Purpose of this set of slides Talking Points Notes
|
|
|
- Harvey Pearson
- 10 years ago
- Views:
Transcription
1 Purpose of this set of slides Communicate and discuss ICD-10 impacts, opportunities, and examples specific to SMA operations in the area of managed care. The move from ICD-9 to ICD-10 is a significant change for SMAs and unlike previous HIPAA efforts, ICD-10 impacts the business of Medicaid as much as its enabling technology systems. ICD-10 s impact will be disruptive in the short-term, but positive over the longer term. The new code sets will benefit the delivery of care by indicating diagnoses and matching payment to care more precisely. In time, it will promote efficiencies and improvements in care documentation, claims processing, and business intelligence. CMS has prepared a series of slides and training materials especially for SMAs, which provide key information about the ICD-10 code sets, how to use them, how to benefit from them, and how to implement them. CMS hopes this information will assist SMAs with effectively implementing and benefiting from this major change to the specificity and content of codes sets used to categorize health care diagnoses and inpatient procedures. Notes Note: the implementation of ICD-10 does not affect HCPCS codes (Levels I and II) for outpatient procedures except in cases where coverage and payment may be dependent on medical necessity as determined by diagnoses codes. For more info on HCPCS codes, please refer to: Unless otherwise specified in this presentation, ICD-10 refers to both ICD10-CM and ICD10-PCS. Unless otherwise specified in this presentation, the word procedures refers to inpatient procedures. 0
2 1
3 2
4 3
5 4
6 5
7 6
8 7
9 8
10 The National Health Care Anti-Fraud Association estimates that fraud amounts to at last three percent of total health care spending, or more than $60 billion per year. Increases funding for the Health Care Fraud and Abuse Control fund to fight fraud in public programs. The Office of Management and Budget estimates that every $1 invested to fight fraud results in approximately $17 in savings. 9
11 10
12 xxx 11
13 : Demonstrates some of the issues with crosswalking : Based on the GEM mapping files less than 5% of the crosswalks are considered exact or not approximate Of the crosswalks that are exact based on the GEM file, a number of those are not actually exact from a clinical perspective. This will be illustrated subsequently. Quality relates to the loss or information or the assumption of information that may not be true. This will be illustrated subsequently. Since there is no significant experience with crosswalking and since there are no agreed upon metrics on the quality of the measures, it will be difficult to evaluate crosswalking quality impacts 12
14 : Demonstrates some of the issues with crosswalking : Based on the GEM mapping files less than 5% of the crosswalks are considered exact or not approximate Of the crosswalks that are exact based on the GEM file, a number of those are not actually exact from a clinical perspective. This will be illustrated subsequently. Quality relates to the loss or information or the assumption of information that may not be true. This will be illustrated subsequently. Since there is no significant experience with crosswalking and since there are no agreed upon metrics on the quality of the measures, it will be difficult to evaluate crosswalking quality impacts 13
15 14
16 15
17 16
18 17
19 18
20 19
21 20
22 21
23 22
24 23
25 24
26 25
27 26
28 27
29 28
30 29
31 30
32 31
33 32
34 33
35 xxx 34
36 35
37 36
38 37
39 38
40 : xxx : Xxx 39
41 : xxx : Xxx 40
42 : xxx : Xxx 41
43 : xxx : Xxx 42
44 : xxx : Xxx 43
45 : xxx : Xxx 44
46 : xxx : Xxx 45
47 : xxx : Xxx 46
48 : xxx : Xxx 47
49 : xxx : Xxx 48
50 49
The Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims.
