Arkansas DMS: ICD-10 Provider Education Series

Transcription

1 Arkansas DMS: ICD-10 Provider Education Series ICD-10 Preparation & Implementation Cathy Munn, MPH RHIA CPHQ Sr. Consultant 1

2 Agenda Why ICD-10 & Why Now? Industry Update Key Points to Remember Impact of the Change Providers Payers Review of ICD-10 Codes & Changes Arkansas DHS Preparation & Planning Provider Preparation Next Steps & Resources 2

3 Industry Update Cutting Costly Codes Act of 2013 A bill to prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set standards. AMA remains opposed to ICD-10 Best Practices for ICD-10-CM Documentation 2012 Preparing for ICD-10-CM CMS continues to move forward with compliance date of October 1,

4 ICD-10-CM/PCS ICD-9-CM: International Classification of Diseases, 9 th revision, Clinical Modification ICD-10: Developed by the World Health Organization as the nomenclature for all countries ICD-10-CM: International Classification of Diseases, 10 th revision, Clinical Modification US only ICD-10-PCS: International Classification of Diseases, 10 th revision, Procedure Classification System US only 4

5 Federal Mandate Timeline Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013 NO GRACE PERIOD Dates of Service (outpatient) After 10/1/2013 Dates of Discharge (Inpatient) After 10/1/2013 Federal Mandate Updated Timeline: February 14, 2012 CMS announces they will reexamine the pace of implementing ICD-10 May 17, 2012 All comments due to HHS for consideration prior to publication of the final rule August 27, 2012 Revised compliance date announced by CMS stating a one-year extension would be granted October 1, 2014 is the revised ICD-10 Implementation Compliance Date 5

6 Things to Remember ICD-10-CM (diagnoses) will be used by all providers in every health care setting ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures ICD-10-PCS will not be used on physician claims This has change has no impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes CPT and HCPCS will continue to be used for physician and ambulatory services including physician visits to hospital inpatients DSM-V codes have been released; however DSM-V is not HIPAA compliant for claims or transactions 6

7 Important Information Inpatient discharges occurring on or after will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission. Outpatient dates of service occurring on or after will use ICD-10-CM codes There will be period of time when payers will be processing both ICD-9 and ICD-10 claims due to claims backlogs, appeals, grievances, etc. Systems will have to utilize both ICD-9-CM and ICD- 10-CM for some period of time. Arkansas Medicaid allows providers 365 days to submit a claim. 7

8 A Few ICD-10 Benefits Better data will be available for: Measuring the quality, safety, and efficacy of care Designing payment systems and processing claims for reimbursement Conducting research, epidemiological studies, and clinical trials Setting health policy Operational and strategic planning and designing healthcare delivery systems Monitoring resource utilization Improving clinical, financial, and administrative performance Preventing and detecting healthcare fraud and abuse Tracking public health and risks 8

9 Current Competing Priorities ACOs/ Patient Centered Medical Home Public Reporting & Quality Measures ICD-10: A key component to success EHR/ MU Value Based vs. Volume 9

10 ICD-9 vs. ICD-10 Diagnosis Codes ICD-9 Diagnosis Codes 13,000 ICD-10 Diagnosis Codes 68, Characters 3-7 Characters First character is numeric or alpha (E or V) Use of decimal after 3 rd character First character is alpha Use of decimal after 3 rd character Characters 2-7 are alpha or numeric letter U is not used Use of dummy placeholder X for future code expansion E codes reference External Causes of Injury & Poisoning in ICD-9. E references the Endocrine system in ICD-10 V codes reference Health Status & Contact with Health Services in ICD-9 V Y codes reference External Causes of Morbidity in ICD-10 10

11 ICD-9 Procedure vs. ICD-10-PCS ICD-9 Procedure Codes 4,000 ICD-10 Procedure Codes 87, Digits 7 Digits All digits are numeric Example: Angioplasty has 3 codes Example: Artery suture has 1 code Alpha or numeric composition Numbers 0-9 Letters O & I are omitted Example: Angioplasty 1298 coding combinations Example: Artery suture 195 coding options The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. 11

