Workflow ¡Analysis: ¡ A ¡founda)onal ¡piece ¡of ¡ ¡ ¡ transi)oning ¡to ¡ICD-‑10 ¡ ¡ Triche ¡Guenin ¡ 303-‑777-‑9680 ¡ Partners ¡Through ¡Change, ¡Inc. ¡ tguenin@partnersthroughchange.com ¡
CMS – ICD-10 Impact Facilitator Triche Guenin Guest Volunteers Elizabeth Etzler Robin Schiffbauer Triche Guenin 303-777-9680 www.partnersthroughchange.com 2
CMS – ICD-10 Impact What Why Identify where, in daily Better understand where the operations, the ICD-9 codes new ICD-10 codes could are used make an impact Train personnel on how to Provide foundation for read and draw process maps ongoing capability to standardize and document processes Identify opportunities for Chance to streamline process improvement while making changes to accommodate ICD-10 compliance Triche Guenin 303-777-9680 www.partnersthroughchange.com 3
CMS – ICD-10 Impact Demonstrate how understanding workflow can facilitate the transition to ICD-10. Show how workflows can: ◦ be leveraged as the umbrella that supports all other studies/initiatives; ◦ provide a construct from which all other changes to organization/policies & procedures can be shared and shown how they interconnect. Specifically points to where ICD-9 activity currently occurs and will be impacted by changes to ICD-10. Triche Guenin 303-777-9680 www.partnersthroughchange.com 4
CMS – ICD-10 Impact Pictoral description of work Shows the “big picture” Quickly surfaces unexpected complexity, problem areas, redundancy, unnecessary loops Focuses on work, not WHO does it Shows interconnectedness of work activities Identifies locations where additional data can be collected and problem areas investigated Triche Guenin 303-777-9680 www.partnersthroughchange.com 5
CMS – ICD-10 Impact In development Completed and in electronic format (e.g. ppt) Medic al Recor Codin g ds pa tie nt Receive & post payment ba Review la outstanding nc claims e? Spool claims N & forward to clearinghouse Er Ap El Receive ror pr ec status from s ov tro payor fo ed nic End un ? ? d? N Print & send to payor Billing Distribute to Contact payor insurance rep (internal) Is cla im co Correct claim rre Write-off Charge pt cti bl e? Write-off criteria Fix error Complete 3 rd consideration de form (incl ni claim/appeal al form) ? Triche Guenin 303-777-9680 www.partnersthroughchange.com 6
CMS – ICD-10 Impact 1. Identify key process areas in organization 2. Develop a SIPOC* diagram of each process area 3. For each process area, understand current state ◦ Gather stakeholders together ◦ Create a process map ◦ Identify not only work activities but other areas of interest (e.g. ICD-9 touch point, systems used, metrics) ◦ Identify opportunities for improvement ◦ Validate with “others” 4. Perform analysis of workflow for changes towards compliance and streamlining for efficiency Triche Guenin 303-777-9680 www.partnersthroughchange.com 7 * SIPOC = Supplier, Input, Process, Output, Customer
CMS – ICD-10 Impact Start with patient processes ◦ Example 1: Patient Pre-Encounter, Patient/Doc Encounter, Fulfill Physician Order, Patient Discharge ◦ Example 2: Patient Intake, Nurse Visit, Patient Encounter, Physician Orders, Patient Exit Identify “other” supporting processes: • Internal Auditing • Medical Records • Coding • EMR/IT Updates/Maintenance • Claims • Research Participation • Billing/Superbill/Documentation • Appeals • Referrals/Precerts/Pre-Authorization • Public Health Reporting • Contracting • Analytics • Risk Mgmt There is no “right” number/series/naming Triche Guenin for your processes! 303-777-9680 www.partnersthroughchange.com 8
CMS – ICD-10 Impact input Supplier 1 Customer 1 output PROCESS input Customer Supplier 2 output 2 Definitions: input • Supplier - whomever provides input into the process Supplier 3 • Input – materials, resources, information, data, guidelines, etc. required to execute the process • Process - sequence of related activities that transform inputs into outputs to provide value for the customer • Output – products/services resulting from the process, addressing the customer’s needs • Customer – whomever receives the output(s) of the process – Triche Guenin may be an internal or external entity 303-777-9680 www.partnersthroughchange.com 9
