2. 2
Perficient is a leading information technology consulting firm serving clients
throughout North America.
We help clients implement business-driven technology solutions that integrate
business processes, improve worker productivity, increase customer loyalty and create
a more agile enterprise to better respond to new business opportunities.
About Perficient
3. 3
• Founded in 1997
• Public, NASDAQ: PRFT
• 2012 revenue of $327 million
• Major market locations throughout North America
• Atlanta, Austin, Boston, Charlotte, Chicago, Cincinnati, Cleveland, Columbus,
Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Los Angeles,
Minneapolis, New Orleans, New York, Philadelphia, San Francisco, San
Jose, Southern California, St. Louis, Toronto, and Washington, D.C.
• Global delivery centers in China, Europe and India
• ~2,000 colleagues
• Dedicated solution practices
• ~85% repeat business rate
• Alliance partnerships with major technology vendors
• Multiple vendor/industry technology and growth awards
Perficient Profile
4. 4
Business Solutions
• Business Intelligence
• Business Process Management
• Customer Experience and CRM
• Enterprise Performance Management
• Enterprise Resource Planning
• Experience Design (XD)
• Management Consulting
Technology Solutions
• Business Integration/SOA
• Cloud Services
• Commerce
• Content Management
• Custom Application Development
• Education
• Information Management
• Mobile Platforms
• Platform Integration
• Portal & Social
Our Solutions Expertise
5. John Bradshaw, Healthcare Industry Consultant at Perficient
John is a consultant in Perficient's national healthcare practice
who specializes in ICD-10 assessments. He has conducted
extensive provider ICD-10 reviews and is well-versed in the
challenges faced by both the provider and payer communities.
Our Speaker
5
6. 6
• Requisite ICD-10 Background Slide!
• Challenges
• Myths
• A Structured Approach
• An Example of a Timeline
• A Dance
• Code Management and ICD-10
• Closing
• Q&A
Agenda
7. 7
What?
• Transition form ICD-9 to ICD-10
• ICD-10 CM (diagnosis)
– 3 to 7 digits instead of the 3 to 5 digits
– 68,000 codes compared to 14,000 codes
in ICD-9
• ICD-10 PCS (inpatient procedure)
− 7 digits instead of 3 to 4 digits
− 84,000 codes compared to 4,000 codes in
ICD-9
When?
• October 1, 2014
• NO DELAYS, NO GRACE PERIODS
Who?
• All HIPAA covered entities who transmit
electronic transactions
− Providers, payers, billing services,
clearinghouses, etc.
Background
Why?
• ICD-9 is obsolete
– It is 30 years old
– It has outdated terms
– Doesn’t reflect current medical knowledge
or advances in technology
– Not descriptive enough
– No room for expansion
– Lack of flexibility
• ICD-10 allows for:
– Greater specificity
• Will improve the ability to measure
health care services and decrease the
need to include supporting information
with claims
– Includes updated medical terminology and
disease classification
– Allows providers to better ID patients with
specific conditions
• Will benefit from tailored disease mgmt.
