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1 Please Bypass The Screen Below For audio call Event number: MUTE YOUR PHONE 6/14/2013 1

2 ICD-10 Readiness Checklist June 14, 2013 Presenter: Miki Hoppe, Manager ICD-10 Business Solutions

3 6/14/2013 3

4 Agenda ICD-10 Overview and Examples Readiness Checklist Overview Education and Training Testing 16 Months Until Compliance! 6/14/2013 4

5 ICD-10 Overview and Background ICD-10-CM (diagnosis) and ICD-10-PCS (inpatient procedure) codes must be used for service dates on and after October 1, 2014 Outpatient claims based on date of service Inpatient claims based on date of discharge Applies to both Electronic and Hardcopy claims 6/14/2013 5

6 Frequently Asked Questions Question: Can both ICD-9 and ICD-10 codes be filed on a single claim? Answer: No. Claims for outpatient services that span the compliance date of 10/1/2014 will need to be split. Inpatient claims are billed based on the date of discharge. Question: Can I start using ICD-10 codes before 10/1/2014? Answer: No. ICD-10 codes do not become effective until date of service 10/1/2014. Question: How does ICD-10 impact CPT codes? Answer: ICD-10 does not impact CPT, HCPCS, NDC or SNOMED coding. 6/14/2013 6

7 ICD-10-CM Example The Importance of Documentation A 70-year-old patient is seen for decreased hearing. After examination, the physician determines the cause was impacted cerumen. ICD-10-CM code options: H61.20 Impacted cerumen, unspecified ear H61.21 Impacted cerumen, right ear H61.22 Impacted cerumen, left ear H61.23 Impacted cerumen, bilateral 6/14/2013 7

8 What code can you bill? Based on the documentation, the appropriate code in this case is: H61.20 Impacted cerumen, unspecified ear If one word had been added to the documentation to specify laterality, a more specific code could be selected. 6/14/2013 8

9 ICD-10 Readiness Checklist 6/14/2013 9

10 ICD-10 Readiness Checklist Lets review an example of a readiness checklist. We will discuss each step in more detail in future webinars. Step 1 Create an implementation team or steering committee Step 2 Impact Analysis Step 3 Financial Impact and Budget Step 4 - Analyze Vendor Products Step 5 Communicate with Payers 6/14/

11 ICD-10 Readiness Checklist Step 6 Initiate Workflow Changes Step 7 Education and Training Step 8 Testing Step 9 Implement Step 10 Monitor 6/14/

12 Step Seven Education and Training 6/14/

13 Education and Training AHIMA estimates that coding staff working outside the hospital inpatient setting will require 16 hours of ICD-10 education. This training should focus on ICD-10-CM. Hospital inpatient coding staff require an estimated 50 hours of ICD-10 education because they need to learn both ICD-10-CM and ICD-10-PCS By now you have probably heard that ICD-10 training will be needed by more than just medical coders. 6/14/

14 Training Strategy Identify who needs training Review your assessment. You identified everywhere a diagnosis is used. Every person who utilizes those items will need some level of training. Examples include: physicians, nurse practitioners, physician assistants, medical technicians, management and administrative staff, coders/billers, IT staff. 6/14/

15 Training Strategy Customize training to the role ICD-10 awareness: Understand the regulation and compliance requirements, understand the difference between ICD-9 and ICD-10 codes. Audience: All staff Anatomy, Physiology, and Medical Terminology: Basic concepts that are relevant to ICD-10. Audience: Clinical staff, coders/billers, administrative & management staff. 6/14/

16 Training Strategy ICD-10 coding: In-depth instruction on ICD-10-CM and/or PCS code categories most applicable to your practice s patient mix, guidelines for coding and reporting. Note: Certified medical coders will need to pass an ICD- 10-CM proficiency test to maintain their certification. Audience: Coders/billers, administrative & management staff. 6/14/

17 Training Strategy Clinical documentation: Explain how documentation impacts coding. Audience: Clinical staff, coders/billers, administrative & management staff. System impacts and solutions: understand the structure changes of the ICD-10 codes, identify how ICD-10 affects systems. Audience: IT staff, administrative & management staff. 6/14/

18 Training Strategy Train at the right time If you haven t yet introduce your staff to ICD-10 and explain the changes and upcoming training. Most experts suggest beginning in-depth coding training 6 9 months prior to the compliance date. Any staff who will be involved in preparing your practice for ICD-10 will need training earlier. Certified coders should check with their coding organization on testing dates and plan training accordingly. 6/14/

