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CoxHealth

Part 1

For most people, 91 percent is pretty good. In an election year, it’s a landslide. In high school, it’s an A. But for CoxHealth in Springfield, Missouri, it’s a good start.

CoxHealth is one of only 50 sites in the U.S. to take part in The Centers for Medicare and Medicaid’s (CMS) comprehensive, end-to-end testing for ICD-10 coding. Its first testing attempt, in January, scored that 91 percent; meaning 91 percent of the claims it submitted to CMS were accepted.

By comparison, CMS reported an average 81 percent success rate for its end-to-end testing participants.

This week, CoxHealth will attempt to improve on its 91 percent. Several of its hospitals will take part in a second round of CMS end-to-end ICD-10 testing.

Speaking about the thorough review, CoxHealth’s System Director for Health Information Management Robin Gann said, “this made me more comfortable, knowing that we, and our systems, are ready for the transition.”

The transition is required for all HIPAA-covered United States health care organizations on October 1. Currently, medical coding in the U.S. is at ICD-9 levels, five digits long. ICD-10 is much more detailed and seven digits (and letters) long.

The ICD-10 transition requires work. During that last week in January, roughly a dozen CoxHealth and Cerner employees in multiple departments worked 351 hours to file 50 encounters in both ICD-9 and ICD-10

“We can see 50 encounters in an hour at one hospital,” said Gann. “We had to devote a great number of hours to this. We were serious.”

CoxHealth, a Cerner ITWorks client, uses several solutions – including Cerner Soarian Financials – across its health system. That span includes five hospitals and 84 outpatient facilities.

During the testing, the CoxHealth team chose common cases in which patients transition between departments in the acute setting. “We wanted to see the failure points,” Gann said.

The team discovered problems; notably, CoxHealth had not taken an updated package for Soarian. “Finding it during the test in January was the right time to find it – not in October,” she said.

Another glitch: the 7th digit of some ICD-10 codes was dropped before the code ever reached Medicare. The reason is still under investigation – which highlights the need for early testing.

This July, in the third round of tests, CoxHealth may expand to some of its ambulatory settings.

By October, Gann hopes to get that 91 percent success rate to 100 percent – and ace ICD-10.

Part 2

In just five days, CoxHealth took its ICD-10 testing number from good to great.

Last month, the 948-bed health system achieved a perfect acknowledgement score on Centers for Medicare and Medicaid Services’ (CMS’) second round of end-to-end ICD-10 testing. This means CMS received all 63 claims submitted by CoxHealth’s three participating hospitals in Southwest Missouri.

Robin Gann, CoxHealth’s system director for Health Information Management, said the solutions used – Cerner® clinical solutions and Cerner Soarian® Financials – “are ready for ICD-10. We should acknowledge and tout that.”

In January, during the Springfield, Mo.-based health system’s inaugural end-to-end test, CoxHealth hit an impressive 91 percent. While CMS has not released its results from the most recent testing, it reported the first testing round’s participants had an average 81 percent success rate.

In January, it took roughly a dozen CoxHealth staff working a combined 351 hours to submit 54 claims from the same three locations. To reach April’s 100 percent, it took fewer employees a combined 167 hours.

Gann credits the progress to workflow changes.

During January’s testing, the coding manager handled claim coding while the coding staff entered data. To check for errors, the team watched each claim process individually. In April, the staff did the coding themselves, watched the claims autogenerate and analyzed the results afterwards.

This perfect score boosted CoxHealth’s confidence for the third and final round of tests, which are scheduled for July. It will simultaneously roll out Cerner ambulatory solutions in its 84 clinics, while including some of those physician practices in the ICD-10 testing. The organization will also test patients from non-Medicare payers.

“We will add on specific patients to test our depth and identify any problems,” Gann said.

Gann maintains January’s roadblocks prepared CoxHealth, a Cerner ITWorks client, for its success in April. “You don’t know what problems you have until you do your testing,” she said.

Gann and Michael Cotton, ICD-10 project leader for CoxHealth, along with Seth Katz of Truman Medical Center, will participate in a Cerner-hosted Twitter chat on Wednesday, May 27 at 11 a.m. Central Time. Twitter users can submit questions using #CernerChat.

CNBC recently featured Truman Medical’s Mitzi Cardenas speaking on ICD-10. Click here to watch the video, which also features Cerner President Zane Burke.

Cerner will host an ICD-10 mock cutover testing event June 1-5. Click here to register.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.