HEALTH INSURANCE & CODING Textbook: Understanding Health Insurance: A Guide to Billing and Reimbursement 11 th edition Website Activities: StudyWARE Online Practice Software linked to the book. SimClam:
Anthem Workers Compensation
Anthem Workers Compensation ICD-10 Frequently Asked Questions What is ICD-10? International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the
Frequently Asked Questions about ICD-10-CM/PCS
Frequently Asked Questions about ICD-10-CM/PCS Q: What is ICD-10-CM/PCS? A: ICD-10-CM (International Classification of Diseases -10 th Version-Clinical Modification) is designed for classifying and reporting
ICD-10 Coding for Audiology
ICD-10 Coding for Audiology Mary Sue Fino-Szumski, Ph.D., M.B.A. Vanderbilt University School of Medicine Vanderbilt Bill Wilkerson Center Department of Hearing and Speech Sciences Disclosure Financial
ICD-10 Preparation for Dental Providers. July 2014
ICD-10 Preparation for Dental Providers July 2014 What is ICD-10? The International Classification of Diseases (ICD) is a set of codes used worldwide to classify medical diagnoses and inpatient procedures.
ICD-10 Frequently Asked Questions For Providers
ICD-10 Frequently Asked Questions For Providers ICD-10 Basics ICD-10 Coding and Claims ICD-10 s ICD-10 Testing ICD-10 Resources ICD-10 Basics What is ICD-10? International Classification of Diseases, 10th
ICD-10: Facts for Hospitals
ICD-10: Facts for Hospitals July 16, 2015 Shana Olshan Director, National Standards Group Centers for Medicare and Medicaid Services 1 Today s Presentation Topics ICD-10-CM and ICD-10-PCS overview ICD-10
Welcome to ICD-10 CLINICAL CLOSE-UP
Welcome to ICD-10 CLINICAL CLOSE-UP Topics ICD-10 Overview About ICD-10 Why ICD-10 Matters ICD-9 vs ICD-10 Clinical Close-Up ICD-10 Documentation GEMs Mapping Tool GEMS vs Coding Manual Bi-Directional
ICD-10 FAQ. How Long Has ICD-9-CM Been In Use?
ICD-10 FAQ How Long Has ICD-9-CM Been In Use? What Code Set Does ICD-9-CM Define? What Code Set Does ICD-10 Define? When was ICD-10-CM Created? What agency maintains ICD-10? Why is ICD-10 better than ICD-9?
ICD-10 Action Plan: Your 12-Step Transition Plan for ICD-10. Written by the AMA CPT Medical Informatics Department
ICD-10 Action Plan: Your 12-Step Transition Plan for ICD-10 Written by the AMA CPT Medical Informatics Department P R A C T I C E T O O L S E P T E M B E R 2 0 1 2 This resource is for educational purposes
ICD-10. October 1, 2015
ICD-10 October 1, 2015 Why is SSIS Changing to ICD-10 CM? Federal Health Insurance Portability and Accountability Act (HIPAA) law requires the use of the International Classification of Diseases, Tenth
MediRegs Coding Suite
MediRegs Coding Suite Specialized health care solutions to accelerate coding compliance and ensure accurate and timely reimbursement MediRegs Coding Suite from Wolters Kluwer Law & Business is a web-based
How To Get A Blue Cross Code Change
OVERVIEW 1. What is an ICD Code? The International Classification of Diseases (ICD) code set is used primarily to report medical diagnosis and inpatient procedures. ICD codes are mandated by the Centers
Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA
Transitioning from ICD-9-CM to ICD-10-CM Tidewater Physicians Multispecialty Group Williamsburg, VA February 22, 2014 Our Agenda Some guidelines for this morning s presentation Our Transformational Point
ICD-10 Overview. The 411 on ICD-10. Camillia Harris, ICD-10 Communications Lead Eric Hendrick, ICD-10 Functional Deputy Project Lead
ICD-10 Overview The 411 on ICD-10 Presented by: Camillia Harris, ICD-10 Communications Lead Eric Hendrick, ICD-10 Functional Deputy Project Lead June 18, 2013 0 Mission We will provide Georgians with access
A Guide to Education and Training for ICD-10 Implementation
A Guide to Education and Training for ICD-10 Implementation Table of Contents Chapter One: Phases of implementation Chapter Two: Timelines for implementation Chapter Three: Part One: Part Two: Part Three:
How To Transition From Icd 9 To Icd 10
ICD-10 FAQs for Doctors What is ICD-10? ICD-10 is the 10 th revision of the International Classification of Diseases (ICD), used by health care systems to report diagnoses and procedures for purposes of
REVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.Ø
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
ICD-10 FROM A NURSE PERSPECTIVE. Learning Objectives 4/22/2015. Adoption of ICD-10 Classification of Diseases CD-10-CM Diagnostic Codes
ICD-10 FROM A NURSE PERSPECTIVE Learning Objectives 1. New ICD-10-CM diagnostic system for Dermatology. 2. Impact of new codes on nursing and clinical support staff. 3. Education and resources available.
