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ICD-10 Provider Education

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1 ICD-10 Provider Education
Developmental Disabilities Provider Association Cathy Munn, MPH RHIA CPHQ Sr. Consultant

2 Overview of ICD-10 Transition Impact of the Change
Agenda Overview of ICD-10 Transition Industry Update Impact of the Change Providers Payers  Provider Preparation Translation Examples Arkansas DHS Preparation & Planning Next Steps & Resources

3 The change to ICD-10 only applies to Medicaid….
Before We Begin….. The change to ICD-10 only applies to Medicaid…. The implementation date for ICD-10 is 10/1/2014… CPT codes will be replaced with ICD-10 codes… The ICD-10 code composition will now be alphanumeric…. ICD-10 is just like any other annual coding update…

4 ICD-10-CM/PCS ICD-9-CM: International Classification of Diseases, 9th revision, Clinical Modification US transitioned from ICD-8 to ICD-9 in 1979 Annual updates ICD-10: Developed by the World Health Organization as the nomenclature for all countries ICD-10-CM: International Classification of Diseases, 10th revision, Clinical Modification – US only ICD-10-PCS: International Classification of Diseases, 10th revision, Procedure Classification System – US only The World Health Organization adopted ICD-10 in 1990 136 countries use ICD-10 Canada was the last to adopt ICD-10 and that was in 2001

5 Federal Mandate Final Rule Originally Published by HHS on January 16, 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 Continued messaging from CMS indicates that there will be NO extension of the implementation date of 10/1/14.

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 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 inpatient hospital visits Release of DSM-V codes occurred in May 2013; however DSM-V is not HIPAA compliant for claims or transactions There will be 320 changes to the CPT codes in 2014 – 175 new codes, 107 revised codes and 47 deleted codes. There is discussion in the industry that some payers may begin requesting submission of ASC codes in ICD-10 as they continue to design new payment methodologies such as value based purchasing and value vs. volume. APA has indicated that they are creating a cross-walk for DSM-V & ICD-10 but nothing official is posted on their website.

7 Important Information
Systems will have to utilize both ICD-9-CM and ICD-10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim. 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 claims in both ICD-9 and ICD-10 Timely filing and the G&A process will require that payers run parallel systems for some period of time – SMAs are looking at 2 years minimum and maybe longer if there are diagnoses that have a “look back” edit attached – pharmacy sometimes employs this with medication PAs A recent article suggested that denials will increase 100 – 200% following the implementation of ICD-10 and will take upwards of 6 months to stabilize. If an authorization spans the September 30th – October 1st timeframe for 2014 providers will be required to submit 1 claim for services through 9/30/14 in ICD-9 and an additional claim for services beginning on 10/1/14 with ICD-10 codes.

8 ICD-9 Current State ICD-9 lacks the specificity & granularity needed to accurately reflect care provided Technology & practice patterns have changed dramatically in 30 years ICD-9 has run out of codes to accurately capture current medical practice Use Lynn’s example of moving to a new town and requesting a new phone number only to be told there are no new numbers available; we’ll give you a general number and then when someone calls you it will ring in a central location; the person answering the phone will come get you.

9 ICD-10 Future State Updates terminology & disease classification consistent w/current practice Expands flexibility for future updates based on technical advances Enhances research & outcomes data capture & quality measure reporting 5 reasons you might like ICD-10: -capture more complete detailed narrative to justify the diagnosis & treatment of your patient -finding the codes you need is easier when you focus on your demographic and not the entire code book -better assignment of codes = better data and justification of treatment & outcomes resulting in higher reimbursement in a P4P environment -better research data – the detail contained in ICD-10 yields much more structured data that can be manipulated & studied from a research perspective -everything you’re doing related to other competing priorities leads up to this as we will see in the next slide

10 Better data will be available for:
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

11 Other Competing Priorities
ICD-10: Key to the success of each initiative ACOs/ Patient Centered Medical Home EHR/ Meaningful Use Value Based Purchasing Public Reporting & Quality Measures ICD-10 should be viewed as the convergence of projects that all work together to improve quality of care. These initiatives cannot be viewed in silos – they work in concert with each other – not in competition. CMS states that I-10, EHR & PQRS all work together to move the H/C system forward toward better coordinated care through greater interoperability & ease of transmitting electronic data, better quality measurement & data reporting in addition to decreased cost due to operational efficiency. ACOs – CMS anticipates that there will be 100 – 200 new ACOs in the next 2 years MU – HIMSS lobbying for extension of Stage 2 while the ONC is moving forward with Stage 3 recommendations Value vs. volume reimbursement Quality reporting – CMS, NQS, NQF & NCQA all working on measure harmonization – measures that include ICD-9 codes There is one other competing priority that isn’t listed here and that is the Marketplace Insurance Exchanges that become effective 10/1/13.

