FREQUENTLY ASKED QUESTIONS ABOUT ICD-10-CM

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1 FREQUENTLY ASKED QUESTIONS ABOUT ICD-10-CM Version 10 - May 2014 Disclaimer: At this time, a new effective date for ICD-10-CM has not been established. Please check with CMS for any additional information. eclinicalworks, WESTBOROUGH, MA. ALL RIGHTS RESERVED.

2 Topics Introduction 4 eclinicalworks Newsletter 4 Frequently Asked Questions about ICD-10-CM 5 Will eclinicalworks support ICD-10-CM codes before or after the effective date? 5 How will eclinicalworks process unspecified codes? 5 Is ecw dependent on other vendors for ICD-10-CM compliance? 6 Does the application maintain a crosswalk between ICD-9-CM and ICD-10-CM codes? 6 Can the crosswalk be customized, or can we load an external crosswalk into the application? 6 What phase of remediation is ecw in currently regarding ICD-10-CM? 6 Have any risks been identified with meeting the compliance date? 7 How will ecw keep clients informed of ICD-10-CM and implementation instructions? 7 Will ecw store ICD-10-CM codes in the same field as the ICD-9-CM (Single-Field Strategy) or will the codes be stored in different fields (Dual-Field Strategy)? 7 Not all payers may be ready on/before October 1 st ; if this occurs, will a practice still be able to submit ICD-9-CM codes to specific payers? 8 How will the ICD-10-CM-compatible version interface with other applications? 8 Does the ecw application maintain a master set of ICD-10-CM codes internally within master tables? 8 What reports within the ecw system currently utilize ICD-9-CM codes and how will ICD-10-CM affect them? 9 Which reports will be added or modified to support ICD-10-CM codes? 9 How will reports (including prompts, parameters, drop-lists, and menus) be enhanced to support both ICD-9-CM and ICD-10-CM codes? 10 Will the embedded CodeCorrect and IMO apps within ecw also be ICD-10-CM compliant? 10 When will ecw provide a testing guide? 10 eclinicalworks, WESTBOROUGH, MA. ALL RIGHTS RESERVED.

3 INTRODUCTION Has ecw scheduled testing on our system with our insurance payers? Will ecw assist with testing claims adjudication with payers? 11 Will a conversion of any ICD-9-CM data to ICD-10-CM data be required? If so, who will perform the conversion a vendor or client? 11 Are additional vendor support services available? 11 What types of professional services/training does ecw offer to clients to assist them with 5010/ICD-10-CM transition? 12 What steps can clients take now to prepare for the ICD-10-CM implementation, not only in the Practice Management modules, but also in the EMR modules? 12 Is ecw using the same segments in the interface that are currently being used by ICD-9-CM codes to exchange ICD-10-CM information with other applications? 12 Are delivery and maintenance of the ICD-10-CM release covered under the client's current maintenance contract? 13 What additional hardware requirements are associated with ICD-10-CM-related software changes? 13 Will additional training be needed for ICD-10-CM functionality in ecw? 13 Appendix: Notices 14 Trademarks 14 Copyright 14 3

4 INTRODUCTION Introduction eclinicalworks Version 10 is ICD-10-CM compliant and currently available. The upgrade to V10 is included in your current Support and Maintenance contract. Please refer to your contract for specific information. Version 10 includes two types of ICD-10-CM tools: 1. An ICD-9-CM to ICD-10-CM GEMs-based mapping tool is available for use within the Progress Note and Billing/Claims windows. Simply enter any known ICD-9-CM code and then select from mapped ICD-10-CM options. This mapping tool is also available as a standalone utility for use in your implementation and education efforts. 2. Additionally, ecw recommends using Smart Search (Powered by IMO ) to help providers search easily for ICD-10-CM codes using text descriptions and keywords. Smart Search may be a good fit for your practice. This additional product can be activated using the eclinicalworks On-Demand Activation tool, which is available under the Admin band in the left navigation pane. ecw will provide webinars on how to use our lookup tools; however it is important to note that each practice is responsible for learning and understanding how to code using ICD-10- CM before the effective date. Be sure to view ICD-10 in Version 10 for more information about what V10 has to offer. Testing of all third-party interfaces (lab Practice Management, etc.) will be required before you can start using ICD-10-CM codes with your vendors. ecw is currently working directly with our preferred third-party interface vendors and will inform you, through newsletters, when the testing process has been completed. ecw is testing claim formatting with our preferred clearinghouses. Our clearinghouses are offering help in testing full-cycle with payers that make testing available. For assistance with implementing the ICD-10-CM changes in your practice, contact professionalservices-sales@eclinicalworks.com. eclinicalworks Newsletter Subscribe to the ecw newsletter ing list to stay informed about eclinicalworks and ICD-10-CM progress as the effective date approaches. To subscribe to the newsletter: Click the link available on the Customer Care Portal: OR Click the link available on the eclinicalworks website: OR Use this direct link: ecw Newsletter 4

