2Overview of ICD-10 Transition Impact of the Change AgendaOverview of ICD-10 TransitionIndustry UpdateImpact of the ChangeProvidersPayers Provider PreparationTranslation ExamplesArkansas DHS Preparation & PlanningNext Steps & Resources
3The 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…
4ICD-10-CM/PCSICD-9-CM: International Classification of Diseases, 9th revision, Clinical ModificationUS transitioned from ICD-8 to ICD-9 in 1979Annual updatesICD-10: Developed by the World Health Organization as the nomenclature for all countriesICD-10-CM: International Classification of Diseases, 10th revision, Clinical Modification – US onlyICD-10-PCS: International Classification of Diseases, 10th revision, Procedure Classification System – US onlyThe World Health Organization adopted ICD-10 in 1990136 countries use ICD-10Canada was the last to adopt ICD-10 and that was in 2001
5Federal MandateFinal Rule Originally Published by HHS on January 16, requiring the adoption of ICD-10 on October 1, 2013NO GRACE PERIODDates of Service (outpatient) After 10/1/2013Dates of Discharge (Inpatient) After 10/1/2013Federal Mandate Updated Timeline:February 14, 2012 – CMS announces they will “reexamine the pace” of implementing ICD-10May 17, 2012 – All comments due to HHS for consideration prior to publication of the final ruleAugust 27, 2012 – Revised compliance date announced by CMS stating a one-year extension would be grantedOctober 1, 2014 is the revised ICD-10 Implementation Compliance DateContinued messaging from CMS indicates that there will be NO extension of the implementation date of 10/1/14.
6Things to RememberICD-10-CM (diagnoses) will be used by all providers in every health care settingICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital proceduresNo impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codesCPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visitsRelease of DSM-V codes occurred in May 2013; however DSM-V is not HIPAA compliant for claims or transactionsThere 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.
7Important 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 codesThere will be period of time when payers will be processing claims in both ICD-9 and ICD-10Timely 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 PAsA 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.
8ICD-9 Current StateICD-9 lacks the specificity & granularity needed to accurately reflect care providedTechnology & practice patterns have changed dramatically in 30 yearsICD-9 has run out of codes to accurately capture current medical practiceUse 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.
9ICD-10 Future StateUpdates terminology & disease classification consistent w/current practiceExpands flexibility for future updates based on technical advancesEnhances research & outcomes data capture & quality measure reporting5 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
10Better data will be available for: A Few ICD-10 BenefitsBetter data will be available for:Measuring the quality, safety, and efficacy of careDesigning payment systems and processing claims for reimbursementConducting research, epidemiological studies, and clinical trialsSetting health policyOperational and strategic planning and designing healthcare delivery systemsMonitoring resource utilizationImproving clinical, financial, and administrative performancePreventing and detecting healthcare fraud and abuseTracking public health and risks
11Other Competing Priorities ICD-10: Key to the success of each initiativeACOs/ Patient Centered Medical HomeEHR/ MeaningfulUseValue Based PurchasingPublic Reporting & Quality MeasuresICD-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 yearsMU – HIMSS lobbying for extension of Stage 2 while the ONC is moving forward with Stage 3 recommendationsValue vs. volume reimbursementQuality reporting – CMS, NQS, NQF & NCQA all working on measure harmonization – measures that include ICD-9 codesThere is one other competing priority that isn’t listed here and that is the Marketplace Insurance Exchanges that become effective 10/1/13.
12ICD-10 Chapter Headings Alpha Character Narrative Description A and B Certain infectious and parasitic diseases.C00 to D48Neoplasms.D50 to D89Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism.EEndocrine, nutritional and metabolic diseases.FMental and behavioral disorders.GDiseases of the nervous system.H00 to H59Diseases of the eye and adnexa.H60 to H95Diseases 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.