12 ICD-10 Chapter Headings Alpha Character Narrative Description A and B
Certain infectious and parasitic diseases. C00 to D48 Neoplasms. D50 to D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. E Endocrine, nutritional and metabolic diseases. F Mental and behavioral disorders. G Diseases of the nervous system. H00 to H59 Diseases of the eye and adnexa. H60 to H95 Diseases of the ear and mastoid process. You will notice that the alpha character E now references the endocrine system and mental & behavioral disorders will be identified by the letter F. There are additional examples of translated codes in the upcoming slides.

13 ICD-9 vs. ICD-10 Diagnosis Codes
3-5 Characters 3-7 Characters First character is numeric or alpha (E or V) First character is alpha Use of decimal after 3rd character Characters 2-7 are alpha or numeric – letter U is not used Use of dummy placeholder “X” for future code expansion At last count there were 69,832 ICD-10 Diagnosis codes according to CMS.. We will look at examples of translations in a few minutes; you will see examples of 1:1 translations as well as 1:many translations. I have included examples of specific codes in ICD-9 that translate to less specific codes in ICD-10. 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

14 Structure and Seventh Character
2 Numeric 3-7 Numeric or Alpha Additional Characters Alpha (Except U) . . A X S M X 8 X 2 X 1 X X 1 X A Code reflects an injury code for Abrasion of the right knee; initial encounter A- Initial R D – Subsequent L S – Sequela Unspecified A – Initial D – Subsequent S - Sequela Category: Superficial injury of knee & lower leg Etiology, anatomic site, severity: Other superficial injuries of knee 1 – Right; 2 – Left; 9 – Unspecified Added 7th character for obstetrics, injuries, and external causes of injury Abrasion of the right knee, initial encounter 3–7 Characters

15 ICD-9 Procedure vs. ICD-10-PCS
ICD-9 Procedure Codes – 4,000 ICD-10 Procedure Codes – 87,000 3-4 Digits 7 Digits All digits are numeric Alpha or numeric composition Numbers 0 - 9 Letters O & I are omitted Example: Artery suture has 1 code Example: Artery suture – 195 coding options Although not relevant to your use of ICD-10, this is an example of the changes in the procedure codes. The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes.

16 ICD-10 Procedure Code Structure
Angioplasty – approach, device, etc. Eponyms will no longer be used in ICD-10 so the Whipple Procedure, the Cesarean Section and other procedures & diagnoses named for specific individual will be replaced by a description such as “extraction of products of conception”.

17 ECT Code Translation FY2013 ICD-9-CM procedure Source Code Title
Source Status FY2013 ICD-10-PCS procedure Target Code Title 94.27 Other electroshock therapy GZB0ZZZ Electroconvulsive Therapy, Unilateral-Single Seizure GZB1ZZZ Electroconvulsive Therapy, Unilateral-Multiple Seizure GZB2ZZZ Electroconvulsive Therapy, Bilateral-Single Seizure GZB3ZZZ Electroconvulsive Therapy, Bilateral-Multiple Seizure GZB4ZZZ Other Electroconvulsive Therapy Here is an example of an ICD-9 procedure code with the translation to ICD-10. Today there is 1 code for ECT but as you can see in this translation, in ICD-10 there are 5 options to code ECT. In this example the G indicates the System which is mental health. The Z indicates there is no body system included in this code and the B indicates that the root operation is the electroconvulsive therapy. The 0 – 4 are indicative of the location of the seizure. The 3 Zs indicate that there are no qualifiers included in this code.

18 Patient Flow Impact Providers change coding practices based on ICD-10
Start Patient Encounter Diagnose Patient Code Claim Submit Claim Receive Claim Begin Adjudication Check Eligibility Determine Benefits Select provider & contract Check Auth Price Claim Payment & Remit Back end processes Revise for ICD-10 reporting Providers change coding practices based on ICD-10 Update data repositories to accommodate new coding Update practice management system Claim priced based on revised fee schedules Update claims submission process Revise authorization process Costs to provider – conservatively …. 3 MD office – 85K 10 MD office 285K Health Plans/IDNs – billions of dollars Components of these costs include training & education, process changes, superbill changes, IT costs, increased cost of documentation and cash flow disruption. Remember you’re A/R will increase, 25% - 40% based on recent industry projections, auto adjudication rates will decrease and your days to pay will increase due to denials and requests for additional information. Know your management metrics and monitor your cash on hand – secure a line of credit. AAPC estimates that MDs will spend 15% more time documenting so conversely they will have 15% less time to see patients… Update system to accept claims Update benefit logic & edits