5 Frequently Asked Questions about ICD-10- CM Will eclinicalworks support ICD-10-CM codes before or after the effective date? eclinicalworks will include both ICD-9-CM and ICD-10-CM code sets in Version 10 of ecw before and after the effective date, which is unknown at this time. Tags: Effective Date, ICD Compliance How will eclinicalworks process unspecified codes? Entering a known ICD-9-CM code returns possible ICD-10-CM code(s), and the provider may choose the appropriate code. If a one-to-one mapping is found, the ICD-10-CM code will populate automatically in the Progress Note or Claim. GEMs The ICD-9-CM to ICD-10-CM conversion solution offered by ecw is based on GEMs (General Equivalence Mappings); the crosswalk created by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). This tool was created to aid with the forward and backward conversion of ICD-9-CM and ICD-10-CM codes. For more information on GEMs: IMO Smart Search ecw is also collaborating with IMO (Intelligent Medical Objects) to provide a list of qualifiers to help users narrow their search for the correct ICD-10-CM code. If a user selects an unspecified code, the system presents a list of qualifiers and related ICD-10-CM codes via a blue hyperlink. Once the user selects the correct qualifier(s), the system narrows the list to the specific code, and adds the selected code to the assessment list. As users become familiar with ICD-10-CM, providers and billers will become more familiar with the code set and will become knowledgeable enough to select codes directly from the ecw-provided ICD-10-CM code list, eventually decreasing the reliance on mapping tools. Tags: GEMs Conversion Utility, Third Party, IMO, Smart Search, and Clearinghouses 5

6 Is ecw dependent on other vendors for ICD-10-CM compliance? IMO Smart Search is prepared with both the ICD-9-CM codes and ICD-10-CM codes, and will provide a crosswalk between the two sets. There will be no changes from eclinicalworks side of the interface. Based on the practice s selection of ICD codes within an encounter, the interface will send the selected codes (whether ICD-9-CM and/or ICD-10-CM) in a single feed. For inbound charge interface, you need to confirm that your vendor is sending the correct codes to ensure billing is accurate. Unlike the transition to ANSI 5010 electronic claim formatting, clearinghouses will not be able to assist with code conversion. The primary role of clearinghouses is to ensure that ICD-10-CM codes selected by the provider and/or biller are correctly formatted before being passed on to payers. NOTE: Practices must be sending electronic claims in 5010 format by the effective date as ANSI X4010 does not support ICD-10. Tags: IMO, Crosswalk, ICD-10-CM Code List, and Third-Party Vendor Does the application maintain a crosswalk between ICD-9-CM and ICD-10- CM codes? No. ecw hosts two crosswalks between ICD-9-CM and ICD-10-CM codes: A GEMs Conversion Utility (supplied by CMS) IMO (Intelligent Medical Objects) crosswalk. ecw stores this crosswalk within the ecw application; however the data housed is not managed by ecw. Tags: IMO and Crosswalk Can the crosswalk be customized, or can we load an external crosswalk into the application? ecw cannot support the ability to customize the crosswalks (GEMs and IMO) because ecw merely hosts the crosswalks from these two external sources. Tags: Crosswalk and Customize What phase of remediation is ecw in currently regarding ICD-10-CM? ecw is currently in the Implementation and Testing phase of our ICD-10-CM project. eclinicalworks is conducting internal and external testing to make sure that an ICD-10-CM 6

7 code flows seamlessly from the Progress Notes, to a claim, and to other preferred thirdparty vendor interfaces (Labs, DI, etc.). We strongly recommend each practice conduct their own testing with their preferred clearinghouses, non-preferred clearinghouses, and payers before the effective date to ensure a seamless transition. Tags: Timeline and Phase Have any risks been identified with meeting the compliance date? No risks have been identified at this time. ecw V10 is compliant with the ICD-10-CM deadline. If you upgrade to ecw V10 before the effective date, you will be compliant with ICD-10-CM. Your claims must be submitted in ANSI 5010 format. If you need help converting from ANSI 4010 to 5010, please log a support case. Act now to avoid delays as the deadline approaches. Tags: Risk and Compliance date, Effective Date How will ecw keep clients informed of ICD-10-CM and implementation instructions? ecw will continue to send client notifications via newsletters on a periodic basis. These notifications will include deadlines, implementation strategies, and any other communication related to ICD-10-CM. A copy of these newsletters will always be accessible from the my.eclinicalworks.com Customer Portal. Tags: Newsletter, Broadcast, and Deadlines Will ecw store ICD-10-CM codes in the same field as the ICD-9-CM (Single- Field Strategy) or will the codes be stored in different fields (Dual-Field Strategy)? ecw is following the Single-Field Strategy, in which the correct code (ICD-9-CM or ICD-10- CM), based on the encounter date, is stored in one field. Tags: Single-Field Strategy 7

