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Project Scope Statement

Project Scope Statement

Project Name Road to 10: ICD-10 CM/PCS Conversion Project ICD10012015

Number
Project Manager ICD-10 Committee Prioritization High
Owner(s) Executive Medical Director, Compliance Director, Coding and Reimbursement
Manager

Statement of In this section of the scope statement, we specifically elaborate on what the
Work—Project project will create. One should also discuss here how the project team
Description and plans to accomplish this project. This section should be quite detailed,
Project Product because it creates the basis for the entire project and prepares you for
development of your upcoming WBS. Here you should list the high-level
tasks and describe how each task will be executed for the project. This
section should be based on information found in the project's charter. For
example, a software development project would have an overall description
(two to three paragraphs explaining the project product). This would be
followed by 7–10 pages going into detail about the work being completed
on the project.

Project Deliverables
What are the tangible outputs or services of this project? What
big-picture items will have to be created or performed in order to
accomplish the statement of work? These are a list of items that
will be the result of the execution of the project work packages
in the WBS. For example, if your task is to develop software
program for application A, one of your deliverables will be
software application developed. The project examples in this
class normally have 10 to 15 deliverables.

Project Objectives
What are the cost, schedule, and quality objectives of this
project? Your objective statement is likely to be the same or
similar as in your project charter, based on any new knowledge.
Here you might add goals for the project. Objectives can and
often do look past the end for the project, such as an example of
cutting costs in operations by 15%. It is highly possible that your
project objective will have some subobjectives or goals. For
example, the project objective for the software project might be
as follows.
The objective of this project is to develop a new programming
application for the payroll department that will interface with the
existing Kronos system by 10/12/2014 at a budgeted cost of
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Project Scope Statement
$50,000. The goals of the project include the following.
 Create a newly developed program that will be installed
and tested by users.
 Install and load server hardware required for the
application and database environment.

Project Assumptions What are the assumptions on which the project is based?
Project assumptions are those things we believe to be true
without proof for planning purposes. For our software
development, we might assume that users will be available to
test when needed. We have no way to know this for sure during
project planning; thus, it is an assumption for our project. You
should have at least 15–20 assumptions.

Project Constraints What are the major limiting factors that affect the project?
Project constraints are limitations placed upon the project. Many
of them are placed by individuals outside of the project. These
limitations could be laws, regulations, rules, policies,
procedures, or customer or sponsor requirements. Let’s say we
are limited to access for 10 users to test the new application.
This would be a constraint of resources available to test the
project. You should have at least 10–15 constraints.

Exclusions What are the boundaries of the project? What is not going to be
included in the project? This helps the project manager to set
boundaries on the project scope. For example, on our software
development project, we might exclude some specific
functionality on the program. Let’s say Internet access for credit
card payments will not be included in the programming for this
project. You should have at least 10–15 exclusions.

Acceptance Criteria Develop a checklist that will be used by the customer to

measure your performance for the project. This includes the
following: What must the product be able to do when completed
to be acceptable to the customer? What standards or
regulations must the product meet? What performance
specifications must the product meet to be acceptable to the
customer? For example, the new application developed must be
installed in accordance with the standard equipment and
specifications; functionality tested by the user and accepted
prior to implementation.
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Project Scope Statement
Technical What is needed to make this project functional in terms of equipment,
Requirements computers, cash registers, and so forth? What functionality must it have? In
our example, there would be specific types of hardware required, such as 2
HP Proliant DL580 G7 high performance servers are needed for the
application software program execution and database storage. This section
should be three to five pages, depending on the project you selected.

APPROVALS
Type Name Signature Date
Project Manager Approval

Customer or Sponsor Approval

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Project Scope Statement

Road to 10: ICD-10 CMPCS Conversion

Vernita Johnson

09/17/2015

DeVry University

Professor
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Project Scope Statement
The ICD-10 conversion is complex and has been designed to happen in stages. It is regulated by

the Federal, State and Local government. The Health Information Manager, Compliance Manager,

Regulatory Manager, Executive Medical Director as well as the Coding and Reimbursement Manager

must work closely together to ensure that their staff is ready for this conversion. Training other medical

personnel as well as lower level staff such as receptionists is vital to the success of this process. This

process is part of a larger process and will take place in stages. Each stage is vital to the success of the

conversion and will work only if each department does its part in getting ready for the change.

