ICD-10 Implementation Plan · There should be an ICD-10 training plan for each person in place now. AdvantEdge ICD-10 training is available as an option: please contact your Client

AdvantEdge Healthcare Solutions Proprietary 1

ICD-10 Implementation Plan


Table of Contents

Introduction ................................................................................................. 2

Client Communication and Training ............................................................ 2

What AdvantEdge Clients and Physicians Need to Do ............................... 4

How is AdvantEdge preparing for ICD-10? ................................................. 5

Background ............................................................................................. 6

System Readiness ................................................................................... 7

Testing ..................................................................................................... 8

Staff Readiness ....................................................................................... 9

Coder Training ....................................................................................... 10


Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15

(Optional) ICD-10 Training Classes

Client Communication and Training

Chart Audits

Oct 15

ICD-10 CutoverJan 15

ICD-9 / ICD-10

Details on Website

Feb 15

Monthly, Qtly Newsletters

ICD-10 Info

May 15

Documentation

Audits

Dual Coding ICD-10 Coding

Documentation Feedback on “Live” Reports

Jul 15

Dual CodingSep 15

Jun 15

Physician

Feedback,

Training

Jun 15

Documentation Feedback on

“Sample” Reports

Introduction At this point, everyone knows that ICD-10 is on track for implementation October 1 of this year,

just a few months from now. ICD-10 represents a completely new set of codes designed for

much more specificity and includes designations for anatomic site, procedure, visit specific

information and technology. ICD-10 codes can be much more detailed:

Codes start with a letter and may be up to 7 characters.

For example, codes will be very specific to right or left and upper or lower anatomic sites.

The ICD-10 system has more guidelines and more narrow criteria for “not otherwise

specified” codes.

It is important to note that there is no 1:1 crosswalk between ICD-9 and ICD-10.

At this point, every physician and group must be getting ready for ICD-10. For those who are not

ready, CMS has said that denial rates and Days in A/R may increase significantly.

Client Communication and Training Obviously ICD-10 has a significant impact on AdvantEdge clients and, specifically each

physician. In some cases, additional documentation will be required in order for AdvantEdge

coders to assign the correct ICD-10 code. To assist that process, the AdvantEdge newsletter The

Leading Edge has been publishing ICD-9 / ICD-10 comparisons for the past two years. All of

those comparisons are now available on the AdvantEdge website. In addition, several

AdvantEdge whitepapers are available with additional details to help with ICD-10 planning. For

the timeframe between now and October, AdvantEdge has a number of initiatives under way to

assist clients with the transition as shown here and described on the next page.


For specialists including radiologists, pathologists and many others, additional information will

often be needed from referring/ordering physicians in order to have enough detail for ICD-10.

An example is cancer diagnoses: lung, breast, colon, uterus, bladder, brain, etc. In order for a

coder to apply the most specific diagnosis for breast cancer they should know if it is the right or

left breast, lower inner quadrant (C50. 311-right, C50.312- left), the lower outer quadrant

(C50.511-right, C50.312- left), axillary tail (C50.611- right, C50.612- left), upper outer quadrant

(C50.411- right, C50.412- left), areola (C50.011- right, C50.012- left) or at the location of a

previous mastectomy.

There are “unspecified” codes for many situations but most observers are concerned because

over time, they expect insurance carriers to deny claims where unspecified diagnoses are used.

During the initial cutover, it appears that some payers will accept the unspecified codes, but, the

more specific codes will eventually be needed and are recommended.

To help AdvantEdge client physicians identify where documentation needs to change, several

steps are under way.

1. For clients where AdvantEdge does diagnosis coding, we are currently auditing a

sample of reports that will flag the most common ICD-9 codes for each client,

showing how well documentation works for ICD-9 vs. ICD-10.

2. AdvantEdge will then provide documentation feedback to client physicians that will

walk through the documentation requirements in ICD-10 for the diagnosis codes most

commonly used today.

