Agenda Placeholder Agenda Placeholder Agenda Placeholder 1 ICD10 Are You Prepared February 26 2013 Our Presenter Betty Gomez Betty Gomez VP of Regulatory Strategy ZirMeds Industry Liaison ID: 930278
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Slide1
Agenda
Agenda PlaceholderAgenda PlaceholderAgenda PlaceholderAgenda Placeholder
1
ICD-10 Are You Prepared?
February 26, 2013
Slide2Our Presenter – Betty Gomez
Betty Gomez
VP of Regulatory Strategy
ZirMed’s Industry Liaison
21 Years of Health Care EDI Experience
Slide3Webinar Topics
ICD-10 Background – Final RuleWhy is the Industry Going to ICD-10?Comparing ICD-9 to ICD-10 Understanding the Global Impact of ICD-10ICD-10 TimelinePreparing for ICD-10 – Provider Focus
Industry Readiness – Where We Stand TodayRaintree Product Readiness
Slide4ICD-10 Background
January 16, 2009, the Federal Government issued a new HIPAA rule requiring the adoption of ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for all dates of service on or after October 1, 2013. April 9, 2012, the Office of the Secretary, HHS (Health and Human Services) proposed a rule to change the ICD-10 compliance date to October 1, 2014.Compliance with 5010 is necessary prior to implementing ICD-10.
Slide5What is ICD-10?
A coding system for:Diagnosis ICD-10-CM Procedures ICD-10-PCSAffects:All Providers in every healthcare setting (Diagnosis)Inpatient Hospitals (Procedure Codes)It is NOT CPT or HCPCS
It Replaces, and is much more Granular than ICD-9Compliance Date: Oct 1, 2014
Slide6Imagine…
Slide7Single Implementation Date for all Users
September
30
October
1
English
German
(AND English)
Slide8Greater Granularity = More Codes
Slide9Why Move To ICD-10?
ICD-9 is 25 years old
More precise
Greater Accuracy in Reimbursements
Better Fraud Detection
Population Health Analysis
Better Quality of Care
Slide10X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
From
To
X
X
X
X
X
X
X
X
Diagnosis Code Structure
3-5 characters in length
3-7 characters in length
Slide11ICD-9-CM
3-5 characters in length
Digit 1 may be alpha or numeric
Digits 2-5 are numeric
Lacks lateralityDoes not support interoperability ICD-10-CM
3-7 characters in length
Digit 1 is alpha
Digits 2-3 are numeric
Digits 4-7 are alpha or numeric
Allows laterality and bilaterality
Supports interoperability
842.01 –Wrist Sprain and Strain of Carpal
S63.511A –Sprain of Carpal Joint of Right Wrist
Slide12Example - Diagnosis
Old365.71 Mild Stage Glaucoma
New
H40.1211 Low-tension glaucoma, right eye, mild stageH40.1221 Low-tension glaucoma, left eye, mild stage
H40.1231 Low-tension glaucoma, bilateral, mild stageH40.1291 Low-tension glaucoma, unspecified eye, mild stageH40.1311 Pigmentary glaucoma, right eye, mild stageH40.1321 Pigmentary glaucoma, left eye, mild stage
H40.1331
Pigmentary
glaucoma, bilateral, mild stage
H40.1391
Pigmentary
Glaucoma, unspecified eye, mild stage
H40.1411
Capslr
glaucoma w/
pseudxf
lens, right eye, mild stage
H40.1421
Capslr
glaucoma w/
pseudxf
lens, left eye, mild stage
H40.1431 Capslr glaucoma w/pseudxf lens, bilateral, mild stageH40.1491 Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage
Slide13X
X
X
X
X
X
X
X
From
To
X
X
X
X
X
X
X
Procedure Code Structure
3-4 numbers in length
7 numbers in length
Slide14ICD-9-CM
Vol 3
3-4 numbers in length
Based on outdated technology
Generic terms for body parts Lacks description of methodology and approach for proceduresICD-10-PCS
7 alpha-numeric characters in length
Reflects current usage of medical technology and devices
Provides detailed descriptions of methodology and approach for procedures
47.01 - Laparoscopic appendectomy
0DBJ4ZZ - Excision of Appendix,
Percutaneous
Endoscopic Approach
Slide15Example - Procedure
Old84.01 Finger Amputation
New0X6N0Z0 Detachment at Right Index Finger, Complete, Open Approach0X6N0Z1 Detachment at Right Index Finger, High, Open Approach
0X6N0Z2 Detachment at Right Index Finger, Mid, Open Approach
0X6N0Z3 Detachment at Right Index Finger, Low, Open Approach0X6P0Z0 Detachment at Left Index Finger, Complete, Open Approach0X6P0Z1 Detachment at Left Index Finger, High, Open Approach0X6P0Z2 Detachment at Left Index Finger, Mid, Open Approach0X6P0Z3 Detachment at Left Index Finger, Low, Open Approach0X6Q0Z0 Detachment at Right Middle Finger, Complete, Open Approach
0X6Q0Z1 Detachment at Right Middle Finger, High, Open Approach
Slide16Understanding the Global Impact of ICD-10
THIS IS A BUSINESS ISSUE WITH LARGE IMPACTSImpacts Include Many Entities: Providers, payers, vendors, employers, schools, agentsMembers/patients, business associates/trading partners
Workers’ compensation, state agenciesTransplant/disease registries, etc.