The contractor that will update this software program must understand and have knowledge of

medical procedures and must work closely with the medical team that has been assembled to take on this

task. Although a staff of medical team will be working directly with a contractor; orders in regards to

regulations, rules, policies and guidelines comes down from Federal and State government agencies

such as Medicare and Medicaid.

The conversion to ICD-10 is vital to the security and enhancements of medical records for

patients and staffs. This conversion will allow for a greater explicitly in coding data which in turn will

provide clean claims from healthcare providers. It will also provide continuity of patient care from

healthcare providers and health plans and will ensure that appropriate reimbursement take place for

medical services that are rendered to patients. Due to the conversion of ICD-10 codes; hospital and other

medical facilities will be able to submit claims faster and accurately and it will decrease the chance of

double billing. It will allow patient medical records to be more secure than in the past. New and faster

data will allow for billing information to be passed to the billing department without problems and if

patients are referred out they no longer have to worry about their insurance information because it can

now be stored in the system along with their patient health information.

Training coding staff on codes assignment and clinical documentation will be vital to the success

of the conversion. All of the IT systems must be converted in order to take these new codes. All systems

within the facility must be updated. Depending on the software that is used within the facility will
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Project Scope Statement
depend on the amount of time it takes for that facility systems to be updated. Patient Encounter to Health

and Human Services Commissions (HHSC) for quality measurement must be taken into consideration

when these updates are done. As long as procedures are followed and updates are done within the

specified time provider incentives and reimbursements are available for providing preventive healthcare

services to patients. However an explanation of those procedures must accompany patient billing

information. Healthcare Fraud, Waste and Abuse investigations will occur if procedures are not done as

specified. Clean claims are expected to be submitted with the new codes updated since there should be

less chance for error.

The objective of this conversion is to meet Federal and State regulations for medical coding and

documentation. Converting to ICD-10 will also allow for specific ICD coding and shorten the

turnaround of claims being paid out to medical facilities as it ensure that patient information is secured

during this process. This conversion will in turn maintain compliance with Federal and State Regulations

and Guidelines and increase the number of claims a medical facility can bill in a day. However the

conversion is not an option; it is a mandate. The failure to update and convert will result in the closure of

healthcare facilities because payments will not be rendered from insurance payers such as Medicaid and

Medicare as well as other insurance payers. This conversion will increase disease management by

reducing the number of ER visits by twenty percent and establishing a strong link for preventive care by

offering incentives to providers when they render preventive care services and well-check services to

patients. It will serve to increase more urgent care visits for colds and flu related illness and/or flu shots

by providing urgent care facilities the same rates through claim data.

Of course there is a business need to convert; every year ICD codes change, drop, and/or added

to the list of ICD-9 codes and this was a constant struggle for medical facilities to keep up with. Many

providers are busy with patients; however it is easier for them to make notes as it relates to those

patients as they go about their work in today’s medical society thanks to the new technology we have in

using the EHR software program. This software programs allows providers to enter patient information
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Project Scope Statement
instantly and it allows them to see their information from their last visit. However when it comes to

billing for those procedures that the provider rendered they must make sure they enter the correct code

for that procedure and this is where the conversion of the new software program comes in.

From Dec of 2014 to Feb 2015 the IT systems are being interchanged, cross function

review is taking place, policies are put into place, training for the software programs are beginning,

departmental heads are identifying the new codes and translations of these codes are being taken place

with staff. From Feb 2015 to May 2015 testing will begin on systems that have been updated, May 2015

to August 2015 the completion of the ICD-10 codes input should be completed as well as policy and

benefit changes and through Oct 31, 2015 it will be an ongoing process to update and enhance software

systems to be ready to go live if a facility have not already went live therefore the contractor responsible

for this conversion must have updated, installed and worked out all of the kinks for this program to be

successful.

The cost for converting was spread out over a period of time so that medical facilities would not

have to incur these charges all at once. Medisoft Software® is the go to for most medical providers

because they have enhanced clinical software already embedded in their software data. This software

program handles the demographics for patient information, the software allows for updating without

further cost in clinical areas such as adding providers information, medical information and the software

has been updated to accept patient billing information as well and all of this information is handled by

the receptionist. This software program has two parts; it is used to store medical data and to submit

claims as well and the ICD codes are already embedded within the software program. However due to

the conversion the contractor that is responsible for the new software program must include the new

ICD-10 codes in order for billing to have access to that data information. This is a vital aspect to this

update and one that is very well expected. These codes are to ensure that the billing office have access to

any codes that are needed to file a medical claim.