12 Patient Flow Impact Revise for ICD- 10 reporting Back end processes Start Patient Encounter Diagnose Patient Providers change coding practices based on ICD-10 Update data repositories to accommodate new coding Claim priced based on revised fee schedules Revise authorization process Payment & Remit Price Claim Check Auth Select provider & contract Code Claim Submit Claim Receive Claim Begin Adjudication Update practice management system Update claims submission process Update system to accept claims Update benefit logic & edits Determine Benefits Check Eligibility 12

13 Impact on Providers First Things First: Impact Assessment & Gap Analysis Evaluate Vulnerabilities Systems Operations and Processes Clinical Documentation 13

14 System Impacts Identify your current systems and work processes that use ICD-9 codes. This could include: Practice Management Systems Reports Electronic Medical Record Systems Clinical Documentation ICD-9 Code Assignment Encounter Forms and Superbills Public Health and Quality Reporting Protocols & Reports A good rule of thumb: Wherever ICD-9 codes appear today, ICD-10 codes will need to replace them in the future 14

15 System Impacts If applicable, talk with your practice management/ehr vendor(s) about accommodations for both ICD-9 and ICD-10 codes Contact your vendor(s) and ask what updates they are planning for your practice management/ehr system and the anticipated install/update implementation date Check your contract to see if upgrades are included or if there is an additional cost Discuss implementation plans with any clearinghouses or billing services you may use 15

16 Operational Impacts 16

17 Operational Impacts Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition Be proactive, don t wait for vendors to contact you Ask about their plans for ICD-10 compliance and when they will be ready to collaboratively test their systems Ask to see their roadmap that supports their claims of ICD-10 Readiness Utilize CMS checklists and resources new information is posted on 17

18 Operational Impacts Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, fee schedules or reimbursement methodologies 18

19 Operational Impacts Identify potential changes to work flow and business processes Consider changes to existing processes including: Clinical documentation Prior authorization Encounter forms and Superbills Report generation Operational Quality and Public Health reporting Involvement in any Care Management initiatives 19

20 Operational Impacts Assess staff training needs coders, billing staff, ancillary staff. Anticipate that everyone in your office will require some level of ICD-10 awareness training There are many training options and materials available through a variety of resources & venues: Professional Associations AAPC, AHIMA Online Courses ICD10 Monitor, Contexo University Webinars ICD10 Monitor, HC Pro Onsite Training Train the Trainer If you have a small practice, think about collaborating with other local providers 20

21 Operational Impacts Budget for time and costs related to ICD-10 implementation including: Expenses for system changes and software updates Resource materials Training Modifications to forms and Superbills Other budgetary considerations: Unanticipated payment delays, appeals & denials Understand your operational metrics benchmark for efficiency Establish a line of credit 21

22 Superbills - How Will They Change? Increased size Increased specificity Examples can be found at along with other valuable ICD-10-CM resources 22

23 Not so Super-Superbill? ICD-9-CM Varicose veins of lower extremities with inflammation ICD-10-CM I83.10 Varicose veins of unspecified lower extremity with inflammation I83.11 Varicose veins of right lower extremity with inflammation I83.12 Varicose veins of left lower extremity with inflammation 23

24 The appropriate 7 th character is to be added to each ICD-10-CM code: A initial encounter D Subsequent encounter S - Sequela ICD-9-CM ICD-10-CM Sprain and strain of ankle and foot, other S86011x Strain of right Achilles tendon S86012x Strain of left Achilles tendon S86019x Strain of unspecified Achilles tendon S93491x Sprain of other ligament of right ankle S93492x Sprain of other ligament of left ankle S93499x Sprain of other ligament of unspecified ankle S96111x Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, right foot S96112x Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, left foot S96119x Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, unspecified foot S96211x Strain of intrinsic muscle and tendon at right ankle and foot level, right foot S96212x Strain of intrinsic muscle and tendon at right ankle and foot level, left foot S96219x Strain of intrinsic muscle and tendon at right ankle and 24

25 Continued ICD-9-CM Sprain and strain of ankle and foot, other ICD-10-CM S96911x Strain of unspecified muscle and tendon at ankle and foot level, right foot S96912x Strain of unspecified muscle and tendon at ankle and foot level, left foot S96919x Strain of unspecified muscle and tendon at ankle and foot level, unspecified foot 25