19 Operations and Processes Clinical Documentation
Impact on Providers Systems Operations and Processes Clinical Documentation As we begin the think about impacts on your practice we will look at three separate areas of impact…. People, process & technology are the big buckets to keep in mind

20 System Impacts Identify your current systems and work processes that use ICD-9 codes. This could include: Clinical Documentation Encounter Forms and Superbills Practice Management Systems Electronic Medical Record Systems Contracts and Fees Schedules 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 Be sure your practice management systems & EHR are ICD-10 compatible….McKesson story – Yakima Family Health Clinics 80% of your reports will be impacted by the conversion to ICD-10. Clinical documentation is key to many of those competing priorities we discussed earlier – If it’s not documented; it’s not done – plain & simple

21 System Impacts Talk with your practice management system vendor about accommodations for both ICD-9 and ICD-10 codes Will your current system require upgrades? Is the vendor planning system updates for accommodation of ICD-10 codes? When will they be ready to install/update? Are the upgrades included in your current contract? Discuss readiness and remediation plans with any clearinghouses or billing services you may use According to industry surveys ~ 30% of the vendors in the market today will be gone before October 1, 2014 When asked what their plan was with regard to ICD-10, one data warehouse vendor replied “I plan to shut the doors”….Rose Dunn - AHIMA

22 System & 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 Remediation Roadmap that supports their claims of “readiness” Utilize CMS checklists and resources as a guide CMS has stated they will NOT be testing with providers however, there is industry pressure to change this. United HealthCare & Aetna – not testing with everyone – only select LARGE providers Remember it is anticipated that 30% of vendors will be gone from the market before 10/1/14

23 Understand your metrics:
Operational Impacts Talk with your payers about how ICD-10 implementation might impact 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 Understand your metrics: Coding Productivity Coding Accuracy Financial Stability Days in A/R Cash on hand Coding with unspecified codes may not be acceptable in the ICD-10 world. Recent discussion at AHIMA – 2 large payers have said they will accept unspecified codes for approximately 6 months post transition then the claims will be denied or a request for additional information will be sent to the provider thus placing their claim in a suspended state. During the remediation process at Arkansas many of the unspecified codes were eliminated from code sets – if you don’t know if it was the R or L we’re not paying for services…..

24 Identify potential changes to work flow and business processes
Operational Impacts Identify potential changes to work flow and business processes Consider changes to existing processes including: Clinical documentation – viewed as an increasing area of vulnerability & concern in the industry Prior authorization Encounter forms and Superbills Quality and Public Health reporting Involvement in any Care Management or community outreach initiatives Begin to evaluate your documentation in your charts – does it give the level of specificity you will need to code accurately in ICD-10? Evaluate your patient population – what type of patients do you treat – identify top 25 diagnoses and begin to look at ICD-10 codes for these diagnoses – evaluate your documentation – what enhancements are needed? Consider recoding submitted claims in ICD-10. This will give you an idea of the level of improvement that will be needed for documentation. Remember the AAPC statistic – 15% more time to document to eliminate physician queries.

25 Don’t forget the physicians in the awareness training
Operational Impacts Identify the staff in your office who code, or have a need to know the new codes….anticipate that everyone in your office will require some level of awareness training Don’t forget the physicians in the awareness training There are a wide variety of training opportunities and materials available through a variety of resources: Professional Coding Associations – AAPC, AHIMA Online Courses – ICD10 Monitor, Contexo University, Precyse, Nuance Webinars – ICD10 Monitor, HCPro Onsite Training – Train-the-Trainer approach, Coding Boot Camp Non-Traditional - Partner with the HIM Department at a nearby hospital There are many options for training available in the market. Check with the hospital where you have privileges – inquire about what types of training they are offering their staff – see if you as a provider can partner with them – offer to teach an intro A&P class – form collaborative relationships with the HIM department. Inquire about local chapters of ArHIM and AAPC chapters. AAPC has made many of their resources available on their website free of charge. They are offering their implementation tracker & their newsletter free of charge…..www.aapc.org for details

26 Budget for time and costs related to ICD-10 implementation including:
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…… Anticipate something you didn’t plan for or expect…. Cost of transition – 85K small practice (1-3) -> 285K for a 10 man group…..Millions for large hospitals & IDNs – includes education & training, process changes, IT costs, increased cost of documentation & cash flow disruption. Anticipate retirement – 15 – 20% of the workforce may retire before October 1, 2014 – conservative number

27 Superbills - How Will They Change?
Increased size Increased specificity Examples can be found at along with other valuable ICD-10-CM resources The next several slides will provide examples of some of the ICD-9 codes frequently used to bill for developmental disabilities…. This should give you some idea of any changes you will need to make if you currently use a superbill.