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Project Scope Statement
The processing of medical claims is an important part of the medical facility. Although this is a

process that deals with the healthcare realm; however many forget and/or do not realize that healthcare

is a business as well. Cost is an important factor to the well-being of your community hospital and

medical facilities. It is vital that these agencies file clean claims using the right billing codes. In the past

to many mistakes have been made with billing codes and to many patients have been either double billed

or billed for procedures they have not had done. This is due in part to the billing office using wrong

billing codes. The ICD-10 codes should resolve this issue.

The cost for any software program for a large facility can add up. It is wise to use sound judgement

when making the decision to install, update and/or enhance a software program. It has been estimated

that the labor cost for this process is going to be $300,000, the materials are going to cost an estimated

$200,000, the contractors total is $500,000, estimated equipment and facilities $100,000 and travel cost

$10,000 which total an estimated cost of $1,110,000.00. This is a large amount of money but this

conversion must take place.

After this conversion has taken place; the client should be able to submit claims and have them

processed quicker which in turn will equal quicker payments. Patient healthcare information should be

more secure. Transmitting EHR and/or EMR will be more secure and faster, the client will be in line

with the guidelines, rules and regulations of Federal, State and Local government agencies. When the

software programs is updated the current IT systems that the facilities have will then update and process

ICD-10 codes correctly as well which will be used for the new billing policies. Also the current medical

policies will now contain appropriate industry standard information in regards to medical necessity.

Medicare and Medicaid will provide incentives and reimbursements for patient wellness, flu, vaccines,

and all other preventives services rendered. In-network providers will use end to end user ready

guidelines for their software programs. Claims editing system vendors will be up to date with their

Federal guidelines and can create the appropriate ICD-10 edits, data analytics can be verified

appropriately for financial impact and budgets and Project Managers will meet Health and Human
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Project Scope Statement
Services Commission (HHSC) guidelines as well as State Medicaid Agencies by providing them with

updates on the new system and assisting with transmission of data. Provider manuals will be used to

assist with the transition.

The great thing about this software conversion is that every healthcare facility around will use

this same formula; therefore it will be easy to communicate electronically and it should be without error.

All ICD-9 codes will transition to ICD-10 after the first of October, 2015. However ICD-10 PCS

procedure codes will be used only for hospital claims for inpatient hospital procedures and not for

physician claims or regular doctor visits. The conversion has no impact on CPT and HCPCS codes; but

dates must be coded with the ICD-10 codes. The new software system will kick out claims without dates

and dual code reporting will be rejected by CMS.

With the new software program medical record requests can be handled electronically unless

patients request paper request and the same policies and procedures remain in place as before. With the

conversion of ICD-10 provider education will be provided for documentation, risk assessment and

credentialing process.

There are some risks in changing this software program as with any other program such as the

negotiation of new provider contracts as we replace ICD-9 data with ICD-10 CMPCS data. These

contracts must be negotiated and resigned for guideline purposes under Federal and State procedures.

Medicaid and Medicare require that all providers sign documentation which states that they agree to the

fee that is provided by these agencies. Also failure to update medical policies for disease case

management could result in coding error, claims processing issues could occur reports that are mandated

by the state may not be verified automatically by the software system and not submitted in a timely

manner. The new software program may fail to recognize the new code translations for the IT system

when processing claims. Although ICD-10 should be embedded into the new software program there is

no way to know if it will coincide with other software programs such as the EMR and the EHR software

programs till the software has been installed. If the new software program does work with the other
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Project Scope Statement
software programs and their security features the contractor must rework the software program and/or

update the security features to coincide with other programs.

This is no easy task to perform the needed operations that is specified by the guidelines. To

ensure that this procedure is successful the contractor and the medical team must work closely together

to ensure that this software upgrade is correct and that all of the kinks are worked out before it is time

for the conversion to be complete. Allowing enough time for this to happen was vital for the success of

the operation. Agile process management is the process that is taking place here since the software is

being updated, changed and altered for corrections.