13ICD-9 vs. ICD-10 Diagnosis Codes 3-5 Characters3-7 CharactersFirst character is numeric or alpha (E or V)First character is alphaUse of decimal after 3rd characterCharacters 2-7 are alpha or numeric – letter U is not usedUse of dummy placeholder “X” for future code expansionAt 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-10V codes reference Health Status & Contact with Health Services in ICD-9V – Y codes reference External Causes of Morbidity in ICD-10
14Structure and Seventh Character 2 Numeric3-7 Numeric or AlphaAdditional CharactersAlpha(Except U)..AXSMX8X2X1XX1XACode reflects an injury code for Abrasion of the right knee; initial encounterA- Initial RD – Subsequent LS – Sequela UnspecifiedA – InitialD – SubsequentS - SequelaCategory:Superficial injury ofknee & lower legEtiology, anatomicsite, severity:Other superficial injuries of knee1 – Right; 2 – Left; 9 – UnspecifiedAdded 7th character for obstetrics, injuries, and external causes of injuryAbrasion of the right knee, initial encounter3–7 Characters
15ICD-9 Procedure vs. ICD-10-PCS ICD-9 Procedure Codes – 4,000ICD-10 Procedure Codes – 87,0003-4 Digits7 DigitsAll digits are numericAlpha or numeric compositionNumbers 0 - 9Letters O & I are omittedExample: Artery suture has 1 codeExample: Artery suture – 195 coding optionsAlthough 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.
16ICD-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”.
17ECT Code Translation FY2013 ICD-9-CM procedure Source Code Title Source StatusFY2013 ICD-10-PCS procedureTarget Code Title94.27Other electroshock therapyGZB0ZZZElectroconvulsive Therapy, Unilateral-Single SeizureGZB1ZZZElectroconvulsive Therapy, Unilateral-Multiple SeizureGZB2ZZZElectroconvulsive Therapy, Bilateral-Single SeizureGZB3ZZZElectroconvulsive Therapy, Bilateral-Multiple SeizureGZB4ZZZOther Electroconvulsive TherapyHere 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.
18Patient Flow Impact Providers change coding practices based on ICD-10 Start Patient EncounterDiagnose PatientCode ClaimSubmit ClaimReceive ClaimBegin AdjudicationCheck EligibilityDetermine BenefitsSelect provider & contractCheck AuthPrice ClaimPayment & RemitBack end processesRevise for ICD-10 reportingProviders change coding practices based on ICD-10Update data repositories to accommodate new codingUpdate practice management systemClaim priced based on revised fee schedulesUpdate claims submission processRevise authorization processCosts to provider – conservatively ….3 MD office – 85K10 MD office 285KHealth Plans/IDNs – billions of dollarsComponents 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 claimsUpdate benefit logic& edits
19Operations and Processes Clinical Documentation Impact on ProvidersSystemsOperations and ProcessesClinical DocumentationAs 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
20System ImpactsIdentify your current systems and work processes that use ICD-9 codes. This could include:Clinical DocumentationEncounter Forms and SuperbillsPractice Management SystemsElectronic Medical Record SystemsContracts and Fees SchedulesPublic Health and Quality Reporting Protocols & ReportsA good rule of thumb: Wherever ICD-9 codes appear today, ICD-10 codes will need to replace them in the futureBe sure your practice management systems & EHR are ICD-10 compatible….McKesson story – Yakima Family Health Clinics80% 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
21System ImpactsTalk with your practice management system vendor about accommodations for both ICD-9 and ICD-10 codesWill 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 useAccording to industry surveys ~ 30% of the vendors in the market today will be gone before October 1, 2014When asked what their plan was with regard to ICD-10, one data warehouse vendor replied “I plan to shut the doors”….Rose Dunn - AHIMA
22System & Operational Impacts Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transitionBe proactive; don’t wait for vendors to contact youAsk about their plans for ICD-10 compliance and when they will be ready to collaboratively test their systemsAsk to see their Remediation Roadmap that supports their claims of “readiness”Utilize CMS checklists and resources as a guideCMS 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 providersRemember it is anticipated that 30% of vendors will be gone from the market before 10/1/14
23Understand your metrics: Operational ImpactsTalk 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 methodologiesUnderstand your metrics:Coding ProductivityCoding AccuracyFinancial StabilityDays in A/RCash on handCoding 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…..
24Identify potential changes to work flow and business processes Operational ImpactsIdentify potential changes to work flow and business processesConsider changes to existing processes including:Clinical documentation – viewed as an increasing area of vulnerability & concern in the industryPrior authorizationEncounter forms and SuperbillsQuality and Public Health reportingInvolvement in any Care Management or community outreach initiativesBegin 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.