3. AdvantEdge is making its LearningEdge ICD-10 training (described below) available

to client physicians and staff. This will provide a convenient way for those who wish

to gain a more in-depth understanding of ICD-10 to do so on their own schedule. We

are exploring the option for clients to obtain CEU’s as well.

4. During the third quarter, for clients where AdvantEdge does diagnosis coding,

AdvantEdge coders will be “dual coding” selected reports and providing final, “fine

tuning” feedback to physicians where additional or different information is needed to

accurately code in ICD-10.

Recognizing that everyone continues to learn about ICD-10 and its implications, we fully

anticipate that the content of courses, newsletters, etc. will continue to be updated with the latest

information.


What AdvantEdge Clients and Physicians Need to Do

If you haven’t done so already, contact your hospital or professional society and have each

physician and key staff member sign up for ICD-10 documentation training/seminars. If

those resources are not adequate or if you wish to augment them, AdvantEdge ICD-10

training is available (see Coder Training in this document): please contact your Client

Manager.

If you have an EMR or other systems within the practice, your vendor(s) should already

have implemented ICD-10 and be testing with it. If you don’t have specific plans and

schedules, now is the time to insist on them. If you work with hospital systems, now is the

time to become familiar with their ICD-10 features.

If you have office and/or department staff, make sure you know every person and process

that uses or affects diagnosis codes. There should be an ICD-10 training plan for each

person in place now. AdvantEdge ICD-10 training is available as an option: please contact

your Client Manager.

If your physicians or coders do diagnosis coding, make sure everyone is scheduled for in-

depth ICD-10 training. If you wish, AdvantEdge ICD-10 training is available (see Coder

Training in this document). Please contact your Client Manager.

For group practices where AdvantEdge does diagnosis coding, AdvantEdge requires the

name and email address of one physician who is the ICD-10 advocate for the group. This

person will be the point person for ICD-10 information sharing, questions and how

documentation feedback will be handled. They should also advocate within the group to

encourage and enforce ICD-10 compliance and training for everyone involved.

Once awareness training and documentation training have been completed during the third

quarter, all physicians where AdvantEdge does diagnosis coding will be expected to begin

documenting with the specificity required for ICD-10. This is the best way to find

deficiencies and make corrections prior to go-live.

As a contingency against cash flow delays which may be caused by payers who are not

ready or other possible risks, experts recommend that each practice establish a line of credit

for approximately six months of revenue. The time to do so is mid to late summer.



ICD-10 Implementation Taskforce



Sep 15

Jun 15

Physician

Feedback,

TrainingJan 15

Continue Coder

Training

Jul 15

Dual Coding

Apr 15

CMS

Testing

Jan 15

Weekly

Meetings

May 15

BC/BS

Mar 15

Client

Communications

Apr 15

Comm'l Payer Testing

Jul 15

CMS Testing

Oct 15

ICD-10 Cutover

System Testing (Subject to Payer Schedules and Readiness)


Staff Training and Readiness

Aug 15

Jun 15

Provider

Training

Jul 15

Dual Coding

Jan 15

ICD-9 / ICD-10 Details on Website

Feb 15

Monthly, Qtly

Newsletters

ICD-10 Info

May 15

Documentation

Audits

Sep 15

Jan 15

Curricula in place

Jan 15

Ongoing Coder Training

and CertificationJun 15 Jul 15

Dual CodingSep 15

Oct 15

Oct 15

Jul 15

Client Documentation FeedbackDec 15

Jul 15

Client Documentation FeedbackDec 15

May 15

Physician

FeedbackJun 15

May 15

Documentation

AuditsJun 15

Sep 15

Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15

Apr 15

Novitas

Medicare NJ

Medicare MA

Emdeon Comm’lMar 15

Availity

Emdeon

Jul 15

Novitas

CGS

NGS

Medicare IL

Medicare INApr 15

Medicaid OH

Jan 15

Ready to Test

Jun 15

Harvard

PilgrimMay 15

BCBS IL

Aug 15

Medicare NY

Medicaid NY

Medicare OH

How is AdvantEdge preparing for ICD-10?