programs, e.g. diabetes, asthma
8. 8
• Areas of Primary Impact
– Clinical Documentation
– Coding & Billing
– Education & Training
– Reporting & Analytics
• HCR initiatives already underway (MUI&II,EHR)
• Anecdotal information
– Early experience by some Health System and Payer
organizations testing the coding of bills as ICD-10
utilizing existing patient records resulted in a low (< 50%)
success rate
Challenges
9. 9
• Upgrading the systems will make us compliant
• Cross-walk will solve all your problems
• Revenue neutrality
• CMS will delay again
Myths
10. 10
A Structured Approach
• Create initial awareness, outline effort and establish
governance
• Organizational readiness and capacity for change
Assessment
• Program management, drive communication activities,
vendor engagement, Code Management, work streams to
address impacts and operational preparedness
Remediation
• End-to-end integrated testing, include partners
• Validation of Readiness activities
• Training and Education begins
Testing
• Implementation & distribution of Cross-Walk
• Business operations transition plan execution
• Data & Analytics preparation
Readiness
• Begin use of ICD-10 in daily operations
Go-Live
• On-going monitoring of organizational activities impacted by
the ICD-10 change, identifying and making adjustments as
necessary
Post Implementation
11. 11
Assessment
Project
Initiation
Charter Governance Stakeholders
Organizational
Background
Collection
& Review
Operational
Baseline
Interviews Investigations Discovery
Impact &
Gap
Analysis
Review &
Collection of
Activities
Master List of
Findings
Determine
Impacts &
Gaps
Roadmap
& Next
Steps
Identify
Projects &
Initiatives
Complete
Findings &
Observations
Roadmap Recommendation
Plan Project Review
Resources &
Dependencies
Staffing
Kickoff Communication Plan
Steering
Committee/Senior
Management
Roadshow
12. 12
• Method
– Understand Organization and Current State
– Collect and inventory those activities and items that currently
involve/utilize ICD-9
– Develop a portfolio of projects to address the identified impacts and
gaps
– Assess the organization’s readiness for change
• Artifacts
– Assessment Document
– Inventories Workbook
– High-level Project Plan
– Project Portfolio
– Strategic Roadmap
Assessment
13. 13
Inventory Categories
Section Description
Organization Structure List of departments, department managers and who they report to
Customers Organizations, individuals and other entities that are serviced by TCHP
Business Process List of major, minor and other key business processes that support a service provided by TCHP
to it's customers
Business Requirements
Those things that, when met or satisfied, enable the organization to meet its goals and
objectives.
Business Partners Organizations, individuals and other entities contracted by TCHP to augment its services and/or
provide other services to TCHPs customers
Vendors Organizations, individuals and other entities contracted to provide products and support services
to TCHP that enable it to meet its business requirements
Applications
Technology/systems that enable TCHP to execute certain tasks and activities
Interfaces A service that enables an exchange of data to occur between an application, vendor, business
partner or other entity
Reports Compilation of information specifically arranged as to communicate the results of activities or
events to the viewer
Documents
Any of a variety of business documents that describe the services to be delivered and the
manner in which delivery is to be handled, such as fee schedule contracts, plan documents and
standard operating procedures
14. 14
Remediation
Program
Management
Governance Standards Roles &
Responsibilities
PMO
Communication
Communication
Strategy
Awareness
Culture &
Change
Management
Team
Building
Employee
Education &
Training
Operational
Planning
Code
Management
Cross-walk Analytics Distribution Testing
Vendor
Management
Readiness Upgrades Deployment
Reporting &
Analytics
Risk
Management
Data
Warehousing
& Marts
Clinical Operations Financial
Clinical
Documentation
Policies &
Procedures
Records
Patient Care
Team
Coding
Processes &
Applications
EHR Revenue
Ancillary &
Support
Inter-
operability
Foundational
16. 16
• What you need to do
– Establish a governance structure and provide for oversight
– Provide for/enable participation of SMEs and operational leadership during
Assessment
– Assign responsibility/accountability for the completion of the many Remediation
initiatives to the appropriate business & technology leads
– Manage the operational transition to support the 10/1/2014 implementation
– Coordinate the Education and Training of impacted employees
– Stakeholder Awareness
• How you can leverage others
– Program management, trusted advisor, able to look across the entire organization
and unencumbered by any organizational norms
– Bring other key partners to the table to help
– Point assistance with the remediation of transactional platforms, service solutions and
analytics
– Visibility to how peer organizations are addressing various issues
– Drive your Code Management effort
Choreographed Dance
17. 17
• Code Management comprises:
– Cross-walk development
– Analytics
– Distribution
– Testing and validation
• The experience and knowledge gained from developing the
Cross-walk and leveraging it to analyze the impact to the
organization, serves as an important input to the overall
Remediation effort
Code Management and ICD-10
19. 19
• Business Intelligence (BI), Reporting & Analytics based
upon a mix of ICD-9 and ICD-10 originated encounters and
billings
• Greater granularity will provide for a much richer set of data
to drive analytics
• Impact of more detailed patient records
• Risk Stratification
• Case Mix Index Analysis
• Introspection
Long-term Benefits of ICD-10
20. 20
• Organization-wide impact
• While others can assist you, the breadth of the impact
requires long-term engagement in the effort by many from
across the organization
• The scope and effort demand structure, coordination and
collaboration to ensure the maintaining of on-going service
levels and the managed introduction of change
• Code Management drives prioritization of efforts, risk
mitigation and focus
Closing