Transcript ZirMed Powerpoint Template
Agenda
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Agenda Placeholder ICD-10 Are You Prepared?
February 26, 2013
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Our Presenter – Betty Gomez
Betty Gomez VP of Regulatory Strategy ZirMed’s Industry Liaison 21 Years of Health Care EDI Experience 2
Webinar Topics
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ICD-10 Background – Final Rule Why is the Industry Going to ICD-10?
Comparing ICD-9 to ICD-10 Understanding the Global Impact of ICD-10 ICD-10 Timeline Preparing for ICD-10 – Provider Focus Industry Readiness – Where We Stand Today Raintree Product Readiness
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ICD-10 Background
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January 16, 2009, the Federal Government issued a new HIPAA rule requiring the adoption of ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for all dates of service on or after October 1, 2013.
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April 9, 2012, the Office of the Secretary, HHS (Health and Human Services) proposed a rule to change the ICD-10 compliance date to October 1, 2014.
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Compliance with 5010 is necessary prior to implementing ICD-10.
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What is ICD-10?
• A coding system for: —Diagnosis ICD-10-CM —Procedures ICD-10-PCS • Affects: —All Providers in every healthcare setting (Diagnosis) —Inpatient Hospitals (Procedure Codes) —It is NOT CPT or HCPCS • It Replaces, and is much more Granular than ICD-9 • Compliance Date: Oct 1, 2014 5
Imagine…
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Single Implementation Date for all Users
September 30
English
October 1
German (AND English) 7
Greater Granularity = More Codes
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Why Move To ICD-10?
More precise Better Quality of Care Better Fraud Detection Population Health Analysis ICD-9 is 25 years old Greater Accuracy in Reimbursements
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From
DIAGNOSIS CODE STRUCTURE
3-5 characters in length To 3-7 characters in length 10
ICD-9-CM
3-5 characters in length Digit 1 may be alpha or numeric Digits 2-5 are numeric Lacks laterality Does not support interoperability
842.01 –Wrist Sprain and Strain of Carpal
ICD-10-CM
3-7 characters in length Digit 1 is alpha Digits 2-3 are numeric Digits 4-7 are alpha or numeric Allows laterality and bilaterality Supports interoperability
S63.511A –Sprain of Carpal Joint of Right Wrist
Example - Diagnosis
Old
365.71
New
H40.1211
H40.1221
H40.1231
H40.1291
H40.1311
H40.1321
H40.1331
H40.1391
H40.1411
H40.1421
H40.1431
H40.1491
Mild Stage Glaucoma Low-tension glaucoma, right eye, mild stage Low-tension glaucoma, left eye, mild stage Low-tension glaucoma, bilateral, mild stage Low-tension glaucoma, unspecified eye, mild stage Pigmentary glaucoma, right eye, mild stage Pigmentary glaucoma, left eye, mild stage Pigmentary glaucoma, bilateral, mild stage Pigmentary Glaucoma, unspecified eye, mild stage Capslr glaucoma w/pseudxf lens, right eye, mild stage Capslr glaucoma w/pseudxf lens, left eye, mild stage Capslr glaucoma w/pseudxf lens, bilateral, mild stage Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage 12
PROCEDURE CODE STRUCTURE
From To 3-4 numbers in length X X X X X X X 7 numbers in length 13
ICD-9-CM VOL 3
3-4 numbers in length Based on outdated technology Generic terms for body parts Lacks description of methodology and approach for procedures
ICD-10-PCS
7 alpha-numeric characters in length Reflects current usage of medical technology and devices Provides detailed descriptions of methodology and approach for procedures
47.01 - Laparoscopic appendectomy 0DBJ4ZZ - Excision of Appendix, Percutaneous Endoscopic Approach
Example - Procedure
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84.01
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0X6N0Z0 0X6N0Z1 0X6N0Z2 0X6N0Z3 0X6P0Z0 0X6P0Z1 0X6P0Z2 0X6P0Z3 0X6Q0Z0 0X6Q0Z1 Finger Amputation Detachment at Right Index Finger, Complete, Open Approach Detachment at Right Index Finger, High, Open Approach Detachment at Right Index Finger, Mid, Open Approach Detachment at Right Index Finger, Low, Open Approach Detachment at Left Index Finger, Complete, Open Approach Detachment at Left Index Finger, High, Open Approach Detachment at Left Index Finger, Mid, Open Approach Detachment at Left Index Finger, Low, Open Approach Detachment at Right Middle Finger, Complete, Open Approach Detachment at Right Middle Finger, High, Open Approach 15
Understanding the Global Impact of ICD-10
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THIS IS A BUSINESS ISSUE WITH LARGE IMPACTS Impacts Include Many Entities:
• Providers, payers, vendors, employers, schools, agents • Members/patients, business associates/trading partners • Workers’ compensation, state agencies • Transplant/disease registries, etc.
