ICD-10: Is Your Practice on Track for October 1, 2014 Implementation?

Transcription

1 ICD-10: Is Yur Practice n Track fr Octber 1, 2014 Implementatin? Presented by: Cindy Hegner, CCS Patrick A. Wilsn, MD, FCAP Wednesday, February 19, 2014 We will begin n the half hur. There is n audi at this time Cllege f American Pathlgists. All rights reserved.

2 ICD-10: Is Yur Practice n Track fr Octber 1, 2014 Implementatin? Presented by: Cindy Hegner, CCS Patrick A. Wilsn, MD, FCAP Wednesday, February 19, 2014 Yu shuld nw hear audi Cllege f American Pathlgists. All rights reserved.

4 Place sub-brand here ICD-10: Is Yur Practice n Track fr Octber 1, 2014 Implementatin? Presented by: Cindy Hegner, CCS Patrick A. Wilsn, MD, FCAP Wednesday, February 19, 2014 cap.rg

6 ICD-10-CM Implementatin The cmpliance deadline fr ICD-10-CM is Octber 1, 2014 date f service The impact f ICD-10-CM n prviders is very real All prviders need t be making prgress NOW twards ICD-10 readiness 2014 Cllege f American Pathlgists. All rights reserved. 6

7 Agenda ICD-10-CM Implementatin Preparatin Crsswalk Examples Natinal Cverage Determinatin/Lcal Cverage Determinatin (NCD/LCD) Resurces Questin and Answer Sessin 2014 Cllege f American Pathlgists. All rights reserved. 7

8 Timeline Befre 10/1/2014 Finalize all systems and ther changes nt cmpleted Cmplete testing f systems changes Cmplete testing with external cnnectins Review and test cntingency plan Q Cnfirm with Cmputer Systems vendrs that changes/upgrades t vendr systems have been cmpleted Identify g live internal and external supprt resurces Review plan, budget and cash flw cntingencies Q Review Lcal Carrier Decisins fr incnsistencies and missing ICD-10-CM cdes Revise requisitins Plan referral surce training Q Training fr cders and thers impacted by transitin shuld be cmpleted Practice ICD-10-CM cding Q Identify and address prblems and errrs Fllw cmmunicatins plan Mnitr impact f ICD-10-CM transitin n payments, claims denials/rejectins 2014 Cllege f American Pathlgists. All rights reserved. 8

9 Claims Submissin ICD-9 cdes n lnger accepted n claims starting with Octber 1, 2014 date f service ICD-10 cdes will nt be recgnized/accepted n claims befre Octber 1, 2014 date f service Claims cannt cntain bth ICD-9 cdes and ICD-10 cdes If payers are nt ready t accept ICD-10-CM what s yur cntingency plan Prfessinal/Supplier Claims Return as Unprcessable 2014 Cllege f American Pathlgists. All rights reserved. 9

10 Claims that Span Octber 1, 2014 Claims separate claims Befre 10/1/2014 date f service On r after 10/1/2014 date f service Please nte: Hspital inpatient ICD-10-PCS implementatin date is based n discharge r thrugh date Cllege f American Pathlgists. All rights reserved. 10

12 Wh needs t be familiar r aware f ICD-10-CM transitin Physicians Pathlgists and rdering physicians Nn-physicians wh supprt rdering f testing Senir Management IT Persnnel Billing Persnnel Cding Persnnel Accunting Persnnel All persnnel wrking in healthcare 2014 Cllege f American Pathlgists. All rights reserved. 12

13 Cnsequences f Pr Preparatin Increased claims rejectins and denials Increased delays in prcessing payment f claims Imprper payment f claims Diagnsis Cding backlgs Cmpliance issues Decisins based n inaccurate data Significant impact n practice cash flw Transitin is likely t have a cash flw impact Claims payment delays caused by new systems Whle industry n a learning curve Takes mre resurces initially and lng term Prblems can be mitigated with prper advance preparatin 2014 Cllege f American Pathlgists. All rights reserved. 13

