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  1. Agenda • Agenda Placeholder • Agenda Placeholder • Agenda Placeholder • Agenda Placeholder ICD-10 Are You Prepared? February 26, 2013

  2. Our Presenter – Betty Gomez • Betty Gomez • VP of Regulatory Strategy • ZirMed’s Industry Liaison • 21 Years of Health Care EDI Experience

  3. Webinar Topics • 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

  4. ICD-10 Background • 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. • 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. • Compliance with 5010 is necessary prior to implementing ICD-10.

  5. 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

  6. Imagine…

  7. Single Implementation Date for all Users September 30 October 1 English German (AND English)

  8. Greater Granularity = More Codes

  9. Why Move To ICD-10? More precise Better Quality of Care ICD-9 is 25 years old Better Fraud Detection Population Health Analysis Greater Accuracy in Reimbursements

  10. Diagnosis Code Structure From X X X X X X X X X X 3-5 characters in length X X To X X X X X X X X X X X X 3-7 characters in length

  11. ICD-9-CM 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 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 S63.511A –Sprain of Carpal Joint of Right Wrist

  12. Example - Diagnosis Old 365.71 Mild Stage Glaucoma New H40.1211 Low-tension glaucoma, right eye, mild stage H40.1221 Low-tension glaucoma, left eye, mild stage H40.1231 Low-tension glaucoma, bilateral, mild stage H40.1291 Low-tension glaucoma, unspecified eye, mild stage H40.1311 Pigmentary glaucoma, right eye, mild stage H40.1321 Pigmentary glaucoma, left eye, mild stage H40.1331 Pigmentary glaucoma, bilateral, mild stage H40.1391 Pigmentary Glaucoma, unspecified eye, mild stage H40.1411 Capslr glaucoma w/pseudxf lens, right eye, mild stage H40.1421 Capslr glaucoma w/pseudxf lens, left eye, mild stage H40.1431 Capslr glaucoma w/pseudxf lens, bilateral, mild stage H40.1491 Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage

  13. Procedure Code Structure X X X X From X X X X 3-4 numbers in length X X X X X X X To 7 numbers in length

  14. ICD-9-CM Vol 3 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 3-4 numbers in length Based on outdated technology Generic terms for body parts Lacks description of methodology and approach for procedures 47.01 - Laparoscopic appendectomy 0DBJ4ZZ - Excision of Appendix, Percutaneous Endoscopic Approach

  15. Example - Procedure Old 84.01 Finger Amputation New 0X6N0Z0 Detachment at Right Index Finger, Complete, Open Approach 0X6N0Z1 Detachment at Right Index Finger, High, Open Approach 0X6N0Z2 Detachment at Right Index Finger, Mid, Open Approach 0X6N0Z3 Detachment at Right Index Finger, Low, Open Approach 0X6P0Z0 Detachment at Left Index Finger, Complete, Open Approach 0X6P0Z1 Detachment at Left Index Finger, High, Open Approach 0X6P0Z2 Detachment at Left Index Finger, Mid, Open Approach 0X6P0Z3 Detachment at Left Index Finger, Low, Open Approach 0X6Q0Z0 Detachment at Right Middle Finger, Complete, Open Approach 0X6Q0Z1 Detachment at Right Middle Finger, High, Open Approach

  16. Understanding the Global Impact of ICD-10 • 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.

  17. 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 • Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years. • Schedule software upgrades • Monitor payer alerts and readiness. • Prepare for testing with payers and/or clearinghouse. Beyond 2013 • ASAP 2014 ASAP • Budgeting for ICD-10 impacts such as, system upgrades and training • Coder/biller training • Review practice • readiness

  18. Care Flow Assessment Treatment Documentation Documentation Coding Claim Submission

  19. Major Provider Impacts 77% Indicate Top Challenge • Clinical Documentation • Practitioners! • Coding • Business Processes • Superbills / Day Sheets • PM/HIS/EHR Systems • 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)

  20. 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

  21. ICD-10 Project Plan • Phase 1 Implementation Plan Development and Impact Assessment • Phase 2 Risk Mitigation and Implementation Preparation • Phase 3 “Go Live” Preparation • Phase 4 Post-implementation Follow Up

  22. Industry Readiness • The Workgroup for Electronic Data Interchange (WEDI) conducted an industry ICD-10 readiness survey in February 2012 – • Results showed that health care entities were falling behind recommended timelines for implementing ICD-10 code sets by 10/1/13. • Responses indicated some progress had been made, but not keeping up with milestones. • Industry is falling behind • New proposed rule to implement ICD-10 on October 1, 2014 instead of 2013. • WEDI sent out a new survey in January 2013

  23. ZirMed Strategy Value-Add Solutions and Services Analytics ● Education ● Consulting ● Code Translation Outsourced Helping Providers Prepare Webinars ● Playbook ● Assessments ● Get-Well Plans ● Pilots ● Testing Getting ZirMed Prepared Organization ● Remediation ● Internal Training ● Staffing ● Measuring Success

  24. Helping Providers Prepare • Awareness • Webinars • Assessments • Get-Well Plans • Pilots • End-to-End Testing • Resource Center • ICD-10 Survival Tool Kit • Internal Education

  25. Value-Add Services and Solutions • Analytics • Data Translation • Education • Consulting

  26. Analytics • 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

  27. ZirMed ICD-10 Timeline • Set up ICD-10 Resource Center • ZirMed Survival Tool Kit • Webinars • System Remediation • National Pilot ICD-10 Testing • Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years. • Code translation Tool • Testing Portal • Begin testing with Providers and Payers Beyond 3 QTR 2013 • 1 QTR 2013 2014 2QTR 2013 • Education & Consulting Offerings • ICD-10 Analytics • ICD-10 Transition • Analytics – June • Oct 1st start submitting • ICD-10 codes

  28. Supported Versions:- Can create claims with ICD-10 now- 9.3 and higher will support ICD-10- Standard ICD-10 tables available Q2 2013Work with us on new ICD-10 features!- Bariatric User Group: Richard Harwell- Therapy User Group: Kathryn Rigda- Standard/Billing User Group: Clayton Casehttp://usergroups.raintreeinc.com Raintree Product Readiness

  29. 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

  30. In Conclusion • 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

  31. Resources • 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