26 Clinical Documentation Practices If it s not documented.it s not done Outcome Data Reimbursement Liability 26

27 Clinical Documentation Practices A frequent concern heard from providers is that the requirement for documentation to support ICD-10 coding is an unnecessary administrative burden. Is the inclusion of this information really an administrative burden? Laterality left, right, bilateral or unilateral Trimester of pregnancy and weeks of gestation Length of time a patient was unconscious Which finger, and which level in a finger amputation The type of surgical approach for procedures The severity of seizures The stage of a decubitus ulcer 27

28 Clinical Documentation Practices Clinical documentation is the first step in reaching the ultimate goal of better disease and risk management outcomes and data integrity. Clinical documentation improvement best practices provide accurate coding and clinical data. Accurate documentation = accurate coding Accurate coding = richer data & understanding patient needs Ultimately leading us to better patient outcomes 28

29 Clinical Documentation Practices Most of the new concepts introduced in ICD-10 codes are concepts that physicians should be documenting now. Based on 125 clinical documentation engagements performed by 3M Consulting Services, it was found physician documentation does not support coding at the highest level of specificity 30 to 40 percent of the time. Documentation requirements vary greatly by specialty or clinical domain. Codes related to ophthalmology have changed little in scope; however, codes related to the musculoskeletal system have increased dramatically. Over 50% of the ICD-10 codes are related to musculoskeletal conditions. Over 17,000 ICD-10 codes (~25%) are related to fractures. 29

30 Clinical Documentation Practices AHIMA Online Education Physician Series Clinical Documentation for ICD-10: Principles & Practice Short, self-paced training modules Case-based, real life examples Provides more than 200 bite-sized, on-demand, specialtyspecific training modules that can be accessed anytime or anywhere with a mobile device. (computer, tablet or smartphone) Delivers 3-5 minute modules that cover physician s most billed diagnoses & conditions making learning targeted and relevant to their practice specialty. 30

31 New Concepts and Features with ICD-10 31

32 ICD-10 Chapter Titles Character A and B C00 to D48 D50 to D89 E F G H00 to H59 H60 to H95 I J Chapter Title Certain infectious and parasitic diseases. Neoplasms. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. Endocrine, nutritional and metabolic diseases. Mental and behavioral disorders. Diseases of the nervous system. Diseases of the eye and adnexa. Diseases of the ear and mastoid process. Diseases of the circulatory system. Diseases of the respiratory system. 32

33 ICD-10 Chapter Titles Character K L M N O P Q R S and T U Chapter Title Diseases of the digestive system. Diseases of the skin and subcutaneous tissue. Diseases of the musculoskeletal system and connective tissue. Diseases of the genitourinary system. Pregnancy, childbirth and the puerperium. Certain conditions originating in the perinatal period. Congenital malformations, deformations and chromosomal abnormalities. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. Injury, poisoning and certain other consequences of external causes. This letter is currently left vacant. V, W, X and Y External causes of morbidity and mortality. 33

34 Repeating Patterns Of the 69,000 ICD-10 codes, over one third are the same with the exception of the concept of right vs. left. Considering that most of these codes also have an unspecified side option, the ratio is even higher. For every acute fracture code there is a code for initial encounter, subsequent encounter or sequela. Each code x 3. If the encounter is a subsequent encounter, then for each fracture there is a code for routine healing, delayed healing, malunion or nonunion. Each code x 4. 34

35 Understanding Code Patterns Concept Number of Codes Impacted Acute or chronic 1764 Open or closed 10,893 Routine healing, delayed healing 11,290 Right or left 25,230 Initial encounter, subsequent encounter or sequela 47,223 **Health Data Consulting 35

36 Individual Codes vs. Combination Codes Combination codes for conditions and common symptoms or manifestations E10.21 Type I diabetes mellitus with diabetic nephropathy I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris K Crohn s Disease of large intestine with intestinal obstruction Combination codes for Poisonings and External Causes T36.0X1D Poisoning by penicillins, accidental (unintentional), subsequent encounter T42.4X5A Adverse effect of benzodiazepines, initial encounter 36

37 Added Laterality H M Swimmer s ear, left ear Chondromalacia, right shoulder S40.251A Superficial foreign body of right shoulder, initial encounter About 25,000 (36%) of all ICD-10-CM codes are different only in that they distinguish right vs. left 37

38 The patient is receiving active treatment for the condition Surgical treatment Emergency Department encounter Evaluation and treatment by a new physician 38

39 Added Seventh-Character for Episode of Care M80.051A Age related osteoporosis with current pathological fracture, right femur, initial encounter for fracture S06.0X1A Concussion with loss of consciousness of 30 minutes or less, initial encounter S52.132A Displaced fracture of neck of left radius, initial encounter for open fracture Type I or II or initial encounter for open fracture NOS 39

40 After patient received active treatment for the condition and receiving routine care during healing or recovery phase Cast change or removal Removal of external or internal fixation device Medication adjustment Other aftercare and follow-up visits following injury treatment 40

41 Encounter Codes M80.051A Age related osteoporosis with current pathological fracture, right femur, initial encounter for fracture M80.051D Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing 41

42 Complications or conditions that arise as a direct result of a condition Scar formation after burn Use both the injury code that precipitated sequela and code for sequela S added only to injury code, not sequela code S identifies injury responsible for sequela Specific type of sequela (like scar) sequenced first, followed by injury code 42

43 Encounter Codes M80.051A Age related osteoporosis with current pathological fracture, right femur, initial encounter for fracture M80.051D Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing M80.051S Age-related osteoporosis with current pathological fracture, right femur, sequela 43

44 Pathological or Stress Fracture Seventh Characters A D G K P S Initial encounter Subsequent routine healing Subsequent delayed healing Subsequent nonunion Subsequent malunion Sequela 44

45 Fractures Type of fracture Specific anatomical site Displaced vs. nondisplaced Laterality right vs. left Routine vs. delayed healing Nonunion Malunion Type of encounter Initial Subsequent Sequela 45

46 Episode of Care Codes M80.051D Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing M80.051G Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing M80.051K Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion M80.051P Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion 46

47 Fractures Some fracture categories provide for seventh characters to designate the specific type of open fracture based on the Gustilo open fracture classification A fracture not indicated as displaced or nondisplaced should be coded as displaced A fracture not designated as open or closed should be coded as closed 47

48 Gustilo Classification I II III IIIA IIIB IIIC Low energy, Wound less than 1 cm Greater than 1 cm with moderate soft tissue damage High energy wound greater than 1 cm with extensive soft tissue damage Adequate soft tissue cover Inadequate soft tissue cover Associated with arterial injury 48

49 Clinical Scenario Patient presents to the ER for severe right lower leg pain with an open leg wound following a fall from a ladder. The physician documented that the patient had an open transverse fracture of the shafts of the tibia & fibula. ICD-9-CM code: , Open fracture of shaft, fibula with tibia E881.0 Accidental fall from ladder ICD-10-CM codes: S82.221B, Displaced transverse fracture of shaft of right tibia, initial encounter for open fracture NOS S82.421B Displaced transverse fracture of shaft of right fibula, initial encounter for open fracture NOS W11.XXXA Fall on and from ladder, initial encounter 49

50 Inclusion of Trimesters in Obstetrics Codes O Pre-existing essential hypertension complicating pregnancy, second trimester O Anemia complicating pregnancy, third trimester 50

51 Trimesters 1 st Less than 14 weeks 0 days 2 nd 14 weeks 0 days to less than 28 weeks 0 days 3 rd 28 weeks 0 days until delivery Trimester axis of classification rather than episode of care Not all conditions include codes for all three trimesters or is N/A Counted from first day of last menstrual period 51

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53 Pregnancy Codes For example, ICD-10-CM code of O15.03 designates eclampsia in pregnancy, third trimester ICD-9 code for same condition is eclampsia; antepartum condition not delivered during current episode of care Obstructed labor codes incorporate the reason for the obstruction; code extensions are used to identify specific fetus: (1-5) affected by obstetric condition e.g., ICD-10-CM code O64.1xx2 designates obstructed labor due to breech presentation, fetus 2 53

54 Changes to E & V Codes in ICD-10 E codes reference External Causes of Injury & Poisoning in ICD-9 E code references the Endocrine system in ICD-10 Thyroid gland disorders: E00 E07 Diabetes codes: E08 E13 Disorders of glucose regulation & pancreatic internal secretion: E15 E16 V codes reference Health Status & Contact with Health Services in ICD-9 Z codes reference Health Status & Contact with Health Services in ICD-10 V Y codes reference External Causes of Morbidity in ICD-10 54

55 Arkansas Frequently Used V Codes V22.0 Supervision of normal first pregnancy Translates to: Z3400 Encounter for supervision of normal first pregnancy, unspecified trimester V22.1 Supervision of other normal pregnancy Translates to: Z3480 Encounter for supervision of other normal pregnancy, unspecified trimester Z3490 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester V30.00 Single liveborn; born in hospital w/o mention of cesarean delivery Translates to: Z Single liveborn infant, delivered vaginally 55

56 Timeframe Specific Code Changes Time frame for abortion versus fetal death changed from 22 weeks to 20 weeks Acute myocardial infarction time period changed from 8 weeks to 4 weeks 56

57 Acute Myocardial Infarction (AMI) Age definition for AMI has changed to four weeks rather than eight weeks. New categories for subsequent AMI and for complications within 28 days of AMI. Different terminology is used and laterality is included e.g., I21.02 designates ST segment elevation myocardial infarction [STEMI] involving left anterior descending coronary artery 57

58 Per the Official AHA Coding Guidelines: If an AMI is documented as nontransmural or subendocardial, but the site is provided, it is still coded as a subendocardial AMI. The STEMI and NSTEMI are treated differently. Generally, the STEMI is caused by complete obstruction of the coronary artery, and causes damage that involved the full thickness of the heart muscle, while the NSTEMI is caused by a partial obstruction and the damage does not involve the full thickness of the heart wall. 58

59 CHF Specificity Congestive heart failure, unspecified I50.20 Unspecified systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.30 Unspecified diastolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failure I50.32 Chronic diastolic (congestive) heart failure I50.33 Acute on chronic diastolic (congestive) heart failure I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.9 Heart failure, unspecified 59

60 Important Changes Beyond New Concepts Additional information you need to know. 60

61 Pressure Ulcer Specificity Combination Codes ICD-10 pressure ulcer codes are combination codes that include: the site (lower back) of the pressure ulcer; the location (right/left) of the pressure ulcer; the stage of the pressure ulcer. ICD-9-CM Pressure ulcer, lower back AND Pressure ulcer stage II ICD-10-CM L Pressure ulcer of right lower back, stage 2 OR L Pressure ulcer of left lower back, stage 2 OR L Pressure ulcer of sacral region, stage 2* (*episode of care extension) 61

62 Pressure Ulcer Stages Stage 1: Pressure pre-ulcer skin changes limited to persistent focal edema Stage 2: Pressure ulcer with abrasion, blister, partial thickness skin loss involving epidermis and/or dermis Stage 3: Pressure ulcer with full thickness skin loss involving damage or necrosis of subcutaneous tissue Stage 4: Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon, or bone Unstageable: Based on clinical documentation pressure ulcers are those whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. Unspecified: The ICD-10-CM unspecified coding option is not considered a part of the NPUAP staging but is provided for reporting when the documentation is insufficient to assign a more specific code. 62

63 Diabetes Mellitus Combination Codes ICD-10 diabetes mellitus codes are combination codes that include: type of diabetes mellitus body system affected the complication/manifestation affecting the body system ICD-9-CM Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled Moderate nonproliferative diabetic retinopathy ICD-10-CM E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema Diabetic macular edema 63

64 Diabetes Codes & Insulin Use For type II diabetes, a secondary code for long-term (current) use of insulin is required if the patient is using insulin. For example, E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy and Z79.4 Long term (current) use of insulin 64