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ICD-10 Timeline
• Analyze the impact ICD-10 will have on your practice • Review payer contract for diagnosis • Talk with vendors regarding upgrades for ICD-10
ASAP
• Schedule software upgrades • Monitor payer alerts and readiness.
• Prepare for testing with payers and/or clearinghouse.
2013
• Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years.
Beyond ASAP
• Budgeting for ICD-10 impacts such as, system upgrades and training
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• Coder/biller training • Review practice readiness 17
Care Flow
Assessment Documentation Treatment Claim Submission Coding 18 Documentation
Major Provider Impacts
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Clinical Documentation
—Practitioners!
Coding Business Processes
—Superbills / Day Sheets
PM/HIS/EHR Systems
• • • • 77% Indicate Top Challenge
Medical Policies Contracting Staffing / Staff Training Denials, Audits, Revenue Disruption
—Need Generous Lines of Credit • • • •
For Physicians Physicians deal with diagnosis not codes Learn new ICD-10 codes Learn how to use an index Create a new job aid or superbill
(Professional Providers get paid on CPT code not DRG) 19
Preparing for ICD-10 Provider Focus
• • • • • • • Identify the Needs and Action Plans for the Transition Education and resources Information Systems inventory and gap analysis Vendor preparation Documentation improvement Financial impact and payer preparation AHIMA Published a Checklist About Preparing for ICD-10:
http://www.ahima.org/downloads/pdfs/resources/checklist.pdf
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ICD-10 Project Plan
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Phase 1 Assessment Implementation Plan Development and Impact
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Phase 2 Risk Mitigation and Implementation Preparation
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Phase 3 “Go Live” Preparation
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Phase 4 Post-implementation Follow Up
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Industry Readiness
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The Workgroup for Electronic Data Interchange (WEDI) conducted an industry ICD-10 readiness survey in February 2012 –
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Results showed that health care entities were falling behind recommended timelines for implementing ICD-10 code sets by 10/1/13.
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Responses indicated some progress had been made, but not keeping up with milestones.
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Industry is falling behind
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New proposed rule to implement ICD-10 on October 1, 2014 instead of 2013.
WEDI sent out a new survey in January 2013
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ZirMed Strategy
Value-Add Solutions and Services Analytics ● Outsourced Education ● Consulting ● Code Translation Helping Providers Prepare Webinars ● Playbook ● Assessments ● Get-Well Plans ● Pilots ● Testing Getting ZirMed Prepared Organization ● Remediation ● Internal Training ● Staffing ● Measuring Success 23
Helping Providers Prepare
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Awareness Webinars Assessments Get-Well Plans Pilots End-to-End Testing Resource Center ICD-10 Survival Tool Kit Internal Education
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Value-Add Services and Solutions
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Analytics Data Translation Education Consulting
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Analytics
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Insights Analytics
—Utilized in the early planning timeframe (early 2013) —Show Code Usage in the facility —Show how code usage extrapolates into ICD-10 codes —Show 80/20, 90/10, 99/1 code usage for prioritization of focus —Show top revenue impacts •
Transition Analytics
—Utilized after Transition (after Oct 1, 2014) —Show impact of ICD-10 on claims outcomes via remits analysis 26
ZirMed ICD-10 Timeline
• Set up ICD-10 Resource Center • ZirMed Survival Tool Kit • Webinars • System Remediation • National Pilot ICD-10 Testing • Code translation Tool • Testing Portal • Begin testing with Providers
and Payers 1 QTR 2013 3 QTR 2013
• Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years.
Beyond
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2QTR 2013 Education & Consulting Offerings ICD-10 Analytics 2014
• ICD-10 Transition •
Analytics – June Oct 1 st start submitting ICD-10 codes
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Raintree Product Readiness
Supported Versions:
- Can create claims with ICD-10 now - 9.3 and higher will support ICD-10 - Standard ICD-10 tables available Q2 2013
Work with us on new ICD-10 features!
- Bariatric User Group: Richard Harwell - Therapy User Group: Kathryn Rigda - Standard/Billing User Group: Clayton Case
http://usergroups.raintreeinc.com
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Takeaways
• • • ICD-10 is a Provider Initiative. ZirMed is here to help, but we cannot solve this for them like we did 4010 / 5010 The impact on ICD-10 to providers is very real Providers need to be making progress NOW towards ICD-10 readiness 29
In Conclusion
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ICD-10 is just a more mature ICD-9 ICD-10 is inevitable Work for physicians is negligible ICD-10 cost for offices can be small Work for institutions is worthwhile Good preparation is critical Communication is vital Embrace it; Don’t postpone it
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Resources
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ZirMed ICD-10 Resource Center – Support Center CMS Website: http://www.cms.hhs.gov/ICD10/ AHIMA Website: http://www.ahima.org/icd10 WEDI: http://www.wedi.org
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