AdvantEdge is fully prepared to implement ICD-10 on October 1, 2015 including numerous

steps to assist clients with the needed clinical documentation updates. The company has been

working on ICD-10 implementation since 2011. For 2015, the company has an ICD-10 taskforce

coordinating all of the components of ICD-10 that must come together. An overview of these

efforts is shown in this timeline.


Jan 12 Apr 12 Jul 12 Oct 12 Jan 13 Apr 13 Jul 13 Oct 13

System Development

WEDI and CMS Conferences and Seminars

HIMSS ICD-10 Readiness Taskforce

Testing

ICD-10 Whitepapers, Publish ICD-9 / ICD-10 Comparisons in each Newsletter

Coder Familiarization with ICD-10 Coder Anatomy Updates, Training (per AAPC)

Dec-11

ICD-10 Plan Established

Background

In December of 2011, AdvantEdge identified and set up our ICD-10 compliance plan. Our staff

has attended the seminars with the Workgroup for Electronic Data Interchange (WEDI) and

Centers for Medicare and Medicaid Services (CMS) to make sure we have the most current

information and to stay abreast of changes as they are made. Additionally, AdvantEdge staff

have actively participated in the HIMSS ICD10 Readiness Task Force, an industry workgroup

representing providers, payers and vendors. The group meets monthly to discuss current issues

surrounding ICD10 readiness.

Since the beginning of 2014, the AdvantEdge ICD-10 task force has met and continues to meet

on a weekly basis to coordinate all aspects of ICD-10 and to adjust to new industry developments

as they arise. They are focused on three priorities:

System Readiness

Staff Readiness


Details follow on the first two; the last is described at the beginning of this document.


System Readiness

Our development team is concluding a major project that enables all of our software to process

ICD-10 codes—in parallel with ICD-9 codes. We are currently testing with as many payers as

possible. Initial testing phases focused on system interfaces; later phases test on an end-to-end

basis: i.e. from the point of charge entry all the way through claim adjudication and reporting.

The modifications to AdvantEdge’s Virtual Manager to accommodate ICD-10 include:

Data Base changes across the enterprise to accommodate a much larger number

(69,000 vs. 14,000) of longer codes, formatted differently than ICD-9.

Application changes to accommodate ICD-10. Here are a few examples:

o Our claims filing engine was updated for ICD-10 when ANSI 5010 was

implemented.

o Diagnosis code master files have been updated.

o The PQRS database has been expanded.

o Fields on system screens have been expanded.

o Reports have been re-formatted for the longer codes.

Dual validation of ICD-9 / ICD-10 based on date of service (before or after October

1, 2015) and type of service, e.g. workers’ compensation or no-fault cases.

Additional validation by trading partners (payer) to accommodate both ICD-9/ICD-

10.

The ability to process both ICD-9 and ICD-10 at the same time in order to:

o Be able to support the transition time frame immediately before and after

October 1.

o Support payers not required to implement ICD-10 (e.g. workers comp).

o Have a contingency plan for those payers who are not able to accept ICD-10 on

October 1.


System Testing (Subject to Payer Schedules and Readiness)

Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15

Apr 15

Novitas

Medicare NJ

Medicare MA

Emdeon Comm’lMar 15

Availity

Emdeon

Jul 15

Novitas

CGS

NGS

Medicare IL

Medicare INApr 15

Medicaid OH

ICD-10 Live

CMS-1

Jan 15

Ready to Test

Clearinghouses: Emdeon, Availity Go live

Go live

Commercial Payers Go live

Non HIPAA Payers (e.g. WC, Motor Vehicle) Go live

Jun 15

Harvard

Pilgrim

CMS-2 CMS-3

May 15

BCBS IL

Aug 15

Medicare NY

Medicaid NY

Medicare OH

Testing

AdvantEdge participated in CMS’ Front-end testing during the first week of March

2014 and passed all initial testing as shown by electronic acknowledgement

confirming acceptance of all test claims.

