Agenda
• Agenda Placeholder
• Agenda Placeholder
• Agenda Placeholder
ICD-10 Are You Prepared?
February 26, 2013
• Agenda Placeholder
1
1
Our Presenter – Betty Gomez
 Betty Gomez
 VP of Regulatory Strategy
 ZirMed’s Industry Liaison
 21 Years of Health Care EDI
Experience
2
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
3
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.
4
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
5
Imagine…
6
Single Implementation Date for all Users
September
30
October
English
1
German
(AND English)
7
Greater Granularity = More Codes
8
Why Move To ICD-10?
More precise
Better Fraud Detection
ICD-9 is 25 years old
Better Quality of Care
Population Health Analysis
Greater Accuracy in Reimbursements
9
DIAGNOSIS CODE STRUCTURE
X
X
X
X
X
From
3-5 characters in length
To
X
X
X
X
X
3-7 characters in length
10
X
X
ICD-9-CM
ICD-10-CM
3-5 characters in length
3-7 characters in length
Digit 1 may be alpha or numeric
Digits 2-5 are numeric
Digit 1 is alpha
Digits 2-3 are numeric
Digits 4-7 are alpha or numeric
Lacks laterality
Allows laterality and bilaterality
Does not support interoperability
Supports interoperability
842.01 –Wrist Sprain and
Strain of Carpal
S63.511A –Sprain of Carpal
Joint of Right Wrist
Example - Diagnosis
Old
365.71
Mild Stage Glaucoma
New
H40.1211
H40.1221
H40.1231
H40.1291
H40.1311
H40.1321
H40.1331
H40.1391
H40.1411
H40.1421
H40.1431
H40.1491
Low-tension glaucoma, right eye, mild stage
Low-tension glaucoma, left eye, mild stage
Low-tension glaucoma, bilateral, mild stage
Low-tension glaucoma, unspecified eye, mild stage
Pigmentary glaucoma, right eye, mild stage
Pigmentary glaucoma, left eye, mild stage
Pigmentary glaucoma, bilateral, mild stage
Pigmentary Glaucoma, unspecified eye, mild stage
Capslr glaucoma w/pseudxf lens, right eye, mild stage
Capslr glaucoma w/pseudxf lens, left eye, mild stage
Capslr glaucoma w/pseudxf lens, bilateral, mild stage
Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage
12
PROCEDURE CODE STRUCTURE
X
X
X
X
From
3-4 numbers in length
To
X
X
X
X
X
7 numbers in length
13
X
X
ICD-9-CM VOL 3
ICD-10-PCS
3-4 numbers in length
7 alpha-numeric characters in
length
Based on outdated technology
Generic terms for body parts
Reflects current usage of medical
technology and devices
Lacks description of
methodology and approach for
procedures
Provides detailed descriptions of
methodology and approach for
procedures
47.01 - Laparoscopic
appendectomy
0DBJ4ZZ - Excision of Appendix,
Percutaneous Endoscopic
Approach
Example - Procedure
Old
84.01
Finger Amputation
New
0X6N0Z0
0X6N0Z1
0X6N0Z2
0X6N0Z3
0X6P0Z0
0X6P0Z1
0X6P0Z2
0X6P0Z3
0X6Q0Z0
0X6Q0Z1
Detachment at Right Index Finger, Complete, Open Approach
Detachment at Right Index Finger, High, Open Approach
Detachment at Right Index Finger, Mid, Open Approach
Detachment at Right Index Finger, Low, Open Approach
Detachment at Left Index Finger, Complete, Open Approach
Detachment at Left Index Finger, High, Open Approach
Detachment at Left Index Finger, Mid, Open Approach
Detachment at Left Index Finger, Low, Open Approach
Detachment at Right Middle Finger, Complete, Open Approach
Detachment at Right Middle Finger, High, Open Approach
15
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.
16
ICD-10 Timeline
• Analyze the impact ICD-10
will have on your practice
• Review payer contract for
diagnosis
• Talk with vendors regarding
upgrades for ICD-10
• Schedule software upgrades
• Monitor payer alerts and
readiness.
• Prepare for testing with
payers and/or clearinghouse.
ASAP
• Maintain dual
codebases for ICD-9
and ICD-10 for
approximately 2 years.
Beyond
2013
2014
ASAP
• Budgeting for ICD-10 impacts such
as, system upgrades and training
• Coder/biller training
• Review practice
readiness
17
Care Flow
Assessment
Claim Submission
Documentation
Coding
18
Treatment
Documentation
Major Provider Impacts
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
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)
19
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:
http://www.ahima.org/downloads/pdfs/resources/checklist.pdf
20
ICD-10 Project Plan
• Phase 1
Assessment
Implementation Plan Development and Impact
• Phase 2
Risk Mitigation and Implementation Preparation
• Phase 3
“Go Live” Preparation
• Phase 4
Post-implementation Follow Up
21
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
22
ZirMed Strategy
Value-Add Solutions and Services
Outsourced
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
23
Helping Providers Prepare
•
•
•
•
•
•
•
•
•
Awareness
Webinars
Assessments
Get-Well Plans
Pilots
End-to-End Testing
Resource Center
ICD-10 Survival Tool Kit
Internal Education
24
Value-Add Services and Solutions
•
•
•
•
Analytics
Data Translation
Education
Consulting
25
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
26
ZirMed ICD-10 Timeline
•
•
•
•
•
Set up ICD-10 Resource Center
ZirMed Survival Tool Kit
Webinars
System Remediation
National Pilot ICD-10 Testing
• Code translation Tool
• Testing Portal
• Begin testing with Providers
and Payers
1 QTR 2013
• Maintain dual
codebases for ICD-9
and ICD-10 for
approximately 2 years.
Beyond
3 QTR 2013
2QTR 2013
• Education & Consulting Offerings
• ICD-10 Analytics
2014
• ICD-10 Transition
Analytics – June
• Oct 1st start submitting
ICD-10 codes
27
Raintree Product Readiness
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
http://usergroups.raintreeinc.com
28
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
29
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
30
Resources
•
•
•
•
ZirMed ICD-10 Resource Center – Support Center
CMS Website: http://www.cms.hhs.gov/ICD10/
AHIMA Website: http://www.ahima.org/icd10
WEDI: http://www.wedi.org
31