25Don’t forget the physicians in the awareness training Operational ImpactsIdentify 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 trainingDon’t forget the physicians in the awareness trainingThere are a wide variety of training opportunities and materials available through a variety of resources:Professional Coding Associations – AAPC, AHIMAOnline Courses – ICD10 Monitor, Contexo University, Precyse, NuanceWebinars – ICD10 Monitor, HCProOnsite Training – Train-the-Trainer approach, Coding Boot CampNon-Traditional - Partner with the HIM Department at a nearby hospitalThere 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
26Budget for time and costs related to ICD-10 implementation including: Operational ImpactsBudget for time and costs related to ICD-10 implementation including:Expenses for system changes and software updatesResource materialsTrainingModifications to forms and SuperbillsOther budgetary considerations:Unanticipated payment delays, appeals & denialsUnderstand your operational metrics – benchmark for efficiencyEstablish 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
27Superbills - How Will They Change? Increased sizeIncreased specificityExamples can be found atalong with other valuable ICD-10-CM resourcesThe 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.
28Pervasive Developmental Disorders FY2013 ICD-9-CM DiagnosisSource Code TitleFY2013 ICD-10-CM DiagnosisTarget Code Title299.00Autistic disorder, current or active stateF84.0Autistic disorder299.01Autistic disorder, residual state299.10Childhood disintegrative disorder, current or active stateF84.3Other childhood disintegrative disorder299.11Childhood disintegrative disorder, residual stateThe 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”.
29Pervasive Developmental Disorders Cont. FY2013 ICD-9-CM DiagnosisSource Code TitleFY2013 ICD-10-CM DiagnosisTarget Code Title299.80Other specified pervasive developmental disorders, current or active stateF84.5Asperger's syndromeF84.8Other pervasive developmental disorders299.81Other specified pervasive developmental disorders, residual state299.90Unspecified pervasive developmental disorder, current or active stateF84.9Pervasive developmental disorder, unspecified299.91Unspecified pervasive developmental disorder, residual stateWe 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.
30Intellectual Disabilities FY2013 ICD-9-CM DiagnosisSource Code TitleFY2013 ICD-10-CM DiagnosisTarget Code Title315.9Unspecified delay in developmentF81.9Developmental disorder of scholastic skills, unspecifiedF89Unspecified disorder of psychological development317Mild intellectual disabilitiesF70318.0Moderate intellectual disabilitiesF71318.1Severe intellectual disabilitiesF72318.2Profound intellectual disabilitiesF73319Unspecified intellectual disabilitiesF78Other intellectual disabilitiesF79Code 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.
31Intellectual Disabilities ICD-10 CodeDefinitionIQ LevelF70Mild Intellectual DisabilitiesIQ level 50 – 55 to approximately 70Mild mental subnormalityF71Moderate Intellectual DisabilitiesIQ level 35 – 40 to 50 – 55Moderate mental subnormalityF72Severe Intellectual DisabilitiesIQ level 20 – 25 to 35 – 40Severe mental subnormalityF73Profound Intellectual DisabilitiesIQ level 20 – 25Profound mental subnormalityNOTE – Borderline intellectual functioning with IQ level above 70 – 84 is coded R41.83This 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.
32Developmental Delays FY2013 ICD-9-CM Diagnosis Source Code Title Target Code Title783.40Lack of normal physiological development, unspecifiedR62.50Unspecified lack of expected normal physiological development in childhoodR62.59Other lack of expected normal physiological development in childhoodAnother example of 1:many translations
34Down’s Syndrome FY2013 ICD-9-CM Diagnosis Source Code Title Target Code Title758.0Down's syndromeQ90.0Trisomy 21, nonmosaicism (meiotic nondisjunction)Q90.1Trisomy 21, mosaicism (mitotic nondisjunction)Q90.2Trisomy 21, translocationQ90.9Down syndrome, unspecifiedAnother 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.
35Clinical Documentation If it’s not documented….it’s not doneOutcome DataLiabilityReimbursementBased 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”.
36Clinical 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.