14 Tips fr preparatin Assign and executive/practice leader t be respnsible fr the ICD-10-CM transitin Make sure yur requisitin asks the necessary questins fr accurate lcatin f the specimen r patient cnditin fr rdering the test Plan hw yu will prvide the necessary training fr all emplyees f yur lab Start training yur cders and billing staff n later than June 2014 Intrduce ICD -10 t all lab emplyees August r September 2014 Create an educatin plan fr yur pathlgists Create a client relatinship plan fr yur rdering physicians and relevant staff Budget fr training Ask yur insurance payers what their prcess and timing is fr transitining t ICD Cllege f American Pathlgists. All rights reserved. 14

15 Tips fr preparatin Ask all f the fllwing Hspital Billing peratins Referring physicians These questins Have they started planning and preparing fr ICD-10? If s, what and when? If they will nt be ready by Oct 1, 2014 what are their plans fr claims after Oct 1st? (eg, Califrnia Medicaid will nt be ready) What type f ICD-10-CM testing is/will be required? What is their ICD-10-CM testing windw? Very Imprtant 2014 Cllege f American Pathlgists. All rights reserved. 15

16 ICD-10-CM Cding Tips Each healthcare encunter shuld be cded t the level f certainty knwn fr that encunter Unspecified cdes shuld need t be selected less ften due t greater number f cde chices in ICD-10-CM Unspecified cdes shuld be reprted when they mst accurately reflect what is knwn abut the patient s cnditin at the time f that particular encunter When sufficient clinical infrmatin isn t knwn r available abut a particular health cnditin t assign a mre specific cde, it is acceptable t reprt the apprpriate unspecified cde It wuld be inapprpriate t select a specific cde that is nt supprted by the medical recrd dcumentatin t rder r perfrm testing that is nt medically necessary fr the care f the patient nly greater cding specificity 2014 Cllege f American Pathlgists. All rights reserved. 16

17 ICD-10-CM Educatin Csts and Planning 1. Identify resurces t be used fr training and secure them fr yur practice as there will be a limited supply 2. Will yu utsurce the educatin r cnduct it internally? If yu have a cding expert n staff cnsider the time it wuld take fr him/her t train yur staff 3. What are the csts and benefits f these tw ptins? 4. When will the educatin need t be dne? It is recmmended t start the training yur persnnel six mnths prir t Octber 2014 If yu start t early, yur staff will frget what they learned befre having t apply their ICD-10-CM cding knwledge 5. Wh will need what level f educatin? 2014 Cllege f American Pathlgists. All rights reserved. 17

18 ICD-10-CM Educatin Csts and Planning cnt. 6. What ptins are available fr educatin? Web based training Face t face wrkshps Bks Audi seminars 7. Hw will the wrklad be managed while staff are receiving educatin? 2014 Cllege f American Pathlgists. All rights reserved. 18

19 Tp 100 ICD-9-CM Cdes Reprt Get a reprt f the tp 100 ICD-9-CM cdes yur practice uses Run reprt fr a variety f time perids 12 mnths 3 mnths 1 mnth leading up t implementatin date Run reprt separately fr AP and CP Run it by vlume and charge amunt Identifies which ICD-10-CM cdes t fcus n 2014 Cllege f American Pathlgists. All rights reserved. 19

21 Cde Structure f ICD-10-CM versus ICD-9-CM ICD-9-CM Cde Frmat ICD-10-CM X X X. X X categry etilgy anatmic site, manifestatin X X X. X X X X categry etilgy, extensin anatmic site manifestatin Example: Example: S02.65XA 2014 Cllege f American Pathlgists. All rights reserved. 21

22 Crsswalk Examples ICD-9-CM ICD-10-CM Benign neplasm f cln D12.0 Benign neplasm f cecum D12.1 Benign neplasm f appendix D12.2 Benign neplasm f ascending cln D12.3 Benign neplasm f transverse cln D12.4 Benign neplasm f descending cln D12.5 Benign neplasm f sigmid cln D12.6 Benign neplasm f cln unspecified K Plyp f cln 2014 Cllege f American Pathlgists. All rights reserved. 22