19 Training Strategy Find the appropriate training resource There is no right or wrong way to receive ICD-10 training. Here are some options to consider: CMS, AAPC, AHIMA, and WEDI offer webinars. Some are free; others have fees attached. May offer CEUs for coders. AAPC offers a two-day ICD-10 implementation boot camp. The local chapter has monthly meetings that include ICD-10 information, and an annual Hawaii conference. AHIMA offers online and face-to-face training. Many publications are available for ICD-10 self-study. 6/14/

20 Training Strategy Measure productivity Billers and Coders will need practice using ICD-10 codes to become comfortable. It is reasonable to expect some loss of productivity during the learning-curve. Industry experts recommend having your staff dualcode once they complete training. This allows them to practice using ICD-10 codes, and will give you a sense of the time it will take to code in ICD-10. 6/14/

21 Training Strategy Evaluate learning outcome Work to identify any concerns with coding or medical documentation in time to be corrected prior to the compliance date. Examples: You can measure the success of the training by providing a test a few weeks later to measure retention. Perform an audit of the medical records that are being dual-coded to validate the clinical documentation and the ICD-10 coding. 6/14/

22 Step Eight Testing 6/14/

23 Testing.Testing. The purpose of testing is to prove that a system or process meets the requirements and produces correct results. ICD-10 testing is different than the testing that has been recently completed for HIPAA 5010 was primarily a file format change that required a great deal of technical testing. Many providers were able to rely on their billing partner, clearinghouse, or other vendor to complete the 5010 testing. The good news is that 5010 provides the framework for ICD-10. 6/14/

24 What is left to test for ICD-10? ICD-10 testing is very different from the standard system or file upgrades because it must include the testing of business processes. Review your assessment and be sure to test every change made for ICD-10. Internal processes forms, workflows, etc. Vendor products partner with vendors to test their products and associated workflows. Partner with your billing service, practice management service, or clearinghouse to determine testing needs. 6/14/

25 Types of testing Any upgrade or change to your systems must be tested. The level of testing necessary will depend on your practice set up. Since both code-sets will be used for a period of time, it is critical to ensure any system upgrade or change does not break your current ICD-9 functionalities. This is commonly referred to as regression testing. You must also thoroughly test all functionality to ensure you can operate properly using ICD-10. This end-to-end testing is often called system or user-acceptance testing. 6/14/

26 HMSA s testing approach - Internal HMSA utilizes a combination of vendor supported products and custom development. We began the installation of upgrades, internal development, and internal testing about 18 months ago. HMSA has completed regression testing of our processing systems for all lines of business. Final preparations for end-to-end system test of ICD-10 functionality are underway. Phase 1 of internal system test will begin in July. The final phase of internal system test is planned to be completed in Q /14/

27 HMSA s testing approach - External Targeting to begin some level of provider testing in Q Limited testing of file transfers with interested parties. Test claims must be natively coded. We are not interested in testing cross-walked claims. We realize that we cannot test with every provider and have developed an alternative. 6/14/

28 HMSA ICD-10 Coding Challenge Website 6/14/

29 ICD-10 Coding Challenge In order to become proficient and comfortable in ICD-10 practice is needed HMSA s Coding Challenge website will be available to all participating providers We will publish scenarios, you select the most appropriate ICD-10 code(s), and the website will provide feedback NOTE: This website does not replace ICD-10 training and is not intended to tell you how to file claims. It is a tool to give you an opportunity to practice coding in ICD-10. The URL is ICD10.HMSA.com 6/14/

30 ICD-10 Tools and Resources HMSA Provider Resource Center ICD-10 Information and Resources a.icd.100.htm ICD-10 Code Translator cd10.aspx for questions and suggestions 6/14/

31 ICD-10 Tools and Resources CMS released ICD-10 Implementation Guidelines. Go to CMS.gov and search for ICD-10 Implementation Guide for a free download. The National Center for Vital Health Statistics has published guidelines to be used as a companion to the ICD-10-CM and PCS _final.pdf WEDI ICD-10 Workgroup Send WEDI-ICD-10 mailing list submission to Wedi-icd-10@lists.wedi.org 6/14/

32 Who wants an ICD-10-CM book? We will be giving away one ICD-10-CM Complete Official Draft Code Set a month for the next six months. Answer an ICD-10 coding question. Send your answer to ICD10@HMSA.com by Friday, June 21, 2013 at 4:00 pm. We will randomly select one participant from all correct answers received and send that person a copy of the ICD- 10-CM. 6/14/

33 June 2013 ICD-10 Question What is the ICD-10-CM code for a subsequent encounter for a stress fracture of the left fibula with nonunion? your answer to ICD10@HMSA.com for your chance to win! 6/14/

34 QUESTIONS? Join us on Friday July 12 at 12:30 pm HST for the next ICD-10 Webinar. You don t need to pre-register, just log on to nstage/g.php?t=a&d= Event code Dial in for the audio at /14/