ICD 10 CM 9/4/2012. Course Objective: Objectives: Session 1 INTRODUCTION TO ICD 10 CM. Managers

Transcription

1 ICD 10 CM INTRODUCTION TO ICD 10 CM for CA s and Chiropractic Office Managers Course Objective: Make the transition to ICD 10 CM as painless and seamless as possible SESSION 1: Awareness What do you know, what do you need to know about ICD 10? SESSION 2: Planning Develop an ICD 10 transition plan for your office and practice. SESSION 3: Implementation Getting under the hood of ICD 10, how it is similar and how it is different from ICD 9, how to use it. Objectives: Session 1 Make the transition to ICD 10 CM as painless and seamless as possible Create awareness of ICD 10 CM For you, your staff, your DC s Understand the why, what, when, who, how Alert you to resources available Reduce stress 1

2 ICD 10 CM The Tip of the Iceberg Sources ICD 10 Watch HIMSS National Center for Health Statistics CMS HIPAA Website AHIMA ChiroCode Resource/Reference List ICD 10 CM, is free from CMS Includes guidelines, instructions for use Commercial licd 10 CM CM publications (Ingenix, AMA, ChiroCode, others) Montana Chiropractic Association Give us your for ICD 10 Updates 2

3 Dr. Simpson contact info The CHP Group 6600 SW 105 th Ave Ste 115 Beaverton, OR Caveats ( or, my lawyer says I have to say this.) Dr. Simpson has no financial COI Nothing here is intended as legal advice The information in this seminar is not a warrantee to avoid your being bi prosecuted for fraud and abuse The course is not intended to be full scale training in the use of ICD 10 CM coding 3

4 Pop quiz Who invented the ICD? What is it used for? When did it start? Where do you use it in your practice? How will this change to ICD 10 CM affect you? Why ICD 10? ICD 9 CM badly needs to be replaced System is 30 years old Not descriptive enough Terminology and classification of some conditions are outdated and obsolete System is running out of space Many sections are full. Unable to keep pace with advances in medical technology Outdated codes produce inaccurate and limited data Unable to meet current or future health data needs Lack of international comparability Cannot support transition to interoperable health data exchange Bowman and Haugen HIMSS 09 ICD 10 Provides better data for Measuring the quality, safety, and efficacy of care Designing payment systems and processing claims for reimbursement Conducting research, epidemiological studies, and clinical trials Settinghealth policy Operational and strategic planning and designing healthcare delivery systems Monitoring resource utilization Improving clinical, financial, and administrative performance Preventing and detecting healthcare fraud and abuse Tracking public health and risks Bowman and Haugen HIMSS 09 4

5 ICD 10 requires conversion to HIPAA 5010 Standard format for health care data transfer Required for any electronic billing Implementation date: March 31, 2012 We assume you have this accomplished (and you know what happens when you assume anything ) Will this impact me? Yes!! Any electronic claims submission You are, or do business with HIPAA covered entities, Medicare, Medicaid, private payers Expect others (e.g. PIP, workers comp) to follow suit Waanh!! I don t wanna do this!! If you never prepare a CMS 1500 form Never send an insurance company a bill Never bill Medicare or Medicaid Never submit an order (imaging, DME) 5

6 Questions?? No Impact on Use of CPT CPT will continue to be used for Reporting physician and other professional services Procedures performed in hospital outpatient departments and other outpatient facilities Implications: You and your DC Awareness Education Training Practitioners Practice managers Office staff 6

7 Implications: Your office Encoding Software Billing / Financial Productivity ABN Clinical Documentation Systems Claims Submission Software Utilization Management Quality Management Clinical Protocols Medical Necessity Laboratory Dual systems Implications: Vendors Future applications and contracts: Will the application be compliant with ICD 10 CM standards? What is the plan for ICD 10? Upgrade or replacement? Timeline for testing? Go live Production? Cost? Implications: Vendors Future applications and contracts: Will the application be compliant with ICD 10 CM standards? What is the plan for ICD 10? Upgrade or replacement? Time line for testing? Go live > Production? Cost in time and $$? 7

8 Questions?? ICD 10 Time Line Work on ICD 10 began in 1983, completed in 1992 ICD 10 has > 155,000 different codes (~17,000 codes available in ICD 9) ICD 10 includes both diagnoses (CM) and procedures (PCS) for in patient CPT will continuefor outpatientservices ICD 10 adoption was relatively swift in most of the world ICD 10 code sets will be effective in US October 1, 2014 A first draft of ICD 11 (!!) is expected in 2010 Wikipedia /2009 8

9 Breaking News!! The AMA has urged House Speaker John Boehner to stop the switch to the new diagnosis coding sets known as ICD 10. American Medical News 2/6/12 The acting head of the Centers for Medicare and Medicaid Services said today the agency is considering extending its timeline for ICD 10 code conversion compliance. Health Information Week 2/12/12 HHS Announces ICD 10 Delay In a fact sheet announcing a proposed rule that sets a deadline of Oct. 1, 2014 to comply with the ICD-10 system HHS believes the change in the compliance date for ICD 10 would give providers and other covered entities more time to prepare and fully test their systems it did not HIT firms that have been working to meet the 2013 deadline. DHHS Proposed Rule Finally, this rule proposes to change the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD 10 CM) for diagnosis coding, including the Official ICD 10 CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD 10 PCS) for inpatient hospital procedure coding, including the Official ICD 10 PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, _PI.pdf 9

10 Standards compliance date HHS proposes that covered entities must be in compliance with ICD 10 on October 1, The proposed rule, CMS 0040 P, may be viewed at A news release on the proposed rule may be viewed at Meanwhile, back at the AMA Last week, the American Medical Association sent a letter to acting CMS Administrator Marilyn Tavenner asking the federal government to further delay the compliance date for the transition to ICD 10 code sets to Oct. 1, 2015, Modern Healthcare reports (Conn, Modern Healthcare, 5/11) Read more: calls for further delay to icd10 compliance deadline.aspx#ixzz1uxepwbf8 but Don't cancel your next ICD 10 steering committee meeting. Stopping ICD 10 in its tracks would literally take an act of Congress. It's a federal law, and would require more than Tavenner's support or opposition. keep your ICD 10 initiatives going. There are too many unknowns now. ICD 10 Watch 10 timeline its revision not destruction 10

11 Associations Speak Out on New ICD 10 Date MGMA is pleased that CMS is looking at a one year extension of ICD 10 The AMA says postponement of ICD 10 is the first of many steps that regulators need to take to reduce the number of costly, time consumingregulatory burdens AHIMA prefers no delay in ICD 10, notes that the extension is the shortest possible time of one year. AHIMA also calls for continued focus on ICD 10 implementation icd 10 hipaa accountable care health plan identifier html Don t stop! Healthcare providers need to work on productivity and clinical documentation. That requires someone to understand ICD 10 codes and distribute that knowledge to the staff. Starting training now becomes very compelling if the knowledge is used to improve ICD 9 coding, productivity and reimbursements. Some sort of return on investment can be gained sooner than later. icd 10 training should start sooner later Consequences of Inadequate Preparation Coding & billing backlogs Increased claims rejections and denials Increased delays in processing authorizations and reimbursement claims Improper claims payment Compliance issues Decisions based on faulty data 11

12 Questions?? Up next ICD 10 CM Planning for Implementation Develop an ICD 10 transition plan for your office and your practice. 12