ICD-10 Frequently Asked Questions
ICD-10 Frequently Asked Questions ICD-10 General Overview... 3 What is ICD-10?... 3 Why are we adopting ICD-10?... 3 What are the benefits of the ICD code expansion?... 3 What does ICD-10 compliance mean?...
ICD 10 Testing for Small Providers
WEDI Strategic National Implementation Process (SNIP) ICD-10 Workgroup ICD-10 Testing Sub-workgroup ICD 10 Testing White Paper ICD 10 Testing for Small Providers February 24, 2015 Workgroup for Electronic
REVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.2
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
ICD-10-CM and ICD-10-PCS Frequently asked questions for HIM and Patient Financial Services Leaders
ICD-10-CM and ICD-10-PCS Frequently asked questions for HIM and Patient Financial Services Leaders Executive questions What is the current status of ICD-10? The U.S. Department of Health and Human Services
Introduction to ICD-10: A Guide for Providers. Centers for Medicare & Medicaid Services
Introduction to ICD-10: A Guide for Providers Centers for Medicare & Medicaid Services 1 Table of Contents Compliance Date: October 1, 2014» What is ICD-10?» Why ICD-10 matters» Why transition to ICD-10»
Transition to ICD-10: Frequently Asked Questions
This reference document was developed to answer provider questions about the mandated transition to the ICD-10 code sets. It will be updated as additional information becomes available. We encourage you
Getting Ready for ICD-10. Part 1: The Basics
Getting Ready for ICD-10 Part 1: The Basics Introduction In the United States, on October 1, 2015 the ICD 9 code set used to report medical diagnoses and inpatient procedures will be replaced by the International
A. CPT Coding System B. CPT Categories, Subcategories, and Headings
OST 148 MEDICAL CODING, BILLING AND INSURANCE COURSE DESCRIPTION: Prerequisites: None Corequisites: None This course introduces CPT and ICD coding as they apply to medical insurance and billing. Emphasis
Meeting the ICD-10 Compliance Date. Are You Going to Be Ready?! HCCA Regional Conference November 2011
Meeting the ICD-10 Compliance Date. Are You Going to Be Ready?! HCCA Regional Conference November 2011 1 Speaker Gloryanne Bryant, RHIA, CCS, CCDS Regional Managing Director HIM Revenue Cycle, Kaiser Permanente
ICD-10 Frequently Asked Questions
Below are some frequently asked questions (FAQs). Please refer to this FAQ often as updates will be made regularly. Last updated 11/30/2015. The US Department of Health and Human Services (HHS) has mandated
ICD-10 DRG Impacts at the Hospital Level
A Health Data Consulting White Paper 1056 Ave S Edmonds, WA 98020-4035 206-478-8227 www.healthdataconsulting.com ICD-10 DRG Impacts at the Hospital Level Joseph C Nichols MD Principal 12 Nov 2011 TABLE
Coding with. Snayhil Rana
Coding with ICD-9-CM CM Snayhil Rana ICD-9-CM CM Index Pre-Test Introduction to ICD-9-CM Coding The Three Volumes of the ICD-9-CM ICD-9-CM Coding Conventions Other ICD-9-CM Sections ICD-9-CM for Claim
ICD-10-CM and PCS Implementation in the U.S.