Slide17ICD-10 Timeline
Beyond
ASAP
2013
2014
Budgeting for ICD-10 impacts such as, system upgrades and training
Coder/biller training
Review practice
readiness
Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years.
Schedule software upgrades
Monitor payer alerts and readiness.
Prepare for testing with payers and/or clearinghouse.
Analyze the impact ICD-10 will have on your practice
Review payer contract for diagnosis
Talk with vendors regarding upgrades for ICD-10
ASAP
Slide18Care Flow
Assessment
Documentation
Coding
Treatment
Documentation
Claim Submission
Slide19Major Provider Impacts
For PhysiciansPhysicians deal with diagnosis not codesLearn new ICD-10 codesLearn how to use an indexCreate a new job aid or superbill
(Professional Providers get paid on CPT code not DRG)
77% Indicate Top Challenge
Clinical Documentation
Practitioners!
Coding
Business Processes
Superbills
/ Day Sheets
PM/HIS/EHR Systems
Medical Policies
Contracting
Staffing / Staff Training
Denials, Audits, Revenue Disruption
Need Generous Lines of Credit
Slide20Preparing for ICD-10 Provider Focus
Identify the Needs and Action Plans for the TransitionEducation and resources
Information Systems inventory and gap analysisVendor preparation
Documentation improvement
Financial impact and payer preparationAHIMA Published a Checklist About Preparing for ICD-10: http://www.ahima.org/downloads/pdfs/resources/checklist.pdf
Slide21ICD-10 Project Plan
Phase 1 Implementation Plan Development and Impact AssessmentPhase 2 Risk Mitigation and Implementation PreparationPhase 3 “Go Live” Preparation
Phase 4 Post-implementation Follow Up
Slide22Industry Readiness
The Workgroup for Electronic Data Interchange (WEDI) conducted an industry ICD-10 readiness survey in February 2012 – Results showed that health care entities were falling behind recommended timelines for implementing ICD-10 code sets by 10/1/13.Responses indicated some progress had been made, but not keeping up with milestones.
Industry is falling behindNew proposed rule to implement ICD-10 on October 1, 2014 instead of 2013.WEDI sent out a new survey in January 2013
Slide23ZirMed Strategy
Value-Add Solutions and Services
Analytics ● Education ● Consulting ● Code Translation
Helping Providers Prepare
Webinars ● Playbook ● Assessments ● Get-Well Plans ● Pilots ● Testing
Getting ZirMed Prepared
Organization ● Remediation ● Internal Training ● Staffing ● Measuring Success
Outsourced
Slide24Helping Providers Prepare
AwarenessWebinarsAssessmentsGet-Well PlansPilotsEnd-to-End TestingResource Center
ICD-10 Survival Tool KitInternal Education
Slide25Value-Add Services and Solutions
AnalyticsData TranslationEducationConsulting
Slide26Analytics
Insights AnalyticsUtilized in the early planning timeframe (early 2013)Show Code Usage in the facilityShow how code usage extrapolates into ICD-10 codesShow 80/20, 90/10, 99/1 code usage for prioritization of focusShow top revenue impactsTransition Analytics
Utilized after Transition (after Oct 1, 2014)Show impact of ICD-10 on claims outcomes via remits analysis
Slide27ZirMed ICD-10 Timeline
Beyond
2QTR 2013
3 QTR 2013
2014
Education & Consulting Offerings
ICD-10 Analytics
ICD-10 Transition
Analytics – June
Oct 1
st
start submitting
ICD-10 codes
Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years.
Code translation Tool
Testing Portal
Begin testing with Providers and Payers
Set up ICD-10 Resource Center
ZirMed Survival Tool Kit
Webinars
System Remediation
National Pilot ICD-10 Testing
1 QTR 2013
Slide28Supported Versions:
- Can create claims with ICD-10 now- 9.3 and higher will support ICD-10- Standard ICD-10 tables available Q2 2013Work with us on new ICD-10 features!- Bariatric User Group: Richard Harwell
- Therapy User Group: Kathryn Rigda- Standard/Billing User Group: Clayton Case
http://usergroups.raintreeinc.com
Raintree Product Readiness
Slide29Takeaways
ICD-10 is a Provider Initiative. ZirMed is here to help, but we cannot solve this for them like we did 4010 / 5010The impact on ICD-10 to providers is very realProviders need to be making progress NOW towards ICD-10 readiness
Slide30In Conclusion
ICD-10 is just a more mature ICD-9ICD-10 is inevitableWork for physicians is negligibleICD-10 cost for offices can be smallWork for institutions is worthwhileGood preparation is critical
Communication is vitalEmbrace it; Don’t postpone it
Slide31Resources
ZirMed ICD-10 Resource Center – Support CenterCMS Website: http://www.cms.hhs.gov/ICD10/ AHIMA Website: http://www.ahima.org/icd10 WEDI:
http://www.wedi.org