icd-10: end-to-end testing from a collaboration perspective · • the icd-10 cm (clinical...

A n O r i e n t a t i o n a n d P a n e l D i s c u s s i o n

A p r i l 1 8 , 2 0 1 3

ICD-10:End-to-End Testing

from a Collaboration Perspective

Randy Brittingham (Vendors)CPU Medical Management Systems, Inc.

randy@cpumms.com

Curt Cvikota (Billing Services)The Cvikota Companyccvikota@gmail.com

Joseph Gonzalez (Clearinghouse)Secure EDI

jgonzalez@secureedi.com

George Vancore (Payer)Florida Blue

george.vancore@bcbsfl.com

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

Session Objectives

1. To increase your awareness and understanding of the challenges that ICD-10 brings to Physicians; Providers; Payers; Vendors; Clearinghouses and others in the Health Care industry.

2. To increase your understanding of the current state of ICD-10; recent regulatory decisions and industry perspectives.

3. To share insights into why collaboration between Physicians; Providers; Payers; Vendors; Clearinghouses and others in the Health Care industry is critical to a successful ICD-10 implementation.

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

Recent History and Current State of the Industry

• On February 16, 2012, the DHHS announced its intent to delay ICD-10.

• On April 9, 2012, the DHHS announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014.

• On June 19, 2012, delegates at AMA's Annual Meeting adopted a policy to evaluate ICD-11 as an alternative to replace ICD-9. The AMA will conduct more research and will report back to their House of Delegates in May of 2013.

• On August 24, 2012, the OMB approved the DHHS request to postpone ICD-10 from October 1, 2013 to October 1, 2014.

• On April 11, 2013, WEDI completed its 2nd ICD-10 Readiness Survey; results indicated a lack of preparedness on the part of providers, payers and vendors.

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

Regulatory Fundamentals

• In January 2011, the DHHS announced the final rules for new medical diagnosis and procedure code sets (ICD-10) under HIPAA-AS.

• The successful implementation of the new electronic transaction standard (HIPAA 5010) is a pre-requisite to the implementation of ICD-10.

• ICD-10 is intended to improve clinical data reporting, improve patient care quality, enhance claim processing and promote increased interoperability across all health care industry stakeholders.

• Significant impacts to provider billing and payment processing may be realized across the health care industry if stakeholders fail to collaborate, coordinate and communicate on their ICD-10 initiatives.

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

Regulatory Fundamentals (continued)

• The ICD-10 CM (Clinical Modifications) and ICD-10 PCS (Procedure Coding Structure) are the new medical diagnosis and procedure code sets under HIPAA-AS.

• These new code sets represent a fundamental overhaul to the current ICD-9 coding system.

• ICD codes are used to codify medical diagnoses and procedures, calculate and adjudicate coverage, compile medical statistics, assess quality of care and help manage clinical quality outcomes for patients.

• The current ICD-9 codes sets are outdated and do not reflect advances in medical technologies nor are they descriptive enough.

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ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

Regulatory Fundamentals (continued)

• As highlighted in the final rule, the new ICD-10 CM and PCS code sets are intended to:

• Provide greater flexibility to enable future capabilities.

• Provide more descriptive and robust categories for precise coding.

• Enable streamlined reimbursement processes.

• Provide richer medical data with higher degrees of details and quality for further analysis; help enrich clinical care profiles and patient outcomes.

• Maximize the value of clinical data and the business value of interoperability of e-health initiatives and the Electronic Health Record (EHR).

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ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

What’s Changing? ICD-10 CM is the new medical code sets under HIPAA-AS for diagnosis reporting and replaces ICD-9 CM in all U.S. health care settings.

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

What’s Changing? ICD-10 PCS identifies medical procedures for use in U.S. inpatient hospital settings only; does not replace CPT/HCPCS codes for outpatient services.

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

What’s Changing? In addition to structural and content changes to the code sets, there are medical terminology changes that are also being implemented. A few examples follow:

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

The implementation of ICD-10 is “Service Date” driven for outpatient services and “Discharge Date” driven for inpatient services!!

So, how does this impact you?

Do you need to co-exist between ICD-9 and ICD-10after the mandated compliance date?

What happens if a pre-authorization is issued under ICD-9 but the Service is not performed until after ICD-10 is implemented?

Implementation Date?

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)

Open Panel Questions and Discussion

Thank You

ICD-10:End-to-End Testing from a Collaboration Perspective

(An Orientation and Panel Discussion)