Indian Health Service (IHS) Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment
Form Approved
OMB No. 0917-0036
Exp. Date:
With which IHS Area are you affiliated?
Aberdeen
Alaska
Albuquerque
Bemidji
Billings
California
IHS HQ
Nashville
Navajo
Oklahoma
Phoenix
Portland
Tucson
Other
If other, please specify
What is your organization’s affiliation?
Indian Health Service
Tribal
Urban
Other
If other, please specify
With which facility type are you most closely affiliated?
Ambulatory
Hospital
Other
If other, please specify
Please indicate your discipline area.
Administration
Behavioral Health
Business Office
Contract Health Services
Clinical Application Coordinator
Coding
Finance
Health Information Management
Information Technology
Laboratory
Nursing
Pharmacy
Physician
Quality Management
Radiology
Other
If other, please specify
Does your organization currently have an ICD-10 Committee?
Yes
No
Unknown
If yes, please identify the activities that the ICD-10 committee discussed and/or acted on?
Budget
Clinical documentation improvement
Training
RPMS patches
Regular meetings
Outreach
Coder retention
Coding backlog
Revenue impact
Other
If other, please specify:
Does your organization have a Clinical Documentation Improvement (CDI) program?
Yes
No
Unknown
If yes, what steps are being taken to improve clinical documentation to support ICD-10?
Involving physicians in improvement process
Assessing documentation
Building relationships among coders and physicians
Developing or improving coder/physician query process
Using CDI tools from IHS or others
Other
If other, please specify
Have you accessed the IHS ICD-10 website? (ICD-10 Website: http://www.ihs.gov/icd10)
Yes
No
Are you a member of the IHS 'ICD-10 Prep' Listserv? (ICD-10 Prep Listserv: http://www.ihs.gov/listserver/index.cfm?module=signUpForm&list_id=201)
Yes
No
Has an ICD-10 budget been identified for your site (i.e., training, resources, CDI)?
Yes
No
Unknown
Is there a person coordinating ICD-10 activities in your site?
Yes
No
Unknown
Have you attended any ICD-10 training or an ICD-10 presentation?
Yes
No
Unknown
If yes, please identify the course or presentation
Has your facility contacted or had contact from any third party payer about ICD-10 readiness?
Yes
No
Unknown
If yes, which payers?
If yes, for the payers with which your site has been in contact, will they be accepting both ICD-9 and ICD-10 codes?
Yes
No
Unknown
Do you feel confident that your facility will successfully transition to ICD-10?
Yes
No
What are your top concerns for a successful transition?
Clinical documentation
Coder knowledge
RPMS software upgrades
Physician involvement
Revenue impacts
Patient impacts
Competing activities (Meaningful Use, Affordable Care Act, etc.)
Other
If other, please specify
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0917-0036. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336E, Washington D.C. 20201. Attention: PRA Reports Clearance Officer.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | kkeats |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |