweeps for these tweets  and dropping off the hashtags – my quick and dirty parsing script dropped these off and I don’t have time to re-process.

Coding/Clinical Documentation Improvement/Computer Assisted Coding
CDI, coders and physician documentation: the magic trio for 1-10 success. Align resources for backup support. Dr. Holmes

CAC, coding from the EHR, more IT support. All needed for ICD -10, especially in ACOs. AHIMA

Clinical documentation is foundational. As documentation improves, so does the picture of quality care.
Physician documentation and ICD-10. Bring all diagnoses capture together to make it easier for docs: paper, transcription, speech, EHR.

Increased specification of location is significant in ICD-10. Coders and CAC- know those body parts! Take A&P training!
Big ICD-10 impact for MD, care manager and coder. Roy Foster from Cerner idea: IT reviews documentation, alerts md real time. Cool!

"You can invest in CAC, but if documentation isn't there, it won't help at all" Roy Foster, Cerner during TrustHCS panel.
Find all pockets of coding going on in your organization today. Results may surprise you. Keith Olenik, I-10 consultant

Physician problem list and ICD-10. Categorize problems into acute, chronic but stable and cured. Dr. Holmes
HIM directors want CAC? Look for ego-driven CIO. If he/she wants to be IT leader in your state, show them CAC.

Good I-9 coders will be excellent I-10 coders. Don't retire yet! Please! - Kim Felix - IOD

Getting EHR documentation templates ready for I-10. Need HIM and IT collaboration. Use extra year to do this. Big payoff!
The Pending Delay

“Don’t delay your implementation. You just got an extra year. Maybe it was hopeless, but it’s not now” Kenda West Tavakoli, MHA
Payer says 1 year delay is good. 2-year delay derails project. Provider partners needed for testing. Reach out and get testing!

“This (ICD-10) is going to happen, it is not the metric system.” Glenn Mitchell, MD, MPH, FACEP, CPE, w/ NAI Consulting
CMS: Delay Necessary, But ICD-10 Will Happen

Three things you need for 1-10 according to Rose Dunn: chocolate, drugs, humor.
A look inside #AMA lobbyists' role in the ICD-10 delay

Polls & Statistics
Is your physician staff for or against ICD-10? Answer the poll at the Journal of AHIMA ICD-10 Summit site

Poll: Do you plan to implement CAC to assist with ICD-10 coder productivity?
“We are in this together, 64,000 of us going strong,” Lynne Thomas Gordon, CEO of AHIMA

ICD-10 experience from Canada: coder productivity never recovers. 20 percent drop remains. Doris Gemmel, Accenture
Cleveland Clinic predicts $30m for I-10. Staff augmentation is lion share. Training second. What is your budget?

Miscellanous Ideas & Comments
ICD-10 is an enabler. It's about managing all the new opportunities, now that we have the ability to do so. Nellie Leon-Chisen

Just starting ICD-10? CIOs say do assessment to identify revenue vulnerabilities. Assess all your system vendors.
ICD-10 education. Dianne Haas from TrustHCS says "everyone except housekeeping, grounds keepers and food service."

CIOs. 5 things to do with extra time: install CAC, focus training, build coders, shore up testing, ready physicians.
Kim Felix from IOD says beef up documentation in OR reports for PCS coding in I-10. Any ideas on teaching surgeons? Coders in OR?

Respiratory predicted top MDC revenue loser in iCD-10. Cardiology DRGs see revenue drop. Louis Rossiter, New Health Analytics
Do Not Rely on GEMs to Calculate the Financial Impact of ICD-10 -  

“Interoperability is a journey, not a destination.” –ONC’s Dr. Doug Fridsma
AHIMA takes leadership role internationally on standards. Who would've thought? Icd10 summit. Dr. Doug Fridsma.

Tea leaves not only way to gauge ICD-10 impact on bottom line-Try predictive modeling
Reimbursement Impact of ICD-10 -  

Closing Tweet
We had a great time at #AHIMA ! Thank you to everyone who stopped by and said hi.