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Agenda. Agenda Placeholder Agenda Placeholder Agenda Placeholder Agenda Placeholder. ICD-10 Are You Prepared? February 26, 2013. Our Presenter – Betty Gomez. Betty Gomez VP of Regulatory Strategy ZirMed’s Industry Liaison 21 Years of Health Care EDI Experience. Webinar Topics.

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agenda
Agenda
  • Agenda Placeholder
  • Agenda Placeholder
  • Agenda Placeholder
  • Agenda Placeholder

ICD-10 Are You Prepared?

February 26, 2013

our presenter betty gomez
Our Presenter – Betty Gomez
  • Betty Gomez
    • VP of Regulatory Strategy
    • ZirMed’s Industry Liaison
    • 21 Years of Health Care EDI Experience
webinar topics
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
icd 10 background
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.
what is icd 10
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
single implementation date for all users
Single Implementation Date for all Users

September

30

October

1

English

German

(AND English)

why move to icd 10
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

slide10

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

slide11
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

example diagnosis
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

slide13

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

slide14
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

example procedure
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

understanding the global impact of icd 10
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.
icd 10 timeline
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
care flow
Care Flow

Assessment

Treatment

Documentation

Documentation

Coding

Claim Submission

major provider impacts
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)

preparing for icd 10 provider focus
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
icd 10 project plan
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
industry readiness
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
zirmed strategy
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

helping providers prepare
Helping Providers Prepare
  • Awareness
  • Webinars
  • Assessments
  • Get-Well Plans
  • Pilots
  • End-to-End Testing
  • Resource Center
  • ICD-10 Survival Tool Kit
  • Internal Education
value add services and solutions
Value-Add Services and Solutions
  • Analytics
  • Data Translation
  • Education
  • Consulting
analytics
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
zirmed icd 10 timeline
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
slide28

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

takeaways
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
in conclusion
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
resources
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