Sinaiko Healthcare Consulting, Inc. offers a comprehensive ICD-10 Service Offering to assist healthcare providers and payers in every facet of ICD-10 implementation. Our organization is uniquely qualified not only to provide guidance on ICD-10 and HIPAA 5010, but also to evaluate readiness for the changes, to recommend solutions and to assist with the implementation of those solutions. Our consulting organization staff members have practical experience in information technology, clinical care,compliance, revenue cycle, clinical documentation improvement and coding.
Our ICD-10 Approach
While we recognize that a “one size fits all” approach isn’t appropriate for all organizations, we have developed a framework to assist our clients with managing the initial phase of the ICD- 10 and HIPAA 5010 transformation with an ICD-10 Readiness Assessment that specifically identifies and categorizes
all people, processes, systems and data elements impacted by these conversions. Our phased approach includes the following:
- Assessment and Planning
- Development of an ICD-10 Implementation Strategy
- Gap Analysis
- Development of a Solution Implementation Roadmap
- Findings, Recommendations and Stratification of Solutions
Our ICD-10 Solution Suite
Evaluation and Preparedness Assessment
- ICD-10 Preparedness Assessment
- System and Application Readiness Assessment and Planning
- HIPAA 5010 Gap Analysis
- HIM Coding Workflow and Capacity Evaluation
- Coder Audits and CDI Queries
- Physician Coding Audits
Clinical Documentation Improvement
- ICD-10 Clinical Documentation Education and Improvement Program
- ICD-10 Clinical Documentation Gap Analysis Review
- ICD-10 EMR/EHR Design Improvements for Clinical Documentation
Education and Training
- Organization-Wide ICD-10 Awareness Training
- Medical Staff ICD-10 Awareness Training
- In-house Coder ICD-10 CM/PCS Training
- In-house Coder Anatomy and Physiology Training
Other
- Financial Modeling and Budgets
- Evaluation of Contracts
Clients
- Hospitals
- Integrated health systems
- Health plans
- Medical groups and physicians
- Homecare & Hospice
- Skilled Nursing Facilities
- DME and other suppliersCD-10 SOLUTION SUITEClients
ICD-10 Preparedness Assessment
Sinaiko’s ICD-10 Readiness Assessment enables our clients to determine their current level of ICD-10 readiness and awareness. The first imperative in the operational assessment is for organizations to understand their own environment and to identify which systems, people and processes are impacted by the conversion to ICD-10. Developing that inventory of components is essential to an effective remediation and implementation strategy. While ICD-10 may seem primarily like a coding and documentation issue, we recognize that all areas of the revenue cycle will be significantly impacted by the use of the new coding standards. Our assessment addresses all areas of the revenue cycle – from pre-visit through final resolution of a claim – to ensure that appropriate attention is paid to all areas where diagnosis codes are used for patient care, reporting, claims generation and payment.
House-Wide ICD-10 Awareness Training
Sinaiko conducts house-wide ICD-10 Awareness Training for all staff members that will be impacted by the conversion to new code sets. The education is designed for senior management, clinical and medical staff, admitting, registration, patient financial services, case/utilization management, Health Information Management, IT, Coding and others who benefit from an enhanced understanding of ICD-10 and its impact on the organization. Customized sessions can be provided for specialty areas impacted by the ICD-10 transition.
Medical Staff ICD-10 Awareness Training
Our firm is very experienced with providing both general and detailed training sessions to
our clients’ medical staff members in all types of formats. Our custom designed medical staff awareness training provides physicians with a high level of understanding of the impact of ICD- 10 on clinical care, clinical workflow processes and clinical documentation. The training typically consists of a two phased approach; first, a general high-level overview of the impact of ICD-10 on medical staff, followed by physician education by specialty with more concrete examples of changes. The goal of the sessions is to leave the medical staff with practical information which they can use on a daily basis.
In-house Coder ICD-10 CM/PCS Training
Sinaiko provides education and training to our clients’ coding staff. Our training includes an introduction to ICD-10-CM and ICD-10-PCS classification systems, the application of coding principles and guidelines, and the appropriate usage of the medical record as a source document. Our AHIMA certified ICD-10 trainers conduct coding education with particular emphasis on the following objectives:
- Review of code structure and coding conventions for ICD-10-CM and ICD-10-PCS
- Review of ICD-10-CM and ICD-10-PCS Official Coding Guidelines
- High-level review of medical terminology, anatomy and physiology, and disease pathology concepts relevant to coding
- Introduction to the uses and applications of the hospital’s encoder to the coding process
- Side-by-side concurrent coding for instruction
- Development of continuing coding education protocols
Our instructors provide attendance certificates that can be submitted to AHIMA or AAPC for continuing education credit.
In-house Anatomy and Physiology Training
Effective ICD-10 coding begins with enhanced biomedical skills and an elevated knowledge of
anatomy and physiology. Sinaiko provides in-house anatomy and physiology training to prepare
our clients’ coding staff for ICD-10 coding. We typically begin with an initial proficiency test to
evaluate the baseline measure of comfort with the principles of anatomy and physiology as they
relate to coding skills. We then develop and deliver robust anatomy and physiology training to
prepare coders for the elevated knowledge of biomedical concepts to ensure success with the implementation of the ICD-10 code set.
