Version 5010 and ICD-10: Closer Than You Think
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1 Version 5010 and ICD-10: Kristine Sande, Moderator Version 5010 New standard for HIPAA electronic transactions Takes effect January 1, 2012 ICD-10 Codes Transition happens October 1,
2 Presenters Christi Dant Centers for Medicare and Medicaid Services Bill Finerfrock National Association of Rural Health Clinics Presentation Lasts about 45 minutes Submit questions using chat tab directly beneath slides Q & A period to follow 2
3 Presentation Please mute phones Slides at Do not close webinar window Technical issues: Presentation Webinar being recorded Notification will be sent when available 3
4 Christi Dant Centers for Medicare and Medicaid Services Topics To Be Covered! Why the change?! Getting ready for 5010 & ICD-10! Some of the major challenges! Resources and suggestions to help you prepare! 4
5 Version 5010 HIPAA requires covered entities to use mandated standards for electronic healthcare transactions, including claims, remittance, eligibility, claims status requests, their related responses. Effective January 1, 2012, all electronic transactions must use Version 5010, an upgrade from Version 4010/4010A. More on V Requires changes to the software, systems, and some business procedures related to billing. Affects all physicians, providers, and suppliers who bill electronically. Why? The current V.4010/4010A cannot accommodate expansions such as Medicare Part D and ICD-10. A new platform is required. The upgrade replaces patches with fixes. 5
6 What Happens if Iʼm Not Ready? On or after January 1, 2012, you must use Version Thatʼs the law and there are potential consequences for noncompliance: Electronic transactions that do not use Version 5010 standards may not be processed. Failure to use current HIPAA standards may put you in violation of contract provisions with payers. Subject to enforcement actions by CMS. ICD-10! Refers to the diagnosis and procedure code sets Replaces ICD-9 code sets and includes updated medical terminology and classification of diseases. More logically organized, more detailed and specific, and more clinically accurate 6
7 Why the change?! ICD-10 provides more specific data than ICD-9 Ø Better reflects current medical practice Ø The current coding system is running out of capacity Ø Expanded data capture improves capabilities Quality measurement Analysis of disease patterns / population health Tracking & responding to public health outbreaks Makes claims submission more efficient To identify fraud, waste, and abuse Benefits of ICD-10! More accurate payments for new procedures Fewer miscoded, rejected, and improper reimbursement claims Decreased need to include supporting documentation with claims Improved ability to measure healthcare services Increased sensitivity when refining grouping and reimbursement methodologies 7
8 Who Is Affected?! Anyone who is covered by HIPAA: Health care providers that conduct electronic transactions Payers including Medicaid and Medicare Clearinghouses Many non-hipaa covered entities use ICD-9 codes: Vendors and business associates of covered entities Workerʼs compensation programs Life insurance companies Researchers, epidemiologists, statisticians When Do I Need to Be Ready?! Remember the Dates Date January 1, 2012 April 1, 2013 October 1, 2013 Ac(on Full Implementa3on of Version 5010 Begin Coder & Staff Training on ICD- 10 CM/PCS Full Implementa3on of ICD- 10 8
9 ICD-10 Will Affect Everything! From physicians to nurses, to the lab and front desk, everyone will need to understand and prepare for the transition. ICD is not just a billing code. Update policies and procedures. Any office policy or procedure tied to a diagnosis code must be changed with special attention to disease management, registries, tracking and reporting. Medical record documentation. ICD-10 coding requires additional specificity. Providers and coders alike should review practices to assure alignment. Now Is the Time to Prepare! Version 5010 and ICD-10 transitions require business and systems changes throughout the health care industry. Organizations need to have plans and budgets in place to address the potential for rejected claims and delays in reimbursement. 9
10 Transitioning to ICD-10! Identify your current systems and work processes that use ICD-9 codes Communicate implementation plans between providers, payers and vendors Identify potential changes to work flow and business processes Budget for time and money related to the implementation and loss of productivity Allow enough time to test transactions Assess staff training needs Biggest Challenges Lack of full comprehension of the scope and complexity of necessary changes. Significant Blind Spots remain (ubiquity of ICD-9 code applications; impacts on research/historical data) Competing priorities There is no road map. Limited resources -- $ and technical/ contractual Grow Your Own SMEs Competition for vendors/contractors will be intense. 10
11 What Can Be Done Now? Active engagement. REMEMBER: THIS IS NOT AN IT PROJECT! Learn more about ICD-10. Lift every rock and peer underneath. Look for ICD-9 codes and its derivative data everywhere and consider who/how to address it. REMEMBER: THIS IS NOT JUST AN IT PROJECT! Start now to enhance clinical documentation to align with ICD-10 and build staff competencies in anatomy and biomedical terminologies. ICD-10 Resources to Help You Prepare! CMS ICD-10 Web site: CMS ICD-10 Listserv: ICD10/02d_CMS_ICD-10_Industry_ _U pdates.asp Professional, clinical, trade associations 11
12 Readily Available CMS Resources! Industry & Associations Resources: An Example! 12
13 Questions?! REQUESTS:! Ø Act as ICD-10 Ambassadors. Spread the word!! Ø Identify and share best practices and resources as you come across or create them. Ø Explore ways to collaborate and share resources (particularly SMEs) CMS Contact:! Christi Dant Office of E-Health Standards & Services Bill Finerfrock National Association of Rural Health Clinics 13
14 Q & A Submit questions using chat tab directly beneath slides Thank You! Contact us at with any questions Survey to be sent out Recording will be available on RAC website 14
15 Version 5010 and ICD-10: 15
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