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© 2015 TriZetto Corporation
ICD-10: Ready, Set, Go!
August 27, 2015
© 2015 TriZetto Corporation
Learning Objectives
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• Review types of activities that should have happened or should be happening in your organization now to prepare for ICD-10.
• Understand how your clearinghouse and other industry organizations can help.
• Identify key metrics to monitor before and after Oct. 1.
© 2015 TriZetto Corporation4
Get Ready
© 2015 TriZetto Corporation
Are you ready for the new coding standard?
• You must use ICD-10 codes for all services provided on or after Oct.1, 2015.
• You must use ICD-9 codes for all services provided before Oct. 1, 2015.
ICD-10 Compliance Deadline Is Coming
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Make A Plan
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Obtain access to ICD-10 codes
Train your staff
Identify your top codes
Update your processes
Talk to your vendors and health plans
Test your system and processes
© 2015 TriZetto Corporation
Obtain Access To ICD-10 Codes
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The codes are available from many sources and in many formats:
• Code books
• CD/DVD and other digital media
• Online – download from cms.gov/ICD10
• Practice management systems
• Electronic health record (EHR) products
• Smartphone apps
© 2015 TriZetto Corporation
Understand The Role Of Your Clearinghouse
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Clearinghouses can help by:
• Identifying problems that lead to claims being rejected.
• Providing guidance about how to fix rejected claims (e.g., more or different data needed to be included).
Clearinghouses cannot:
• Code unless they offer a billing service.
• Call payers regarding denials on your behalf.
© 2015 TriZetto Corporation
Train Your Staff
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Determine who needs training? What level of training is needed? When should training should take place?
• Train on ICD-10 fundamentals.
• What ICD-9 diagnosis codes does your practice see most often? Start with the top 25.
• Practice coding in ICD-10 using current clinical documentation. Flag any cases where more documentation is needed.
• Talk about ICD-10 at regular staff meetings so the issue is always in focus.
© 2015 TriZetto Corporation
Update Your Processes
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Review your current systems and work processes that use ICD-9 codes.
• Update hardcopy and electronic forms.
• Resolve documentation gaps identified while coding top diagnoses in ICD-10.
• Make sure clinical documentation captures new coding concepts. Examples include:
• Laterality—or left versus right
• Initial or subsequent encounter for injuries
• Trimester of pregnancy
• Types of fractures
© 2015 TriZetto Corporation
Talk to Your Vendors and Payers
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• Call your vendors to confirm the ICD-10 readiness of your practice management system.
• Review your contract to determine if regulatory updates are included in your maintenance.
• If your existing system is unable to accommodate the ICD-10 codes, or your vendor is not upgrading the system for ICD-10, you will likely need to purchase a new system.
• Confirm that the health plans, clearinghouses and third-party billing services you work with are ICD-10 ready.
• Document who to call should there be any ICD-10 related issues.
© 2015 TriZetto Corporation
Test Your System
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Verify that you can use your ICD-10-ready systems to:
• Generate a claim
• Perform pre-authorization, eligibility and benefits verification
• Schedule an office visit
• Schedule an outpatient procedure
• Prepare to submit quality data
• Update a patients history and problems
• Code a patient encounter
© 2015 TriZetto Corporation
Test With Your Trading Partners
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• Have you submitted test claims to your clearinghouses and payers? What about the vendors, labs and hospitals you work with?
• Focus on the partners you regularly work with.
• Explore alternate ways to submit claims to payers if you think your systems might not be ready for ICD-10 by Oct. 1.
• Ask other payers you work with about different options.
© 2015 TriZetto Corporation14
Get Set
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Key Metrics
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Baseline and monitor key performance indicators (KPIs) to measure the success of your transition to ICD-10:
• Top Used ICD-9 Codes
• Claim Volume – Total Claims and Rejection Claims
• Top Rejections
• Days to File by Payer
• Denial Rate / Denial Impact
• Top Denials by Payer
• Average A/R Days Trending
• Billed vs. Paid Trending
© 2015 TriZetto Corporation
Managing Denials
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• How do you identify appeal and track claims that were incorrectly denied?
• Claim rejections and denials are expected to increase in the immediate aftermath of ICD-10.
• Now is the time to strengthen denial management processes.
© 2015 TriZetto Corporation
Track Your Denials
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• Don’t wait until ICD-10 hits to address the increase in denials.
• Understand what types of denials your practice currently receives. Get these under control before ICD-10.
• Track the amount of reimbursements denied, the reason for denial and your appeal status.
• Create a plan of action now for denials coming on or after Oct. 1, 2015 due to ICD-10 coding issues.
© 2015 TriZetto Corporation
Identify Denial Trends
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Why are your claims getting denied today?
• Find details of your denials on your remits or explanation of benefits.
• Stop denials before they start by adding alerts to the system.
• Address the management of denials to prevent denials all together!
© 2015 TriZetto Corporation19
Go!
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Last 30 Days
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Confirm everything is ready to go:
• Planning completed.
• Go live tasks and associated actions have been identified and are in place.
• Response team in place to address potential issues.
• KPIs in place.
© 2015 TriZetto Corporation
Oct. 1st and Beyond
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You made it! Now what?
• Ensure claim reimbursement continues at the ICD-9 rate.
• Watch the impact on workflow and productivity.
• Continue to train staff beyond Oct. 1.
• Lessen the impact to your revenue by monitoring KPIs to quickly identify any issues.
© 2015 TriZetto Corporation
Industry ICD-10 ResourcesAmerican Academy of Professional Coders (AAPC)
ICD-10 Information and Resource Page
American Health Information Management Association (AHIMA)
ICD-10 Information and Resource Page
American Medical Association (AMA)
ICD-10 Information and Resource Page
Centers for Disease Control and Prevention (CDC)
International Classification of Diseases, Tenth Revision (ICD-10)
Centers for Medicare and Medicaid Services (CMS)
ICD-10 Information and Resource Page
Road to 10
Health Information Management Systems Society (HIMSS)
HIMSS ICD-10 Playbook
Workgroup for Electronic Data Interchange
ICD-10 Workgroup
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© 2015 TriZetto Corporation
There’s A Code For That
F43.0
Acute stress reaction
© 2015 TriZetto Corporation
Contact Information
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Laura Pazera
© 2015 TriZetto Corporation
Thank you
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