CMS is conducting more end-to-end testing in 2015 and AdvantEdge is

participating with at least 2 MACs. This is a volunteer process where CMS selects a

limited number of submitters per MAC. AdvantEdge has volunteered and is

participating in as many test schedules as the MACs will accept. AdvantEdge has

successfully tested already with CMS Novitas, CMS NGS Medicare of

Massachusetts and Emdeon.

We have been invited to test with BCBS of Illinois and will be testing through our

Availity clearinghouse.

We tested with the Emdeon and Availity clearinghouses in 2014 and sent accepted

test claim files. Additional MAC testing via the clearinghouses is scheduled for 2Q

2015.

For payers exempt from the ICD-10 mandate (workers compensation and no fault),

we are working with Emdeon to monitor their ICD-10 implementation plan. Our

systems are prepared to convert from ICD-10 to ICD-9, if necessary, for these

payers.



Staff Training and Readiness

Dec 15Jul 15 Sep 15Jan 15

Coder TrainingJul 15

Dual CodingJan 15

Curricula in placeJul 15

Client Documentation Feedback

Coder Training

Other Staff Training

Dual Coding

Client Documentation Feedback

ICD-10 Coding

Documentation

Feedback

Staff Readiness

The AdvantEdge coding team has been preparing for ICD-10 for more than 2 years, using the

guidelines from AHIMA and the AAPC. Among other items, these guidelines strongly

recommend expanded coder training in physiology and anatomy. AdvantEdge coders have

already completed the required anatomy and physiology education sessions through AHIMA that

will be instrumental in the correct coding for ICD-10. In addition, our coders are gaining

experience through dual coding of selected cases. This training is timed so that coder knowledge

will be fully complete for the October first cutover.

Other AdvantEdge staff members will be trained on ICD-10 as required by their job functions.

The overall timeline is shown here.


Coder Training

All AdvantEdge coders currently certified for ICD-9 are required to complete training and be

recertified for ICD-10. Unlike many firms, all AdvantEdge coders are certified by the recognized

industry standard setters: AAPC or AHIMA.

To facilitate ICD-10 education, AdvantEdge has established a comprehensive coding curriculum

which all coders are currently completing (see timeline below). To support delivering it, the

company has 2 AAPC-certified trainers on staff. The curriculum was designed by and for

AdvantEdge using AAPC and AHIMA criteria and has been approved for CEU credits by both

AHIMA and AAPC. The customized content allows AdvantEdge to target courses to the specific

coding scenarios of its clients.

Some features of the training for AdvantEdge coders are:

Specialty-specific ICD-10 training for all coders featuring the most common codes used

by their AdvantEdge clients.

Training online using LearningEdge. This allows coders to return to courses for

refreshing knowledge and/or to prepare for ICD-10 Certification. In addition,

LearningEdge tracks scores and provides managers with status reports on coder training.

The 25-week program (see diagram on the next page) includes all major modules of ICD-

10 plus periodic webinars for review of the material and quizzes to ensure

comprehension. Content includes:

o Main changes from ICD-9-CM

o Documentation issues

o Exercises and coding examples

o Quizzes and tests

A 10-week dual coding period using the most common diagnosis codes, with significant

focus on exercises and quizzes.

The periodic webinars with our AHIMA certified ICD-10 trainers provide personal

attention and an open forum for Q&A.

The timeline for coder training (currently underway) is shown on the next page. Note that

portions or all of these training courses are available to client physicians and staff where

they wish to get in-depth understanding of ICD-10 requirements.



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The radiology coder training includes a focus on the diagnosis codes used most frequently by

our clients. These same codes are the basis for initial feedback (“gap analysis”) to client

physicians on their documentation and where it will need to be made more specific. For

radiology clients, here are 20 common ICD-9 codes and their ICD-10 impacts:


Similarly, anesthesia coder training includes a focus on common diagnosis codes including those

in this table.

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Documents

ICD-10 Implementation Plan · There should be an ICD-10 training plan for each person in place now. AdvantEdge ICD-10 training is available as an option: please contact your Client