28 Pervasive Developmental Disorders
FY2013 ICD-9-CM Diagnosis Source Code Title FY2013 ICD-10-CM Diagnosis Target Code Title 299.00 Autistic disorder, current or active state F84.0 Autistic disorder 299.01 Autistic disorder, residual state 299.10 Childhood disintegrative disorder, current or active state F84.3 Other childhood disintegrative disorder 299.11 Childhood disintegrative disorder, residual state The first slide reflects the translations for Autism. The next slide will outline the translations for Asperger’s and other pervasive disorders. You will notice that on these codes we see a more definitive code regarding the active vs. residual state in ICD-9 than we do in ICD-10 where it is listed as “other”.

29 Pervasive Developmental Disorders Cont.
FY2013 ICD-9-CM Diagnosis Source Code Title FY2013 ICD-10-CM Diagnosis Target Code Title 299.80 Other specified pervasive developmental disorders, current or active state F84.5 Asperger's syndrome F84.8 Other pervasive developmental disorders 299.81 Other specified pervasive developmental disorders, residual state 299.90 Unspecified pervasive developmental disorder, current or active state F84.9 Pervasive developmental disorder, unspecified 299.91 Unspecified pervasive developmental disorder, residual state We see the same phenomena here regarding the classification of the state of the disease…this is where clear & concise documentation in the medical record becomes critical to the proper assignment of the ICD-10 codes. Notice for codes and that these codes are now specific to Asperger’s syndrome.

30 Intellectual Disabilities
FY2013 ICD-9-CM Diagnosis Source Code Title FY2013 ICD-10-CM Diagnosis Target Code Title 315.9 Unspecified delay in development F81.9 Developmental disorder of scholastic skills, unspecified F89 Unspecified disorder of psychological development 317 Mild intellectual disabilities F70 318.0 Moderate intellectual disabilities F71 318.1 Severe intellectual disabilities F72 318.2 Profound intellectual disabilities F73 319 Unspecified intellectual disabilities F78 Other intellectual disabilities F79 Code give us an example of a general code or unspecified code in ICD-9 being translated to a more specific code in ICD-10. I have included the definitions for intellectual disabilities on the next slide. These codes are 1:1 translations.

31 Intellectual Disabilities
ICD-10 Code Definition IQ Level F70 Mild Intellectual Disabilities IQ level 50 – 55 to approximately 70 Mild mental subnormality F71 Moderate Intellectual Disabilities IQ level 35 – 40 to 50 – 55 Moderate mental subnormality F72 Severe Intellectual Disabilities IQ level 20 – 25 to 35 – 40 Severe mental subnormality F73 Profound Intellectual Disabilities IQ level 20 – 25 Profound mental subnormality NOTE – Borderline intellectual functioning with IQ level above 70 – 84 is coded R41.83 This slide provides specific information regarding the IQ level associated with each level of intellectual disability. The code for borderline intellectual functioning is also included as a reference.

32 Developmental Delays FY2013 ICD-9-CM Diagnosis Source Code Title
Target Code Title 783.40 Lack of normal physiological development, unspecified R62.50 Unspecified lack of expected normal physiological development in childhood R62.59 Other lack of expected normal physiological development in childhood Another example of 1:many translations

33 Cerebral Palsy FY2013 ICD-9-CM Diagnosis Source Code Title
Target Code Title 343.2 Congenital quadriplegia G80.0 Spastic quadriplegic cerebral palsy 343.0 Congenital diplegia G80.1 Spastic diplegic cerebral palsy 343.1 Congenital hemiplegia G80.2 Spastic hemiplegic cerebral palsy 333.71 Athetoid cerebral palsy G80.3 343.8 Other specified infantile cerebral palsy G80.4 Ataxic cerebral palsy 343.3 Congenital monoplegia G80.8 Other cerebral palsy 343.9 Infantile cerebral palsy, unspecified G80.9 Cerebral palsy, unspecified

34 Down’s Syndrome FY2013 ICD-9-CM Diagnosis Source Code Title
Target Code Title 758.0 Down's syndrome Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction) Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction) Q90.2 Trisomy 21, translocation Q90.9 Down syndrome, unspecified Another example of the 1:many translations we find in ICD-10. The diagnosis of Down’s syndrome is now very specific providing data for ongoing research in this field.