8 Not all payers may be ready on/before October 1 st ; if this occurs, will a practice still be able to submit ICD-9-CM codes to specific payers? Version 10 has been set up with a global effective date. For non-hipaa mandated payers who may not make the change on the global effective date, eclinicalworks V10 provides an insurance-level override; allowing you to set individual compliance dates by payer. Be proactive begin contacting your payers now, especially those not covered by HIPAA (such as Auto and Liability insurers), to ask about their planned implementation date. Tags: Insurance and Payers How will the ICD-10-CM-compatible version interface with other applications? ecw V10 saves ICD-10-CM codes in the same manner that it saves the ICD-9-CM codes. This results in significantly lower risks to any interfaces that utilize these codes. No changes are needed on the ecw side to support ICD-10-CM. For inbound charge interfaces, please confirm that your vendor is sending the correct codes to ensure billing is accurate. Tags: Interfaces, Partners, and Vendors Does the ecw application maintain a master set of ICD-10-CM codes internally within master tables? Yes, ecw will ship ICD-10-CM codes as it did with the ICD-9-CM codes in V9. Tags: ICD-10-CM Compendium 8

9 What reports within the ecw system currently utilize ICD-9-CM codes and how will ICD-10-CM affect them? Reports Utilizing ICD-9-CM Codes Daily Scorecard Monthly Scorecard Monthly Scorecard (same report, different folder) Collections Report Account Based Collections Report Claim-Based Patient Analysis Report CPT * -Level ICD Codes with Patient Demographics Diagnosis Codes Analysis by Diagnosis Analysis by Diagnosis with Age Group Analysis by Diagnosis with Age Group and Visit Type Analysis by Diagnosis with ICD Group and Visit Type Analysis by Diagnosis with Visit Type Analysis by Diagnosis (Dashboard) Diagnosis Dashboard Although these reports use ICD-9-CM codes, there will be no need to change your reports after the transition to ICD-10-CM, unless you have custom reports. If you have custom reports, identify these using Custom Reports and remediate as necessary. Contact professionalservices-sales@eclinicalworks.com if you need help modifying your reports. Tags: Reporting Which reports will be added or modified to support ICD-10-CM codes? All eclinicalworks ebo Canned Reports that currently support ICD-9-CM codes will be compatible to support ICD-10-CM codes as well. Tags: Reporting * CPT 2012 American Medical Association. All rights reserved. 9

10 How will reports (including prompts, parameters, drop-lists, and menus) be enhanced to support both ICD-9-CM and ICD-10-CM codes? All reports requiring diagnosis information will contain prompts for ICD-10-CM. Information on ICD-10-CM will also be available as metadata for use in custom report creation. ecw will provide documentation to identify standard reports that contain ICD codes. See the preceding Reports table for a list of reports that currently include ICD-9-CM codes. The corresponding ICD-10-CM codes must be added to their Reporting ICD-Groups to get accurate data beyond the effective date. Tags: Reporting Will the embedded CodeCorrect and IMO apps within ecw also be ICD-10- CM compliant? The ICD-10-CM integration with IMO is complete in ecw V10. ecw is currently working with MedAssets to ensure that integrated CodeCorrect edits reflect the use of ICD-10-CM within claims. Development is expected to be completed well before the effective date. Tags: CodeCorrect and IMO When will ecw provide a testing guide? ecw currently has the ICD-10-CM in Version 10 Guide published on the my.eclinicalworks.com Customer Portal. This guide covers all sections within ecw that have been enhanced for V10, providing you with a comprehensive list of sections to be tested as part your ICD-10 in V10 testing plan. eclinicalworks recommends that organizations plan and begin testing well in advance in preparation of the ICD-10 Go-Live date. Tags: Testing Plan 10

