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ICD-10 UpdateAll Blue 2014 Workshops

Agenda

All Blue Workshops 2014 > ICD-10

Provider ReadinessSteps for Provider PreparednessBCBST Readiness SummaryBCBST ICD-10 Testing InformationQuestions & Next Steps

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ICD-10 Provider Readiness

All Blue Workshops 2014 > ICD-10 4

WEDI survey showed roughly 80% of health care providers had not completed business changes or begun testing before 2014. Twenty percent of vendor respondents said they were halfway or less than halfway complete with product development in support of ICD-10

Thirty-seven percent of today’s documentation is ready for the transition, according to the American Association of Professional Coders

Roadmaps are available at CMS.gov that include the following:- Small and Rural clinical practices- Small Hospitals- Large Practices- Communications Plan guidance- Checklists

Activities for Provider Preparedness

All Blue Workshops 2014 > ICD-10 6

Assess Workflow and Systems- Complete a gap analysis on the expected workflow and process changes- Include IT systems

Assess System Vendor Readiness- Upgrade or replace the practice’s IT systems - Include forms and reports

Documentation Considerations- Assess whether current clinical documentation will support the level of

specificity necessary- Priority list of diagnoses requiring more detailed documentation

Revenue and Cash Flow Considerations- Know which payers have fully transitioned to ICD-10-CM- Professional services are paid based on the procedure code, but the

diagnosis code supports medical necessityTrain on New Processes and Systems- Ensure staff can be trained prior to the compliance date on all changes

BlueCross Preparedness

All Blue Workshops 2014 > ICD-10 7

BCBST Systems Testing- Quality Assurance Testing is complete for Core Systems- System Integration Testing and End-to-End testing is in process- UAT Testing is in process

Provider Testing- Pilot Testing began October 2013- Provider Testing Tools are being implemented - Provider Testing is open for professional and institutional providers

Provider Communications- Provider Administration Manual updates throughout the year- BlueAlertSM articles for the remainder of the year will focus on ICD-10

updates- Compliance statement on BCBST.com and FAQs

Training of BCBST Employees- Training began in 2013 and will continue in 2014 and 2015

ICD-10 Delay Planning has concluded

Professional Testing Tool – Web-Based Self Help• Browser Requirements (Chrome, Safari, Internet Explorer, or FireFox)• Give health care providers (physicians, etc.) pre-defined, clinically based

medical scenarios to review and determine the ICD-10 codes• Enter the data in an easy, efficient manner• Provide peer reports and/or notification of the correlation between input

and output codesProvider Steps for tool registration and testing• Provider Registers on the website• Provider users access application• Provider completes scenarios• Provider reviews results

To express interest in testing, send email to ICD10_GM@BCBST.com

ICD-10 Provider Testing Tool

All Blue Workshops 2014 > ICD-10 9

Each Specialty has a maximum of ten narratives available.

Each Narrative defines a specific healthcare encounter (Narratives include Chief Complaint, Past Medical History and Office Visit Notes pertaining to a Patient)

Providers register via a website, and will receive an email inviting them to participate with an embedded link to the testing tool

ICD-10 Provider Testing Tools - Narratives

All Blue Workshops 2014 > ICD-10 9

ICD-10 Provider Testing Tools – Provider Report Sample

All Blue Workshops 2014 > ICD-10 9

Chief Complaint :

Pt presented to the E.R. with chest pain and shortness of breath CardiologyNarrative 1

Past Medical History:

Pt. takes Crestor 10 mg. daily and Zestril 30 mg daily for HTN. Pt is a 1 -2 pack/day smoker who has smoked for about 35 years.

Office Visit Notes:

I was consulted to see this patient who was admitted to the hospital yesterday with chest pain that radiated down his left arm and shortness of breath. Pt. was tachycardic, hypertensive and complaining of pain at an 8 on a scale of 1-10. CBC was normal, pt. has a history of hyperlipidemia and poor diet. He smokes 1 - 2 packs/cig/day and doesn't exercise. Pt was given Nitro yesterday and oxygen @ 2l/NC with minimal relief, so was placed in ICU on a continuous Nitroglycerin drip. He has also been given 2mg Morphine Sulfate I.V. prn pain. A cardiac catheterization was performed and found that the patient has atherosclerotic heart disease of one native coronary artery. His LAD coronary artery is blocked over 80%, so after discussion with the patient and his wife, it was decided that the best option will be to undergo a Coronary bypass in the am. Will continue to monitor vital signs and nursing staff is to call if there is any change in patient's status.

Total Providers: 3

Total Unique Answers: 3

Your Answer: R0789

SAMPLE

ICD-10 Provider Testing Tool – Provider Specialties

MedTenn Conference 2014 > ICD-10 9

Specialty Total Narratives Specialty Total NarrativesAllergy/Immunology 9 Obstetrics & Gynecology 10Audiologist 6 Occupational Therapist in Private Practice 9

Cardiovascular disease 9 Ophthalmology 9Certified Nurse Midwife 6 Optometry 9Chiropractic 9 Orthopedic Surgery 9

Clinic or Group Practice 9 Otolaryngology 9Dermatology 9 Pediatric Medicine 10Emergency Medicine 9 Physical Medicine and Rehabilitation 9

Endocrinology 9 Physical Therapist in Private Practice 9Family Practice 10 Plastic and Reconstructive Surgery 10Gastroenterology 9 Podiatrist 10

General Practice 9 Psychiatry 9General Surgery 10 Psychologist 9Hematology 9 Psychologist, Clinical 9

Hematology-Oncology 9 Pulmonary Disease 9Infectious Disease 9 Radiation Oncology 9Internal Medicine 10 Rheumatology 9

Nephrology 9 Thoracic Surgery 9Neurology 10 Urology 9Nurse Practitioner 10 Vascular Surgery 9

Grand Count 363

Facility Testing Tool – Web Based Self Service• Browser Requirements (Chrome, Safari, Internet Explorer or FireFox)• Providers can test scenarios with DRG code being returned (Grouper 30)• Scenarios can be selected by the testing provider• Largely based upon DRGs of interest• Evaluation of results • To express interest in testing send e-mail to ICD10_GM@BCBST.com

Provider Steps for tool registration and testing• Provider contacts BCBST, BCBST loads claim scenarios• Provider Registers on the website• Provider users access application• Provider completes scenarios• Provider reviews results

Provider can express interest in testing by sending an email to ICD10_GM@BCBST.com

ICD-10 Provider Testing Tool - Institutional

10ICD-10 Program

Questions & Next Steps

All Blue Workshops 2014 > ICD-10 10

Appendix

All Blue Workshops 2014 > ICD-10 11

Useful LinksTennessee Hospital Association (THA) www.THA.comTennessee Medical Association (TMA)

www.tnmed.orgBCBST ICD-10 Page (BCBST.COM)

www.bcbst.com/providers/icd-10.pageAmerican Association of Professional Coders (AAPC)

www.aapc.com/icd-10/index.aspxAmerican Health Information Management Association (AHIMA)

www.ahima.org/icd10Implementation Planning (CMS) www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10/02b_Latest_News.aspCMS “Road to ICD-10” Toolkit http://www.roadto10.org/

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association