35 Clinical Documentation
If it’s not documented….it’s not done Outcome Data Liability Reimbursement Based on our review of these frequently used diagnosis codes I think you will agree that “if it’s not documented it’s not done AND you can’t bill with the most appropriate & specific code needed”.

36 Clinical Documentation Practices
Clinical documentation improvement “best practices” provide an opportunity for accurate coding and richer clinical data. Accurate data will allow us to better understand our patients; their compliance with care management initiatives and which treatments lead to better outcomes. Complete clinical documentation will promote accurate coding thus leading to more accurate payment that could legitimately look different than it does today. Hospitals and IDNs have had CDI programs in place for several years in anticipation of EHRs and ICD-10.

37 Patient presents to the ER for severe right lower leg pain with an
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: 823.32, 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 AHIMA example Notice the 3 Xs in the code capturing the fall from the ladder – this indicates placeholders for further expansion of the code. You can see from this example that the need for clear, concise documentation is key to assigning the correct codes.

38 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 Remember the W-code that indicated the fall from the ladder in the previous illustration….

39 Other Resources & Reminders
Additional information & resources you might find helpful….

40 CMS Resources The CMS website is a great resource for information – it’s your tax dollars at work so take advantage of it….

41 CMS Resources Another example of the resources available – there are guides for all size practices and timelines for the translation in addition to checklists and guides for talking to your vendors and payers

42 This is the icon for the AR ICD-10 Website which was launched in April of this year. We are committed to keeping the content on this website fresh and up to date with articles from the industry that the CWG believes will be helpful to our viewers. Updates are made weekly so be sure to check often for the latest industry news and tips to ensure a smooth transition from ICD-9 to ICD-10. You can access the AR ICD-10 website from the AFMC, Value Options or QSource websites in addition to the DMS website

43 Arkansas DHS Current State
Arkansas Medicaid has been working on ICD-10 for over two years Progress to date: Operational assessment complete Remediation of Medical Policy, Edits and Audits complete Remediation of Pharmacy Policy & edits nearing completion Provider Manuals currently under review Systems requirements obtained – HP/MMIS, Xerox/ACS & other integrated & stand alone systems Arkansas DHS reports, forms, and brochures currently under review Ongoing Provider Outreach Meetings/Webcasts Provider Bulletins Newsletters ICD-10 Website Internal & external testing scenarios are under development Per CMS; external testing should begin October, 2013

44 Now What? What should you as a practitioner be doing to prepare for ICD-10? We’ve talked about the impacts within your practice, now let’s take a look at some high level steps that should already be underway…

45 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 The need for leadership & communication cannot be overstated – everyone needs to understand the urgency behind the transition to ICD-10. There has to be a strategy in place and with that strategy comes the need for leadership for the team and the practice.

46 Operational Assessment
Understand which systems & processes will be impacted 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 Clinical 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 Billing transmissions – EDI Vendor readiness Remember what I said at the beginning – anywhere you are using ICD-9 codes today you need to be prepared to transition those codes to ICD-10 before 10/1/2014

47 Documentation Assessment
Provider practices and specialty departments should examine their patient population in terms of: High volume/high cost Patient demographic & payer mix: Medicare, Medicaid, Commercial insurance 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 Understanding your operations and having good baseline metrics will be vital to a smoother transition from ICD-9

48 Documentation Assessment
Evaluate your current documentation Does it specify right vs. left? Does it provide the specificity needed to accurately assign an ICD-10 code? Conduct a sample audit to evaluate clinical documentation Review claims coded in ICD-9 and code them in ICD-10 Is the documentation sufficient? Share the audit results with the providers Understanding of the future documentation needs will reduce queries, pended claims & denials post 10/1/2013

49 Monitor the AR ICD-10 Website for information regarding testing
Largest testing effort in the history of healthcare Not a routine upgrade with minimal testing before implementation Recommended that you employ end to end testing with vendors, providers & payers to 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 Monitor the AR ICD-10 Website for information regarding testing A recent industry update indicated that United Healthcare & Aetna would only be testing with large providers and only for very specific timeframes. Identify your most vulnerable payers and contact them regarding testing. AR Medicaid is anticipating testing with providers in the 4th quarter of Further information will be made available via the ICD-10 website, through the HP Wire and from the respective provider representatives.

50 Industry Web Site Resources
These are just a few of the many resources that are available…..in no particular order

51 CMS Resources

52 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:

53 AR Medicaid ICD-10 Website
Remember to check here often for updated information – and to submit questions that you have regarding ICD-10. Specific coding questions will NOT be answered.

54 Questions & Comments


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