11 Has ecw scheduled testing on our system with our insurance payers? Will ecw assist with testing claims adjudication with payers? ecw is not a claims submitter, so is not able to conduct end-to-end testing of adjudication results. ecw has successfully tested the formatting of claim batches with our preferred clearinghouses (ClaimRemedi, Emdeon, Navicure, and Gateway /TriZetto ). If you are using a non-preferred clearinghouse OR if you have a direct connection with any payer, you may be able to test with that payer. Contact your non-preferred clearinghouse or direct-connect payer for more instructions. You must be submitting in ANSI 5010 format and be upgraded to Version 10 before you can test. Tags: Insurance Payers Will a conversion of any ICD-9-CM data to ICD-10-CM data be required? If so, who will perform the conversion a vendor or client? ecw will not perform an automatic conversion of ICD-9-CM to ICD-10-CM codes. The conversion is mainly anticipated on existing workflows that include templates, Order Sets, etc., to make sure that these features function properly when ICD-10-CM codes are used. The timeframe for conversion depends on the amount of Order Sets, templates, etc., that have been created on your database. For more information refer to the ICD-10-CM in V10 Guide and contact ecw services at professionalservices-sales@eclinicalworks.com. Tags: ICD-9-CM to ICD-10-CM Conversion Are additional vendor support services available? Yes. Professional services are available for practices requesting additional assistance with the ICD-10-CM conversion process. For more information, please contact professionalservices-sales@eclinicalworks.com or refer to the Services tab within my.eclinicalworks.com. Tags: Professional Services and Training 11

12 What types of professional services/training does ecw offer to clients to assist them with 5010/ICD-10-CM transition? ecw offers many consulting options aimed at streamlining implementation of ICD-10-CM, while improving your day-to-day operations and minimizing impact on your A/R. Based on your needs and a thorough analysis of your practice, an Account Manager will create a team of subject-matter experts best able to address your requirements and budget. Contact professionalservices-sales@eclinicalworks.com for more information or refer to the Services Tab under my.eclinicalworks.com. Tags: Professional Services and Training What steps can clients take now to prepare for the ICD-10-CM implementation, not only in the Practice Management modules, but also in the EMR modules? Users are encouraged to find the equivalent ICD-10-CM codes for the ICD-9-CM codes currently stored in the system within the templates, Order Sets, Superbills, etc. This proactive step will help in easy conversions once V10 is implemented. Another important component of ICD-10-CM readiness is making sure you are current on your Content Updates. If you need help streamlining your implementation of ICD-10-CM, please contact professionalservices-sales@eclinicalworks.com for more information or go to the Services Tab on my.eclinicalworks.com. Tags: Prep for V10, Prep for ICD-10-CM, and Build Process Is ecw using the same segments in the interface that are currently being used by ICD-9-CM codes to exchange ICD-10-CM information with other applications? There are no special upgrades required for your interface to function. ecw will use the same current HL7 format and will send the ICD-10-CM codes to the same location where the ICD-9-CM codes were previously being sent. Tags: Interface Format and Interface Upgrade 12

13 Are delivery and maintenance of the ICD-10-CM release covered under the client's current maintenance contract? Delivery and maintenance of ICD-10-CM codes are included in your support and maintenance contract as long as your service contract is up to date. Tags: Delivery of V10, Support, and Maintenance What additional hardware requirements are associated with ICD-10-CMrelated software changes? ecw does not anticipate any additional hardware requirements for ICD-10-CM. Tags: Hardware Changes Will additional training be needed for ICD-10-CM functionality in ecw? No, additional training is not needed for ICD-10-CM functionality of V10. The new ICD-10- CM codes will work similarly to the ICD-9-CM in V10 of eclinicalworks. ecw does not train on ICD-10-CM. Note: eclinicalworks V10 has many other enhancements, such as Meaningful Use Stage 2 compliance, and additional training is recommended. ecw offers free training in the form of Webinars and recorded Webinars. To obtain additional ecw training resources, the Professional Services Team at professionalservices-sales@eclinicalworks.com, or contact your ecw Strategic Account Manager (SAM). Tags: ICD-10-CM Training 13

14 APPENDIX: NOTICES Trademarks ebo eclinicalworks eclinicalworks and ebo are registered trademarks of eclinicalworks, LLC. All other trademarks or service marks contained herein are the property of their respective owners. Current Procedural Terminology (CPT ) CPT is a registered trademark of the American Medical Association. ClaimRemedi ClaimRemedi is a registered trademark of ClaimRemedi Inc. Emdeon Emdeon is a Registered Trademark of the Emdeon Corporation. Gateway EDI /TriZetto Gateway EDI and TriZetto are registered trademarks of TriZetto. IMO IMO registered trademark is owned by Intelligent Medical Objects, Inc. MedAssets MedAssets is a registered trademark of MedAssets, Inc. Navicure Navicure is a registered trademark owned by Denny, Jim, M. McCahill. Copyright CPT Copyright Notice 14

15 CPT 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. MedAssets Copyright Statement MedAssets is a registered trademark of MedAssets, Inc. 15