Transcript Document

ICD-10: Practice Insight
Readiness
Presented by:
Jim Goerlich – VP of Sales
Agenda
TABLE OF CONTENTS
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Why ICD-10?
Obstacles for ICD-10 Implementation
Practice Insight Solution
Benefits of the Practice Insight Product
Why ICD-10?
1.
Patient Care: Many improvements have been made to coding in ICD-10-CM. For
example,
• single code can report a disease and its current manifestation (i.e., type II diabetes
with diabetic retinopathy).
• In fracture care, the code differentiates an encounter for an initial fracture; followup of fracture healing normally; follow-up with fracture in mal-union or nonunion;
or follow-up for late effects of a fracture.
2. Increased Specificity: While an ICD-9-CM code may identify a condition of, for example,
the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right
ovary, left ovary, or bilateral condition of the ovaries.
3. Effect on Practice: The big differences between the two systems are differences that
will affect information technology and software at your practice. **
**Source: http://www.aapc.com/icd-10/faq.aspx#why
Why ICD-10?
Issue
ICD-9-CM
ICD-10-CM
Volume of codes
approximately 13,600
approximately 69,000
Composition of codes
Mostly numeric, with E and V
codes alphanumeric. Valid codes
of three, four, or five digits.
All codes are alphanumeric,
beginning with a letter and with a
mix of numbers and letters
thereafter. Valid codes may have
three, four, five, six or seven
digits.
Duplication of code sets
Currently, only ICD-9-CM codes
are required. No mapping is
necessary.
For a period of two years or more,
systems will need to access both
ICD-9-CM codes and ICD-10-CM
codes as the country transitions
from ICD-9-CM to ICD-10-CM.
Mapping will be necessary so that
equivalent codes can be found for
issues of disease tracking, medical
necessity edits and outcomes
studies.
In short, ICD-10 can:
1.
Improve the
quality of care
2. Allow providers
to code with
higher specificity
in order
3. Provide better
service to patient.
ICD-10 Obstacles
There are 4 main obstacles that practices should prepare to experience: **
1) Training and Re-Training: Most organizations realize their support staff will be required to
undertake additional training.
a) Code Volume: biller’s required to learn how to utilize roughly 150,000 codes as opposed
to the 18,000 associated with ICD-9. T
b) Impact: his additional training could take from 50 to 100 hours for each biller.
2) Decreased Productivity: In the short-term, the training period required for the ICD-10
transition:
a) reduces physicians and staff time dedicated to their normal duties
b) patient visits may take longer due to the increased detail of the code standards.
c) submission delays are likely because coders will need to ask questions of physicians in
order to verify information.
**Source: http://www.mdbillingexpert.com/icd-10-obstacles/
ICD-10 Obstacles
3) Processing Overlap:
a) October 1, 2014 - all claims go out in ICD-10. This is mandated by the date of service and
not the date of transmission. This means any claim with a date of service after October
1st, must go out in ICD-10 format.
b) Dual Claim Submission- If billers are behind they will be required to submit claims in
both formats until they get caught up. As a result older claims could be in play for
months after October 1st causing claims to be rejected, denied and appended.
4)
Stalled Cash Flow: Fallout from the ICD-10 conversion will have an effect on the entire
healthcare community likely causing a slowing in cash inflow. During the adjustment period
there could be an increase in claim errors and delays.
**Source: http://www.mdbillingexpert.com/icd-10-obstacles/
Practice Insight ICD-10 Solution
Overview:
1. ICD-10 codes and CMS GEMs are loaded directly into the DX Search.
2. All possible scenarios for the ICD-9 to ICD-10 Diagnoses Search are
listed in the GEMS Mapping Section.
3. The DX search contains a tree view for diagnosis that contain
multiple matches in ICD-10. The tree view shows a parent-child
relationship for the code.
4. Users have the ability to reverse search from ICD-10 to ICD-9.
5. The Description field works as a key word search in order to use the
search as a stand-alone tool.
Benefits of the Practice Insight ICD-10
Solution
1) The Coding Perspective: You can gain an understanding of your practice’s situation with
ICD-10 through the CMS General Equivalent Mappings (GEMs) data. GEMs bridge the
language gap between ICD-9 and ICD-10 CM to help understand, analyze, and manage
moving to the new code sets.
2) The Reimbursement Perspective: Having a solution that will allow you to identify the
codes that have been billed on actual claim data helps the practice identify their most used
and highest paid codes and focus on how these codes translate to ICD-10 in order to better
predict the potential shift in reimbursement.
3) The Compliance Perspective: This tool along with the existing claim analytics will help the
practice make sure that they are currently coding compliant and are prepared to become
compliant BEFORE the payer begins adjudicating in ICD-10.
ICD10 Code Analysis Report
Graph
Description:
Benefit:
Sorts ICD-9 Codes by Ratio Descending
Focus on most used ICD-9’s that may have more than 1
translation, so user can learn the new code set to
determine the most relevant ICD-10 code.
Detail
Description:
Benefit:
List most used ICD-9’s by Claim Volume
Understand potential impact on revenue.
Question and Answer