Welcome to. Countdown to ICD-10: TOP 10 THINGS TO DO TO PREPARE FOR ICD-10
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1 Welcome to Countdown to ICD-10: TOP 10 THINGS TO DO TO PREPARE FOR ICD-10
2 Topics for Discussion ICD-10 Overview Countdown to ICD-10 Top 10 Things to Do to Prepare for ICD- 10 Get to Know ICD-10 Know Your Role and Responsibility Follow Your Roadmap Conduct Systems Checks Train Your Brain Practice Makes Perfect Build Your Resources Testing Testing Testing Patience & Patients Stay Informed ICD-10 FAQs Resources Contact 1
3 ICD-10 Overview Federal Mandate under Health Insurance Portability and Accountability Act (HIPAA) Regulations ICD-10 mandatory for all HIPAA-covered entities Entities include: hospitals, physicians and other practitioners, health insurers, 3 rd party payers, electronic transmission firms, clearinghouses, hardware/software vendors, billing practice and management firms, health care administrative and oversight agencies, public and private health care research institutions New ICD-10-CM and ICD-10-PCS code sets ICD-10-CM replaces ICD-9-CM (Volumes 1 and 2) ICD-10-PCS replaces ICD-9-CM (Volume 3) ICD-10 has no direct impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) ICD-10 is coming! 2
4 A few facts about ICD-10: ICD-10 Overview World Health Organization - developed ICD-10 in 1994, later adopted by HHS and CDC, provision of HIPAA regulations Moving from 9 to 10 - US is last industrialized nation to adopt ICD-10 HIPAA-covered entities - health care providers, payers, clearinghouses, billing services and others must transition to ICD-10 ICD-10 pros and cons - discussed widely within health care community since 2009 ICD-10-CM and ICD-10-PCS code sets Replaces ICD-9-CM (Volumes 1 and 2) and ICD-9-CM (Volume 3) Total of 141,923 codes BUT only some used by providers Mandatory compliance date - October 1, 2015 Reminder 5010 transaction standards, required prerequisite IT systems must accommodate BOTH ICD-9 and ICD-10 codes 3
5 ICD-10 Overview For services rendered on or after October 1, 2015 All claims must use ICD-10 codes Claims using ICD-9 codes for services rendered on or after October 1, 2015 will NOT be accepted For services rendered before October 1, 2015 All claims must use ICD-9 codes Systems must accommodate BOTH ICD-9 and ICD-10 codes Effective with the October 1, 2015 compliance date Significant Code Increase from ICD-9 to ICD-10 Increasing from 14,000 to approximately 69,000 ICD-10-CM codes Increasing from 3,000 to approximately 87,000 ICD-10-PCS codes ICD-10 has more than nine times the codes in ICD-9 4
6 Why ICD-10 Matters: ICD-10 Overview ICD-10 advances health care and the implementation of ehealth initiatives ICD-10 captures advances in medicine and medical technology ICD-10 improves data for quality reporting ICD-10 improves public health research, reporting and surveillance 5
7 Top Ten Things to Do to Prepare for ICD Get to Know ICD-10 Understanding background information makes transitioning easier Acknowledge the necessity for ICD-10 Recognize the risks of non-compliance Recognize the benefits that come with transitioning and compliance Learn the differences between ICD-9 versus ICD-10 Learn who needs to transition to ICD-10 6
8 Top Ten Things to Do to Prepare for ICD Know Your Role & Responsibility Everyone in your organization has a part in the transition Champion ICD-10 Champion Coders Billers Clinicians Practice Managers IT Systems Managers IT Managers Organization Clinicians Coders Billers Practice Managers 7
9 Top Ten Things to Do to Prepare for ICD Follow Your Roadmap Execute your plan Perform an office assessment Utilize your ICD-10 Roadmap Distribute collateral material (organization updates, newsletters) Establish lines of external communication (vendors, clearinghouses, payers) Maintain regular internal communication (clinicians, coders, billers and practice management staff) 8
10 Top Ten Things to Do to Prepare for ICD Conduct Systems Checks Address technical impacts of ICD-10 Business processes IT systems upgrades (accommodate both ICD-9 and ICD-10) Policy updates 9
11 Top Ten Things to Do to Prepare for ICD Train Your Brain Ensure you and your staff are properly trained Anatomy and Physiology Medical Terminology Coder Training Train the Trainer ICD-10 Code Books Practice Tests Coding Certifications 10
12 Top Ten Things to Do to Prepare for ICD Practice Makes Perfect Practice using ICD-10 codes by crosswalking your most commonly used ICD-9 codes to ICD-10 codes General Equivalence Mappings (GEMs) - Code Conversion Tools: External links are not affiliated with the Bureau for Medical Services. Links are intended for provider convenience only. 11
13 Top Ten Things to Do to Prepare for ICD Build Your Resources Gather Resources Dedicated ICD-10 websites Association ICD-10 information Valuable articles and white papers Search engines Share Resources Distribute to team members Use in creative ways (i.e., newsletters, websites, flyers) Collaborate with other organizations Talk about what works (i.e., training, organization methods, productivity efforts) 12
14 Top Ten Things to Do to Prepare for ICD Testing Testing Testing Test and Assess Complete internal testing Perform external testing Reassess staff training Document testing results Analyze results 13
15 Top Ten Things to Do to Prepare for ICD Patience & Patients Change takes time Set realistic goals Plan for contingencies Monitor the operational impacts and suggest remedies Remember your patients ICD-10 should not affect the way you interact with your patients while providing care 14
16 Top Ten Things to Do to Prepare for ICD Stay Informed Stay in the know about ICD-10 Attend conferences, fairs, webinars, and podcasts Sign-up for mailing lists Take advantage of ICD-10 FAQs & Fact Sheets Join the conversations (social media: Twitter, Facebook, YouTube) 15
17 ICD-10 FAQs Q: How do I learn more about ICD-10? A: For the latest news and resources, visit the CMS ICD-10 website, the World Health Organization (WHO) ICD-10 Page and the WV Molina Medicaid Solutions ICD-10 Transition Website. You can also sign up for CMS ICD-10 Industry Updates. Q: Where can we find a list of the new ICD-10 diagnosis codes? A: There are numerous resources available, but usually at a cost. The CMS website offers a wealth of information on ICD-10 and the new codes. CMS has a General Equivalence Mapping (GEMs) tool that provides an ICD-10 diagnosis code to an ICD- 9 diagnosis code. The GEMs tool is a basic tool and is not inclusive of all of the new ICD-10 codes. Q: Is there crosswalking software or some special algorithm available that we can use to go from one code to the other? A: There are various websites and resources that offer a number of translation tools or toolkits for ICD-10. Some are free; some are sold at varying prices. CMS has published its General Equivalence Mapping System (GEMs tool) to help with the crosswalking. It is available at Note that this free tool is not comprehensive, but is frequently updated to add new codes. 16
18 ICD-10 Resources 17
19 ICD-10 Resources Centers for Medicare & Medicaid Services (CMS) CMS ICD-10 Main Page CMS Overview CMS ICD-10 Implementation Planning HHS, CMS ICD-10 Final Rule and October 1, 2015 Compliance Date Announcement World Health Organization (WHO) ICD-10 Page West Virginia Resources WV Molina Medicaid Solutions ICD-10 Transition Website 18
20 Contact Molina Provider Relations Unit Molina Medicaid Solutions (304) or 1 (888) Terrie Randolph, Molina Provider Representative Terrie.Randolph@Molinahealthcare.com (304) Cary Johnson, Molina Provider Representative Cary.Johnson@Molinahealthcare.com (304)
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