ICD-10-CM and PCS Implementation in the U.S. Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA AHIMA-Approved ICD-10-CM/PCS Trainer Objectives Where do we stand as of May, 2014 We ll cover The U.S. Classification Experience
Preparing for ICD-10. What Your Practice Needs to Know
WRS Health Preparing for ICD-10 2 Executive Summary The healthcare industry is set to undergo an important change on October 1, 2014, when the mandatory adoption of the ICD-10 codes go into effect. The
ICD -10 TRANSITION AS IT RELATES TO VISION. Presented by: MARCH Vision Care, 2013
ICD -10 TRANSITION AS IT RELATES TO VISION Presented by: MARCH Vision Care, 2013 INTRODUCTION During the summer of 2008, the Department of Health and Human Services (HHS) initiated the implementation process
The Official Guidelines for coding and reporting using ICD-9-CM
Reporting Accurate Codes In the Era of Recovery Audit Contractor Reviews Sue Roehl, RHIT, CCS The Official Guidelines for coding and reporting using ICD-9-CM A set of rules that have been developed to
ICD-10 User Guide July 2015
ICD-10 User Guide July 2015 Contents Introduction... 3 Set up the Crosswalk parameter... 3 Set up the ICD-10 compliance date for an insurance carrier... 4 Add the employer insurance... 6 New ICD Search
Medical Necessity and Coding
Medical Necessity and Coding NEW MEXICO HEALTH INFORMATION MANAGEMENT ASSOCIATION FALL CODING WORKSHOP September 14, 2012 Hyatt Downtown Albuquerque, NM Presented by: Andrea Busby, RHIA ADHIMA, INC Goals
TRANSITIONING FROM ICD-9 to ICD-10 CODES. Presented by: Michael Langer, Office Chief, Behavioral Health and Prevention
TRANSITIONING FROM ICD-9 to ICD-10 CODES Presented by: Michael Langer, Office Chief, Behavioral Health and Prevention September 25, 2015 2 TOPICS Coding and System Changes Understanding the ICD-10 Format
Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding
Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding Clinical Coding Diagnosis Codes Clinicians select ICD-CM codes to describe a patient s diagnoses, symptoms, and clinical findings.
State Medicaid ICD-10 Implementation Assistance Handbook
State Medicaid ICD-10 Implementation Assistance Handbook Health Innovation Prepared by the Centers for Medicare & Medicaid Services (CMS), Center for Medicaid, Children's Health Insurance Program (CHIP)
Preparing for ICD-10 Advance Preparation for Implementation Charles Brownlow, OD [email protected]
Preparing for ICD-10 Advance Preparation for Implementation Charles Brownlow, OD [email protected] International Classification of Diseases (ICD-9, ICD-10) Both include codes for all medical conditions,
Transitioning to EDI HIPAA 5010 and ICD-10
Transitioning to EDI HIPAA 5010 and ICD-10 Challenges & Opportunities October 17, 2010 Outline I. HIPAA 5010 EDI Changes HIPAA 5010 Overview Transactions Affected CORE Certification II. III. IV. ICD-10
1. Coverage Indicator Enter an "X" in the appropriate box.
CMS 1500 Claim Form FIELD NAME INSTRUCTIONS 1. Coverage Indicator Enter an "X" in the appropriate box. 1a. Insured's ID Number Enter the patient's nine-digit Medical Assistance identification number (SSN).
Extreme Makeover - ICD-10 Code Edition: Demystifying the Conversion Toolkit
Extreme Makeover - ICD-10 Code Edition: Demystifying the Conversion Toolkit Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, FHIMSS Principal - Dak Systems Consulting, San Mateo CA DISCLAIMER: The views and opinions
How to Avoid an Office Meltdown: Find Out the Facts about ICD-10-CM. Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Appendix
How to Avoid an Office Meltdown: Find Out the Facts about ICD-10-CM Table of Contents Chapter 1 Why Is ICD-9 Being Replaced?... 3 How Is ICD-10-CM Different?... 4 How Does the New Format Compare?....5
ICD-10 Overview. The U.S. Department of Health and Human Services implementation deadline for compliance with ICD-10, Mandate is October 1, 2014.