23 Crsswalk Examples cnt. ICD-9-CM ICD-10-CM Malignant neplasm f breast (female), unspecified C Malignant neplasm f nipple and arela, unspecified female breast C Malignant neplasm f central prtin f unspecified female breast C Malignant neplasm f upper-inner quadrant f unspecified female breast C Malignant neplasm f lwer-inner quadrant f unspecified female breast C Malignant neplasm f upper-uter quadrant f unspecified female C Malignant neplasm f lwer-uter quadrant f unspecified female breast C Malignant neplasm f axillary tail f unspecified female breast C Malignant neplasm f verlapping sites f unspecified female breast C Malignant neplasm f unspecified site f unspecified female breast 2014 Cllege f American Pathlgists. All rights reserved. 23

24 Crsswalk Examples cnt. ICD-9-CM ICD-10-CM Atrphic gastritis withut mentin f hemrrhage K29.30 Chrnic superficial gastritis withut bleeding K29.40 Chrnic atrphic gastritis withut bleeding K29.50 Unspecified chrnic gastritis withut bleeding 2014 Cllege f American Pathlgists. All rights reserved. 24

25 Crsswalk Examples cnt. ICD-9-CM ICD-10-CM Lipma f ther skin and subcutaneus tissue D17.1 Benign lipmatus neplasm f skin & subcutaneus trunk D17.20 Benign lipmatus neplasm f skin & subcutaneus unspecified limb D17.21 Benign lipmatus neplasm f right arm D17.22 Benign lipmatus neplasm f left arm D17.23 Benign lipmatus neplasm f right leg D17.24 Benign lipmatus neplasm f left arm D17.30 Benign lipmatus neplasm f unspecified site D17.39 Benign lipmatus neplasm ther site 2014 Cllege f American Pathlgists. All rights reserved. 25

27 Natinal Cverage Determinatin (NCD) Lcal Cverage Determinatin (LCD) Natinal Cverage Determinatins (NCDs) are thse decisins made by CMS and applied natinally by all Medicare Administrative Cntractrs (MAC) ICD-10-CM NCDs are currently available Transmittals-Items/R2852CP.html Lcal Cverage Determinatins (LCDs) are thse decisins made by the individual MAC Scheduled t be available in April 2014 Changes will impact Requisitins (paper and electrnic) 2014 Cllege f American Pathlgists. All rights reserved. 27

29 Surces fr ICD-10-CM training American Health Infrmatin Management Assciatin AHIMA.rg Medical Grup Management Assciatin MGMA.cm American Assciatin f Prfessinal Cders AAPC.cm Training: and Cmmunity Clleges Ask yur hspitals if they are prviding ICD-10-CM educatin 2014 Cllege f American Pathlgists. All rights reserved. 29

30 Web Sites with ICD-10-CM Resurces Wrld Health Organizatin ICD-10-CM General Equivalence Mapping 10-CM-and-GEMs.html CMS Prvider Resurces AHIMA ICD-10-CM Free access t ICD-10-CM medical cdes Quick Reference Infrmatin 10QuickRefer.pdf WEDI (Wrkgrup fr Electrnic Data Interchange) HIMSS (Health Infrmatin and Management Systems Sciety) Centers fr Disease Cntrl ICD-10-CM Official Guidelines fr Cding and Reprting Cllege f American Pathlgists. All rights reserved. 30

31 Bks and Tls n ICD-10-CM Cding Detailed Instructin fr Apprpriate ICD-10-CM Cding Ingenix Advanced Anatmy and Physilgy fr ICD-10-CM/PCS Intrductin t the ICD-10-CM cding system Principles f ICD-10-CM Cding 3 rd Editin Principles f ICD-10-CM Cding Wrkbk 3 rd Editin 2014 Cllege f American Pathlgists. All rights reserved. 31

32 Summary Timeline Systems Review Claims submissin testing Cntingency planning Training and practice fr yur affected pathlgists and staff Payer plans Key referring surces Tp ICD-9-CM cdes PQRS, NCD, LCD AP/CP Fcus n yur reality nt the hype 2014 Cllege f American Pathlgists. All rights reserved. 32

33 Wrap-up Recrding f this webinar will be psted n Next ICD-10-CM Webinar ICD-10-CM Lcal Carrier Decisins and ther updates May 21, 2014 at 1:30pm Central pst webinar questins t practicemanagement@cap.rg 2014 Cllege f American Pathlgists. All rights reserved. 33

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