37Patient presents to the ER for severe right lower leg pain with an Clinical ScenarioPatient presents to the ER for severe right lower leg pain with anopen leg wound following a fall from a ladder. The physiciandocumented that the patient had an open transverse fracture of theshafts of the tibia & fibula.ICD-9-CM code:823.32, Open fracture of shaft, fibula with tibiaE881.0 Accidental fall from ladderICD-10-CM codes:S82.221B Displaced transverse fracture of shaft of right tibia, initial encounter for open fracture NOSS82.421B Displaced transverse fracture of shaft of right fibula, initial encounter for open fracture NOSW11.XXXA Fall on and from ladder, initial encounterAHIMA exampleNotice 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.
38Changes to E & V Codes in ICD-10 E codes reference External Causes of Injury & Poisoning in ICD-9E code references the Endocrine system in ICD-10Thyroid gland disorders: E00 – E07Diabetes codes: E08 – E13Disorders of glucose regulation & pancreatic internal secretion: E15 – E16V codes reference Health Status & Contact with Health Services in ICD-9Z codes reference Health Status & Contact with Health Services in ICD-10V – Y codes reference External Causes of Morbidity in ICD-10Remember the W-code that indicated the fall from the ladder in the previous illustration….
39Other Resources & Reminders Additional information & resources you might find helpful….
40CMS ResourcesThe CMS website is a great resource for information – it’s your tax dollars at work so take advantage of it….
41CMS ResourcesAnother 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
42This 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
43Arkansas DHS Current State Arkansas Medicaid has been working on ICD-10 for over two yearsProgress to date:Operational assessment completeRemediation of Medical Policy, Edits and Audits completeRemediation of Pharmacy Policy & edits nearing completionProvider Manuals currently under reviewSystems requirements obtained – HP/MMIS, Xerox/ACS & other integrated & stand alone systemsArkansas DHS reports, forms, and brochures currently under reviewOngoing Provider OutreachMeetings/WebcastsProvider BulletinsNewslettersICD-10 WebsiteInternal & external testing scenarios are under developmentPer CMS; external testing should begin October, 2013
44Now 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…
45Communication & Planning Engage the support of leadershipDefine your strategy & approach to ensure successUnderstand the financial implications of non-complianceEnsure everyone understands the impact of ICD-10ReceptionistNursing StaffPhysiciansCodersBilling StaffCFO/COOSenior Practice Management StaffShare regular updates & communication briefings with staffThe 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.
46Operational Assessment Understand which systems & processes will be impactedUnderstand the impact that the transition will have on people, process & technology; both internal & external to the practiceStaff & providersEducation & awarenessTraining – just in timeWorkflowsOffice through-putClinical documentationCode utilization within the practice – Superbill assessmentCoding & billing turn-around-time/cash flowDenials & resubmission of claimsSystems upgrades/enhancementsPractice management systemsBilling transmissions – EDIVendor readinessRemember 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
47Documentation Assessment Provider practices and specialty departments should examine their patient population in terms of:High volume/high costPatient demographic & payer mix: Medicare, Medicaid, Commercial insuranceDiagnoses that lead to the highest denial, physician query and re-bill rates; andAreas related to quality reporting, improvement initiatives and published RAC reviewsUnderstanding your operations and having good baseline metrics will be vital to a smoother transition from ICD-9
48Documentation Assessment Evaluate your current documentationDoes 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 documentationReview claims coded in ICD-9 and code them in ICD-10Is the documentation sufficient?Share the audit results with the providersUnderstanding of the future documentation needs will reduce queries, pended claims & denials post 10/1/2013
49Monitor the AR ICD-10 Website for information regarding testing Largest testing effort in the history of healthcareNot a routine upgrade with minimal testing before implementationRecommended that you employ end to end testing with vendors, providers & payers to include:Creation of the claimSubmission to payer/EDI vendor/clearinghouse via 837Adjudication of claimReporting back to the provider via EOP/835Adjustments/denials/resubmissionsReport creationDenial tracking & analysisMonitor the AR ICD-10 Website for information regarding testingA 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.
50Industry Web Site Resources These are just a few of the many resources that are available…..in no particular order
52For More ICD-10 Information White Papers (including but not limited to)ICD-10 A PrimerICD-10 Clinical DocumentationICD-10 Physician ImpactICD-10 AdvantagesICD-10 Specified or UnspecifiedChecklists published by CMS for providers (small, medium and large) at:
53AR 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.