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1 Agenda Agenda Placeholder 1 ICD-10 Are You Prepared? February 26, 2013.

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Presentation on theme: "1 Agenda Agenda Placeholder 1 ICD-10 Are You Prepared? February 26, 2013."— Presentation transcript:

1 1 Agenda Agenda Placeholder 1 ICD-10 Are You Prepared? February 26, 2013

2 2 Our Presenter – Betty Gomez  Betty Gomez  VP of Regulatory Strategy  ZirMed’s Industry Liaison  21 Years of Health Care EDI Experience

3 3 Webinar Topics ICD-10 Background – Final Rule Why is the Industry Going to ICD-10? Comparing ICD-9 to ICD-10 Understanding the Global Impact of ICD-10 ICD-10 Timeline Preparing for ICD-10 – Provider Focus Industry Readiness – Where We Stand Today Raintree Product Readiness

4 4 ICD-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.

5 5 What is ICD-10? A coding system for: —Diagnosis ICD-10-CM —Procedures ICD-10-PCS Affects: —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-9 Compliance Date: Oct 1, 2014

6 6 Imagine…

7 7 Single Implementation Date for all Users September 30 October 1 English German (AND English)

8 8 Greater Granularity = More Codes

9 9 Why Move To ICD-10? ICD-9 is 25 years old More precise Greater Accuracy in Reimbursements Better Fraud DetectionPopulation Health Analysis Better Quality of Care

10 10 X XXXXXX XXX XXXXX X From To XXXXXXXX DIAGNOSIS CODE STRUCTURE 3-5 characters in length 3-7 characters in length

11 ICD-9-CM 3-5 characters in length Digit 1 may be alpha or numeric Digits 2-5 are numeric Lacks laterality Does 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

12 12 Example - Diagnosis Old 365.71Mild Stage Glaucoma New H40.1211Low-tension glaucoma, right eye, mild stage H40.1221Low-tension glaucoma, left eye, mild stage H40.1231Low-tension glaucoma, bilateral, mild stage H40.1291Low-tension glaucoma, unspecified eye, mild stage H40.1311Pigmentary glaucoma, right eye, mild stage H40.1321Pigmentary glaucoma, left eye, mild stage H40.1331Pigmentary glaucoma, bilateral, mild stage H40.1391Pigmentary Glaucoma, unspecified eye, mild stage H40.1411Capslr glaucoma w/pseudxf lens, right eye, mild stage H40.1421Capslr glaucoma w/pseudxf lens, left eye, mild stage H40.1431Capslr glaucoma w/pseudxf lens, bilateral, mild stage H40.1491Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage

13 13 XXX XX XX X From To XX XX XXX PROCEDURE CODE STRUCTURE 3-4 numbers in length 7 numbers in length

14 ICD-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 procedures ICD-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

15 15 Example - Procedure Old 84.01Finger Amputation New 0X6N0Z0Detachment at Right Index Finger, Complete, Open Approach 0X6N0Z1Detachment at Right Index Finger, High, Open Approach 0X6N0Z2Detachment at Right Index Finger, Mid, Open Approach 0X6N0Z3Detachment at Right Index Finger, Low, Open Approach 0X6P0Z0Detachment at Left Index Finger, Complete, Open Approach 0X6P0Z1Detachment at Left Index Finger, High, Open Approach 0X6P0Z2Detachment at Left Index Finger, Mid, Open Approach 0X6P0Z3Detachment at Left Index Finger, Low, Open Approach 0X6Q0Z0Detachment at Right Middle Finger, Complete, Open Approach 0X6Q0Z1Detachment at Right Middle Finger, High, Open Approach

16 16 Understanding the Global Impact of ICD-10 THIS IS A BUSINESS ISSUE WITH LARGE IMPACTS Impacts Include Many Entities: Providers, payers, vendors, employers, schools, agents Members/patients, business associates/trading partners Workers’ compensation, state agencies Transplant/disease registries, etc.

17 17 ICD-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

18 18 Care Flow Assessment Documentation Coding Treatment Documentation Claim Submission

19 19 Major Provider Impacts For Physicians Physicians deal with diagnosis not codes Learn new ICD-10 codes Learn how to use an index Create 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

20 20 Preparing for ICD-10 Provider Focus Identify the Needs and Action Plans for the Transition Education and resources Information Systems inventory and gap analysis Vendor preparation Documentation improvement Financial impact and payer preparation AHIMA Published a Checklist About Preparing for ICD-10:

21 21 ICD-10 Project Plan Phase 1Implementation Plan Development and Impact Assessment Phase 2Risk Mitigation and Implementation Preparation Phase 3“Go Live” Preparation Phase 4Post-implementation Follow Up

22 22 Industry 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 behind New proposed rule to implement ICD-10 on October 1, 2014 instead of 2013. WEDI sent out a new survey in January 2013

23 23 ZirMed 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

24 24 Helping Providers Prepare Awareness Webinars Assessments Get-Well Plans Pilots End-to-End Testing Resource Center ICD-10 Survival Tool Kit Internal Education

25 25 Value-Add Services and Solutions Analytics Data Translation Education Consulting

26 26 Analytics Insights Analytics —Utilized in the early planning timeframe (early 2013) —Show Code Usage in the facility —Show how code usage extrapolates into ICD-10 codes —Show 80/20, 90/10, 99/1 code usage for prioritization of focus —Show top revenue impacts Transition Analytics —Utilized after Transition (after Oct 1, 2014) —Show impact of ICD-10 on claims outcomes via remits analysis

27 27 ZirMed 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

28 28 Supported Versions: - Can create claims with ICD-10 now - 9.3 and higher will support ICD-10 - Standard ICD-10 tables available Q2 2013 Work with us on new ICD-10 features! - Bariatric User Group: Richard Harwell - Therapy User Group: Kathryn Rigda - Standard/Billing User Group: Clayton Case Raintree Product Readiness

29 29 Takeaways ICD-10 is a Provider Initiative. ZirMed is here to help, but we cannot solve this for them like we did 4010 / 5010 The impact on ICD-10 to providers is very real Providers need to be making progress NOW towards ICD-10 readiness

30 30 In Conclusion ICD-10 is just a more mature ICD-9 ICD-10 is inevitable Work for physicians is negligible ICD-10 cost for offices can be small Work for institutions is worthwhile Good preparation is critical Communication is vital Embrace it; Don’t postpone it

31 31 Resources ZirMed ICD-10 Resource Center – Support Center CMS Website: AHIMA Website: WEDI: http://www.wedi.org

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