ICD-10 Overview ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization
Compensation and Claims Processing
Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance
Online Claim Entry UB-04. Presented by: Xerox State Healthcare, LLC Provider Relations
Online Claim Entry UB-04 Presented by: Xerox State Healthcare, LLC Provider Relations Resources When online use: Ask Service Representative [email protected] [email protected] Call Center 505-246-0710
Frequently asked questions: ICD-10
Frequently Asked Questions Frequently asked questions: ICD-10 To help health care providers and payers prepare for ICD-10, Optum has prepared the following answers to frequently asked questions. ICD-10
It s Time to Transition to ICD-10
July 22, 2015 It s Time to Transition to ICD-10 What do the changes mean to your SNF? Presented by: Linda S. Little, RN-BSN Clinical Consultant HMM Consulting Office: (631) 265-6289 E-Mail: [email protected]
ICD 10: Final Steps for Successful Implementation
ICD 10: Final Steps for Successful Implementation Gayle R. Lee, JD Matt Elrod, PT, DPT, MEd, NCS Presenters Gayle Lee, JD, has more than 15 years of experience working on health care issues impacting the
The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.
The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a
ICD-10 Compliance Date
ICD-10 Implementation Frequently Asked Questions Updated September 2015 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,
How to Overcome the 5 Biggest Reimbursement Challenges in Joint & Spine Coding
How to Overcome the 5 Biggest Reimbursement Challenges in Joint & Spine Coding Presented by: Carolyn Neumann, CPC Senior Manager Coding and Coverage Access The opinions and codes denoted within are suggestions
Objectives. ICD Background. Introduction to ICD-10 and what you need to know for a Successful Transition
Introduction to ICD-10 and what you need to know for a Successful Transition Sheila Goethel, RHIT, CCS Coding Consultant AHIMA ICD-10-CM/PCS Certified Trainer May 2011 Objectives Introduction of ICD Brief
Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests
Financial Disclosure Teri Thurston does not have any relevant financial relationships with any commercial interests Transitioning to ICD-10 Planning the Journey for Implementation 2 Brief History of ICD-10
Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm
Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology The presentation
Disclaimer. HRSA does not endorse any products or vendors featured in this PDF. These slides are not 508 compliant.
Disclaimer HRSA does not endorse any products or vendors featured in this PDF. These slides are not 508 compliant. Please do not distribute without the permission of HRSA. U.S. Department of Health and
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services ICD-10-CM/PCS THE NEXT GENERATION OF CODING
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services ICD-10-CM/PCS THE NEXT GENERATION OF CODING ICN 901044 April 2013 This publication provides the following information on
To define and explain different learning styles and learning strategies.
Medical Billing and Coding Program Overview The Medical Billing and Coding program prepares students for entry-level employment as a medical billing and/or coding clerk. It discusses the fundamentals of
Not all NLP is Created Equal:
Not all NLP is Created Equal: CAC Technology Underpinnings that Drive Accuracy, Experience and Overall Revenue Performance Page 1 Performance Perspectives Health care financial leaders and health information
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions ELECTRONIC TRANSACTIONS AND CODE SETS The following frequently asked questions and answers were developed to communicate
Making the Transition: ICD-10-CM Diagnosis Codes ICD-10-CM: International Classification of Diseases, 10th Edition, Clinical Modification
1 COA Fact Sheet Making the Transition: ICD-10-CM Diagnosis Codes ICD-10-CM: International Classification of Diseases, 10th Edition, Clinical Modification Mandated Transition to ICD-10 Codes: October 1,
CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS
CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS FIELD NUMBER FIELD NAME 1 a INSURED S ID NUMBER INSTRUCTIONS Enter the patient s nine digit Medicaid identification number (SSN) 2 PATIENT S NAME Enter the recipient