Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests

Transcription

1 Financial Disclosure Teri Thurston does not have any relevant financial relationships with any commercial interests

2 Transitioning to ICD-10 Planning the Journey for Implementation 2

3 Brief History of ICD-10 ICD (International Classification of Diseases) is the international standard for the classification of diseases and other conditions that are recorded on many types of health and vital records ICD-9 revision originated in 1975 The United States began using ICD-9 in 1979 The World Health Organization (WHO) endorsed ICD-10 in May 1990 Other Countries began adopting ICD-10 in 1994 The United States only partially adopted ICD-10 in 1999 for mortality reporting Today most countries are using ICD-10 3

4 Limitations of ICD-9-CM Follows a 1970s outdated coding system ICD-9 has 13,000 diagnosis codes available ICD-9 does not translate with the modern landscape of medicine Lacks clinical specificity to process claims and reimbursement accurately Fails to capture key details of patient conditions for recording and exchanging information Limits the number of characters available (3-5) to account for complexity and severity

5 Benefits of ICD-10-CM ICD-10-CM (CM = Clinical Modifications) ICD-10-CM has 68,000 diagnosis codes ICD-10-CM code set has been expanded to 3 to 7 (alphanumeric character in all positions) and includes placeholder characters (X) Better reflects details that describe clinical severity and complexity. Greater detail will represent medical necessity of services ICD-10 codes permit documentation to be translated with greater accuracy and clear clinical picture

6 Implementation Deadline On October 1, 2015 ICD-10 will replace ICD-9 as mandated by the Health Insurance Portability and Accountability Act (HIPAA) for diagnosis and inpatient procedure coding October is the scheduled implementation date Only ICD-10 codes can only be submitted with dates of service of October 1, 2015 and after ICD-9 codes must still be submitted for dates of service of September 30, 2015 and prior

7 ICD-10 Implementation Strategy Transitioning to ICD-10 begins with examining every setting in which diagnosis codes are captured, stored, analyzed or reported. The assessment process is an opportunity to review current work flow and documentation patterns. To improve and streamline future processes and strengthen the basis for code assignment

8 Compliance Outline Plan your journey Train your team Review and Update your processes Engage your vendors and payers Test your systems and processes

9 Plan Your Journey Understand the impact o ICD-10 will affect how both the business and clinical practices are managed Arrange for training and education for the whole team o Make this training relevant according to position o Delegate portions of training to individuals to train the team Identify processes that need updating and reorganizing o Outline the areas to review, action steps required, checklists to capture where you are in your journey and track what to do next. Pinpoint where diagnosis codes are used through the practice o Forms, encounter forms, practice management reports, and identify the most common codes in all areas within the practice. Identify who will be part of the journey o Roles; delegate and establish accountability for the process

10 Plan Your Journey Prepare ICD-10 transition budget (both time and financial) Training; documentation and coding for practice staff System upgrades Any user training needed for the functionality due to any system upgrades Updating of paper forms, and documents referencing diagnosis codes Estimate your practice monthly revenue for 12 month following the compliance date Increase cash reserves and/or secure a line of credit to reduce potential cash flow disruptions Plan for an increase of AR, underpayments, denials and rejections

11 Train Your Team Documentation training for physicians and techs Code training for staff members who have contact with coding Overview training for staff members engaged in admin. functions User training on the ICD-10 functionality included with system upgrades Schedule times for training for staff members

12 Review and Update Your Processes Improve clinical documentation for increased specificity Review claim rejections and denials with ICD-9 (clearinghouse or EOPs), pinpoint and correct the cause Identify any unspecified ICD-9 codes currently used Identify the top 20 ICD-9 codes and map the ICD-10 code Monitor and track current causes for payment delays, denials Continue to monitor closely for the first 3 to 6 months after the compliance date Revise paper forms and tools that reference diagnosis codes Review clinical forms Track patient complaints

13 Engage Your Vendors and Payers Technology Vendors IT support Software vendors Clearinghouse Billing Services Commercial Payers Medicare - update LCD on refractive lenses Medicaid Military Payer

14 Test Your Systems Internally prepare common test cases Perform internal testing of systems and workflow Conduct external testing with partners (EHR>PM, PM>Clearinghouse, Clearinghouse>Payers, Payers>Clearinghouse, Clearinghouse>PM) Practice coding in ICD-10 and validate supporting clinical documentation processes If using EHR support verify your agreement of the recommended codes

15 Take away points Start building your implementation plan Get your systems and processes ready Outline training and education needs for physicians and staff

16 Summary ICD-10 is coming! As of today no additional delays have been announced. Do not delay in your planning and begin preparing for the transition today. The investment will pay off come October 1, 2015.

17 Resources CMS ICD-10 website: Sign up for ICD-10 news alerts PECAA website - Billing & Coding Practice Assessment Additional PECAA webinars: June 25, 2015 September 17, 2015 December 17, 2015