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Agenda

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ICD-10 Are You Prepared?February 26, 2013

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Our Presenter – Betty Gomez

Betty Gomez

VP of Regulatory Strategy

ZirMed’s Industry Liaison

21 Years of Health Care EDI Experience

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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

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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.

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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

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Imagine…

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Single Implementation Date for all Users

September

30October

1English

German(AND English)

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Greater Granularity = More Codes

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Why 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

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XX X XX X XX 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

ICD-9-CM3-5 characters in length

Digit 1 may be alpha or numericDigits 2-5 are numeric

Lacks laterality

Does not support interoperability

ICD-10-CM3-7 characters in length

Digit 1 is alphaDigits 2-3 are numericDigits 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

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Example - Diagnosis

Old365.71 Mild Stage Glaucoma

NewH40.1211 Low-tension glaucoma, right eye, mild stageH40.1221 Low-tension glaucoma, left eye, mild stageH40.1231 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 stageH40.1331 Pigmentary glaucoma, bilateral, mild stageH40.1391 Pigmentary Glaucoma, unspecified eye, mild stageH40.1411 Capslr glaucoma w/pseudxf lens, right eye, mild stageH40.1421 Capslr glaucoma w/pseudxf lens, left eye, mild stageH40.1431 Capslr glaucoma w/pseudxf lens, bilateral, mild stageH40.1491 Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage

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X 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

ICD-9-CM VOL 33-4 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

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Example - Procedure

Old84.01 Finger Amputation

New0X6N0Z0 Detachment at Right Index Finger, Complete, Open Approach0X6N0Z1 Detachment at Right Index Finger, High, Open Approach0X6N0Z2 Detachment at Right Index Finger, Mid, Open Approach0X6N0Z3 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 Approach0X6Q0Z1 Detachment at Right Middle Finger, High, Open Approach

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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.

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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

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Care Flow

AssessmentDocumentation

Coding

Treatment

DocumentationClaim Submission

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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

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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

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ICD-10 Project Plan

•Phase 1 Implementation Plan Development and Impact Assessment

•Phase 2 Risk Mitigation and Implementation Preparation

•Phase 3 “Go Live” Preparation

•Phase 4 Post-implementation Follow Up

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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

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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

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Helping Providers Prepare

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

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Value-Add Services and Solutions

•Analytics•Data Translation•Education•Consulting

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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

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ZirMed ICD-10 Timeline

Beyond

2QTR 2013

3 QTR 2013

2014• Education & Consulting Offerings• ICD-10 Analytics

• ICD-10 Transition Analytics – June• Oct 1st start submittingICD-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

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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

Raintree Product Readiness

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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

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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

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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