ICD-10 Clinical Documentation Education Program
Our experience shows that most clinical documentation issues arise from a lack of understanding of what documentation is required for the clinical care provided. In addition, electronic medical records (EMR) technology and ICD-10 documentation requirements add a new layer of complexity to clinical documentation. We have found that the most effective way to educate physicians on documentation requirements is to use specific examples of their own services to illustrate documentation improvement opportunities. Our Clinical Documentation Education Program typically includes an evaluation of the current CDI program, initial CDI education for providers, design of a new or improved program, and discussion of EMR/EHR enhancements for improved clinical documentation.
Clinical staff members are encouraged to participate in all phases of the CDI program. Once the initial training sessions are complete, Sinaiko provides a comprehensive transition plan to ensure that the medical group staff can continue the training and progress initiated by the CDI project. Sinaiko’s CDI Program benefits our client organizations in the following ways:
- Increases revenue capture opportunities by ensuring all services performed are documented.
- Creates synergy for an EMR implementation, adoption and optimization
- Provides coders and billers with quantifiable and specific feedback to their physicians to ensure timely fixes to problems or maximize reimbursement opportunity
- Identifies physician training opportunities through standardized, easy to use reports
- Decreases compliance risk by actively pursuing physician education and dealing with identified risk
Information Technology: System and Application Readiness Assessment and Planning
Our 5010 and ICD-10 preparation and readiness strategy includes an inventory of information technology systems, applications, interfaces and data repositories to identify any potential impacts of the change in code sets and structure. We have the resources, tools and experience to guide our clients through the assessment, remediation planning and work effort to prepare them for the technology components of ICD-10 implementation.
We typically begin with a robust technology impact assessment to determine what systems and databases contain ICD-9 data and establish plans and priorities for moving them to ICD-10. Our ICD-10 technology assessment identifies:
- Applications, databases, interoperability feeds, and reporting functions that are impacted
- If application and system changes are vendor-supported or require in-house changes
- Upgrade/remediation paths for vendor supported systems
- Potential needs to replace systems
- Estimated timeline, level of effort and anticipated costs associated with the remediation
- Staffing resources required to support system/application replacements or upgrades
- Sequencing of potential system replacements/upgrades
- Plan to conduct unit and integration testing
HIPAA 5010 Gap Analysis
Our service and technology offering supports HIPAA 5010 implementations either through our technology platform or your existing system’s capability. Our firm can provide professional services for assisting with technology and process testing. Our seasoned team espouses testing standards for efficiency and consistency and can assist with all phases of test strategy, planning, development, and implementation either as a fully outsourced function or as a collaborative initiative with internal resources.
HIM Coding Workflow and Capacity Evaluation
The transition to ICD-10 code sets will have a significant impact on coder productivity in both the short and long term. That fact coupled with the current lack of coders in the industry should force providers to look for productivity and workflow enhancements in their current coding processes that could mitigate the effect of lost productivity.
Experience Integrity Results
Sinaiko has worked with healthcare providers and coders for decades to evaluate coding workflows and processes and to assist in the implementation of best practices which allow coding staff to have more efficient processes and tools to do their jobs. Our Coding Workflow Evaluation toolset assesses the current state of a coding department and identifies areas which may enhance productivity. We recognize that while solutions at one provider organization may not work for all organizations, there are principles of work assignment, timing, chart types and intensity of coding effort that can be explored and effectively adopted at most provider organizations. Our results with these types of projects have typically yielded not only increased capacity but also improved job satisfaction and coding accuracy.
Coder Audits and CDI Queries
In preparation for ICD-10 coding, Sinaiko conducts audits of coding staff to determine their current accuracy levels and to evaluate their readiness for the coding changes with the new code sets. We use an audit methodology across various service types to conduct a representative sampling of an organization’s most common diagnoses, procedures and CDI queries to conduct a detailed audit of medical record documentation and coding quality. Our coding audits focus on the following key areas:
- Records that require additional specificity under ICD-10
- The top diagnosis codes that may require additional documentation
- The ICD-9-CM codes that do not have a direct correlation to an ICD-10 code
- The top MS-DRGs by specialty most impacted by ICD-10
Physician Coding Audits
Sinaiko reviews records for the top physician admitters to determine the accuracy of physician documentation and coding. We review records across various service types and conduct a representative sampling of the most common diagnoses and procedures to develop a detailed audit of medical record documentation and coding quality. We have enhanced our standard clinical documentation methodology to include translation of inpatient Medicare data from ICD-9 to ICD-10. Our audit of physicians’ coding identifies the diagnoses and procedures that require additional specificity in ICD-10, shows the MS-DRGs most impacted by ICD-10, and identifies an organization’s largest ICD-10 opportunities in the areas of physician coding and documentation.
For more information about our HIT / ICD-10 Services, please contact Derek Woo at Derek.Woo@Sinaiko.com |