65 Asthma Asthma 493 w/fourth digits for extrinsic, intrinsic, chronic obstructive & unspecified. J45 Asthma J45.2X Mild intermittent asthma J45.3X Mild persistent asthma J45.4X Moderate persistent asthma J45.5X Severe persistent asthma J45.9X Other & unspecified asthma Fifth digits reflect presence/absence of status asthmaticus or acute exacerbation For example, J45.51 would be assigned for a patient who has severe persistent asthma with (acute) exacerbation. 65

66 Cerebral Infarctions Late effects of stroke are differentiated by type of stroke. Combination codes for common etiologies/manifestations are included ICD-10-CM code I designates cerebral infarction due to thrombosis of left vertebral artery 66

67 This Isn t Payer Versus Provider ICD-10 poses challenges for both payers and providers Readiness for payers and providers There is a potential for 1-2 years of uncertainty or data fog after implementation for payers and providers Data integrity and comparability Readiness will yield financial advantages for those who execute well Cash flow 67

68 CMS Resources 68

69 CMS Resources 69

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71 DMS Remediation Progress Tasks completed Operational assessment Remediation of medical policy, edits & audits Code translations ICD-9 -> ICD-10 3M Code Translation Tool Compilation of system requirements HP MMIS Xerox/ACS Smart PA Arkansas DHS all integrated & stand-alone systems Creation of Risk Remediation Plan Identification of impacted DMS reports, forms & brochures 71

72 DMS Remediation Progress Tasks nearing completion Remediation of Pharmacy policy & edits Remediation of Provider Manuals Creation of internal & external clinical testing scenarios Launch of testing environment Q Remediation of Episodes of Care 72

73 Arkansas DMS Assistance Continued Provider outreach Provider outreach & training Face to face meetings Webinars Periodic Arkansas DMS updates via various messaging channels System updates/remediation efforts: HP MMIS Xerox/ACS SmartPA Arkansas DHS all integrated & stand-alone systems Arkansas ICD-10 Website: Arkansas ICD-10 Frequently Asked Questions documents Recent updates from CMS & the industry ICD-10 mailbox established for submission of questions & comments 73

74 Now What? 74

75 Communication & Planning Engage the support of leadership Define your strategy & approach to ensure success Understand the financial implications of non-compliance Ensure everyone understands the impact of ICD-10 Receptionist Nursing Staff Physicians Coders Billing Staff CFO/COO Senior Practice Management Staff Share regular updates & communication briefings with staff 75

76 Impact Assessment Understand the impact that the transition will have on people, process & technology; both internal & external to the practice Staff & providers Education & awareness Training just in time Workflows Office through-put & documentation Code utilization within the practice Superbill assessment Coding & billing turn-around-time/cash flow Denials & resubmission of claims Systems upgrades/enhancements Practice management systems EHRs Billing transmissions EDI Vendor readiness 76

77 Impact Assessment Facilities, provider practices and specialty providers should examine their patient population in terms of: High volume/high cost Begin translating your codes from ICD-9 to ICD-10 based on volume Patient demographic; Medicare, Medicaid, Commercial insurance Be in contact with your large volume payers to understand their approach & strategy for ICD-10 Diagnoses that lead to the highest denial, physician query and re-bill rates; and Areas related to quality reporting, improvement initiatives and published RAC reviews 77

78 Testing DMS is working to deliver clinical scenarios via the AR ICD-10 Website for providers & facilities to initiate testing DMS must employ end to end testing based on CMS mandates. E2E testing should include: Creation of the claim Submission to payer/edi vendor/clearinghouse via 837 Adjudication of claim Reporting back to the provider via EOP/835 Adjustments/denials/resubmissions Report creation Denial tracking & analysis 78

79 Industry Web Site Resources /Downloads/ICD10SmallandMediumPractices508.pdf 79

80 CMS Resources 80

81 For More ICD-10 Information White Papers (including but not limited to) ICD-10 A Primer ICD-10 Clinical Documentation ICD-10 Physician Impact ICD-10 Advantages ICD-10 Specified or Unspecified Checklists published by CMS for providers (small, medium and large) at: 10ImplementationTimelines.html 81

82 AR Medicaid ICD-10 Icon 82

83 Questions & Comments We have brains in our head & feet in our shoes. Today is our day; our (ICD-10) mountain is waiting so let s get on our way.dr. Seuss 83