CMS – ICD-10 Impact Suppliers Input Process Output Customers Self Patient Pre- Authorization Physicians Payor Ancillary Orders Services Physicians Referring Orders Physician Patient Test/ Physicians Encounter Ancillary Lab Results Orders D/C Team Services Admit Pt Hx/Vitals Encounter Form Team Information/ Physician Notes Coding SME Personnel Physician Triche Guenin 303-777-9680 www.partnersthroughchange.com 10
CMS – ICD-10 Impact Identify scope (start/stop) points Understand the handoffs between other processes (e.g. SIPOC) Determine what additional info needed ◦ ICD-9 use ◦ Metrics ◦ System interface ◦ Opportunities for Improvement Can be used when mapping current (As-Is) or future state (To-Be) work environments Triche Guenin 303-777-9680 www.partnersthroughchange.com 11
CMS – ICD-10 Impact Triche Guenin 303-777-9680 www.partnersthroughchange.com 12
CMS – ICD-10 Impact Starting/Stopping Point Activity Decision Process (out of scope) Work Movement Data Movement *caveat: there are many more standard icons, but these are the basic few Triche Guenin needed to get started…some follow standard convention and others don’t to 303-777-9680 facilitate ease of use www.partnersthroughchange.com 13 13
CMS – ICD-10 Impact Suppliers Input Process Output Customers Self Patient Pre- Authorization Physicians Payor Ancillary Orders Services Physicians Referring Orders Physician Patient Test/ Physicians Encounter Ancillary Lab Results Orders D/C Team Services Admit Pt Hx/Vitals Encounter Form Team Information/ Physician Notes Coding SME Personnel Physician Triche Guenin 303-777-9680 www.partnersthroughchange.com 14
CMS – ICD-10 Impact Basic P Basic Process rocess Start Furth Furth Provide N N Review pt. er er Assess pt. Treat pt. clinical symptoms testin testin summary g? g? Y Y Stop *WIP = Work in process Triche Guenin 303-777-9680 www.partnersthroughchange.com 15
CMS – ICD-10 Impact Validate te handoff processes (and associate ted inputs ts/outp tputs ts) from SIPOC Patient Intake Physici an Coding Coding Order Furth Furth Provide N N Review pt. er er Assess pt. Treat pt. clinical testin testin symptoms summary g? g? Y Y Physici an Patient Order Exit Triche Guenin 303-777-9680 www.partnersthroughchange.com 16
CMS – ICD-10 Impact Key: Gath ther additi tional informati tion System ICD-9 Patient Intake Metrics x% Physici Coding an Order 35% 90% Furth Furth Provide N N Review pt. er er Assess pt. Treat pt. clinical testin testin symptoms summary g g EHR EHR EHR Y Y 10% 65% Physici an Patient Order Exit Triche Guenin 303-777-9680 www.partnersthroughchange.com 17
CMS – ICD-10 Impact Dig deeper in area need to Di to investi tigate te . Coding Determine Document Perform Validate pt initial diagnosis/ Physical complaint/hx diagnosis findings/notes Confirmation EHR Triche Guenin 303-777-9680 www.partnersthroughchange.com 18
CMS – ICD-10 Impact Changes needed to achieve ICD-10 compliance ◦ Content knowledge – clinical personnel/staff (FT/PT) ◦ Template conversions (e.g. forms/screens/documents/policies/ training materials) ◦ Payor coverage ◦ Referral acceptance ◦ Systems & system integration (e.g. # digits, vendor timing/ compliance capabilities) ◦ … Streamlining for efficiency ◦ Incorporate opportunities for improvement ◦ Implement “lean” principles ◦ Automate where possible ◦ Clarify roles & responsibilities ◦ Align skill sets ◦ … Triche Guenin 303-777-9680 19 www.partnersthroughchange.com
CMS – ICD-10 Impact Complete current workflow analysis Get more specific where ICD-9 touches Identify “other” opportunities for improvement Learn nuances of ICD-10 codes applicable to specific practice (e.g. content, combinations, # characters) Develop “new” improved compliant process(es) Determine appropriate roles & responsibilities Document via standard operating procedures Integrate systems to handle/recognize the new codes Train personnel on new processes/roles/forms/codes….. …. Deadline is Oct 2014! Triche Guenin 303-777-9680 www.partnersthroughchange.com 20
Recommend
More recommend
