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Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.
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ICD-‐10
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
Based in South Florida, we partner with healthcare providers and organiza8ons, helping them develop strategies and systems for naviga8ng the new landscape of the healthcare industry. Our clients have enjoyed remarkable success, including award of the Medicare Advantage 5-‐star ra8ng by the Centers for Medicare & Medicaid Services (CMS).
About Quirk Healthcare Solu8ons
WHY IS THIS IMPORTANT?
Quick Overview
• October 1, 2014 hard cut-‐off • Affects all en88es covered by HIPAA • 14,000 ICD-‐9 codes grow to 68,000 ICD-‐10 codes • Version 5010 standards • Significant changes to clinical and revenue cycle systems
• Complex conversion to updated codes • System upgrades to expand data fields for longer codes
• Staff retraining on new versions and codes
The Healthcare World Ends in the Second Half of 2014
9/30/14 – MU A`esta8on Period Ends For Providers Who Have Not A`ested for MU
10/1/14 – ICD10 Implementa8on
12/31/14 – MU A`esta8on Period Ends For Providers Who Have A`ested Before
In Addi8on…
• Affordable Care Act – High deduc8bles already increasing importance of self pay and impac8ng prac8ces’ bo`om lines
• Medicare Reimbursement Cuts
• Sequestra8on • PQRS Penal8es and Scoring Publica8on
WHAT IS ICD10?
ICD-‐10 Historical Retrospec8ve
ICD-‐10 Regulatory Mandates
Federal Mandate Department of Health and Human Services Final Rule CMS-‐0013-‐F Published January 2009
HIPAA 5010
Transac8on formats for payors and providers
January 1, 2012
ICD-‐10
Diagnosis and procedure codes for clinical transac8ons
October 1, 2014
What are ICD-‐10 Codes?
• Granular code set developed by WHO for: – Increased clinical accuracy – Improved disease tracking – Disease trending
• More ICD-‐10 codes compared to ICD-‐9
ICD-‐9 14,000 diagnosis codes 4,000 procedure codes 5 digit numeric codes
ICD-‐10 68,000 diagnosis codes 87,000 procedure codes
7 digit alphanumeric codes
Anatomy of ICD-‐10 Diagnosis Codes
• 3–7 digits • Digit 1 is alpha, including O and I but no U • Digit 2 is numeric • Digits 3–7 are alpha (not case sensi8ve) or numeric • Decimal is aker third digit • Examples:
– A78 – Q fever – A69.21 – Meningi8s due to Lyme disease; and – S52.131a – Displaced fracture of neck of right radius, ini8al encounter for closed fracture
ICD-‐10 Adop8on Maturity Model
HOW DOES ICD10 RELATE TO SNOMED?
What is SNOMED?
• Acronym for Systema8zed Nomenclature Of Medicine – Clinical Terminology
• Interna8onal standard for comprehensive clinical terminology
• Available at no cost through the Na8onal Library of Medicine
• Enables providers and EHRs to communicate in common language – Increased quality of pa8ent care across special8es – Improved accuracy of pa8ent data analysis
What is SNOMED? Con7nued
• Structured into 19 “hierarchies” which define the clinical concept
• Broken down into increasing granularity • Very specific clinical concepts to define pa8ent condi8on
• More complex than ICD-‐10 hierarchy
Why is it important?
• MU2 criteria expands upon MU1 requirements to improve and u8lize HIT and EHRs – Provides consistent, collabora8ve care – Interoperability between EHRs and need for understanding each other • Use of common language
• Problem list
The ICD-‐10 / SNOMED Rela8onship
• SNOMED CT has be`er clinical coverage than ICD • Number of codes:
– SNOMED CT (Clinical finding): 100,000 – ICD-‐9-‐CM: 14,000 – ICD-‐10-‐CM: 68,000
• ICD focus is sta8s8cal – Less-‐common diseases subsumed under general categories – Aker-‐the-‐fact codes
• SNOMED CT is clinically-‐oriented – Used during care – Clinical relevance and user-‐friendliness
• Clinically coded data generates ICD-‐10 code for billing
WHAT CAN I DO?
Leverage the Resources Available to You
• Navicure’s Free ICD10 Comparison Tool • AMA and MGMA Offering Training Guides and Classes
• Intelligent Medical Objects ICD9 to ICD10 Conversion for Exis8ng Problem Lists
Op8mal Plan for 2014
• Developing a plan for 2014 is impera8ve
Q1
-‐ Finalize Plan for 2014
-‐ Upgrade to ICD10 and MU2 2014 Complaint Version
-‐ Implement PQRS
-‐ Review Budget to Ensure You Have Reserves for ACA and ICD10 Impacts
Q2
-‐ Test ICD10 with Clearinghouse and Payers
-‐ First Try at MU for 2014
Q3
-‐ Train Providers and Staff on ICD10
-‐ Make Up Quarter for MU
Q4
-‐ ICD10 Implementa8on
-‐ Increase CBO Staffing for Managing Resolu8on of Payer Issues
Op8mal Plan for ICD10
Impact Analysis • Iden8fy current systems and work processes that use ICD-‐9 codes • Talk with payers about effect of ICD-‐10 implementa8on on provider contracts
Needs Assessment • Workflow and business process changes • Staff training • Prac8ce management vendor accommoda8ons
Project Plan • Implementa8on plan with clearinghouses, billing services, and payers • Inventory systems and workflows • Con8ngency plan for failed go-‐live
Budget • Time and costs related to implementa8on • Training • IT/IS upgrade • Assistance from outside vendor/consultant • Poten8al produc8vity loss
Conversion • Transac8on tes8ng using ICD-‐10 codes • Historic data conversion • Review coded data for claims reimbursement consistent with ICD-‐9 rates
Project Considera8ons
External tes8ng
Internal tes8ng
Provider training
Review system customiza8ons
Core team training
Training
• AHIMA recommenda8on: begin no more than six months before compliance deadline
• Approximately 16 hours for ambulatory coders and 50 hours for hospital coders – Physician prac8ce coders should learn ICD-‐10 diagnosis coding
only – Hospital coders should learn both ICD-‐10 diagnosis and ICD-‐10
inpa8ent procedure coding • Specialty-‐specific ICD-‐10 training • ICD-‐10 coding training integrated into creden8al
maintaining CEUs • ICD-‐10 resources and training materials available through
CMS, professional associa8ons, and socie8es
Best Prac8ces
• Find diagnosis search tools (in EHR or Intelligent Medical Objects). Paper Superbills and Cheat Sheets will no longer work.
• Begin coding in ICD10 before the deadline and let Navicure downcode for you.
• Keep in close contact with payers who aren’t ready. Work with Navicure to con8nue downcoding aker 10/1/14 for these payers.
• Understand that not all payers will be ready and your A/R will be impacted.
QUESTIONS?
