ICD-10 Checklist

Your ICD-10 Checklist: Getting Ready for October 1

Carey ManningManager, Product Marketing

October 1, 2015

3-5 characters

October 1, 2015

14,000 codes

Z89.419: Acquired absence of unspecified great toe

4

Cerebral Artery Occlusion/Stenosis with Infarction

5

*ICD-10 Changes Appear in RED BOLD

ICD-9-CM ICD-10-CM

Etiology:• Embolism• Thrombosis• Unspecified occlusion/stenosis

Etiology: Same as ICD-9-CM• Embolism• Thrombosis• Unspecified occlusion/stenosis

Site:• Cerebral artery

• Anterior• Middle• Posterior

• Cerebellar• Other specified cerebral

artery• Unspecified cerebral artery

Laterality:• Right • Left• Bilateral• Unspecified

October 1, 2015

Opt In / Opt Out

ICD-10 History

7

1975 WHO

approves ICD-9

1981 AIDS

clinically observed for the first time

75 8580 9590 0500 1510

2015 U.S.

adopts ICD-10

2008

Korea adopts ICD-10

2010 ICD-11

released

1990 WHO

approves ICD-10

1999 US adopts ICD-10 for mortality

coding

2007 Thailand adopts ICD-10

1997 Sweden adopts ICD-10

1998 Australia

adopts ICD-10

2000 Canada adopts ICD-10

2014Ebola

Outbreak

Image Source: http://www.healthcarefinancenews.com/news/icd-10-debate-hits-washington-most-prepared-worry-persists

April 14th

• Sustainable Growth Rate Repealed

• No ICD-10 Delay

News from

Washington

9

The ICD-10 transition broadly affects the patient visit

10

Intake

Select chief complaint

Enter vitals

Review of symptoms

Review past medical and social

history

Review medications and

allergies

Exam

Review Intake

Document patient exam

Select diagnosis

Enter orders

Review quality measures

Sign-Off

Review assessment and

plan

Sign off on orders

Complete billing slip

Generate letters

Review charges

Close the patient encounter

Check-In

Verify appointment, demographic,

insurance information

Collect patient payments

Print billing slip

Forms

Check-Out

Schedule follow up appointments

Collect outstanding

balances

Distribute patient

education materials

Enter charges

Five areas of focus

11

1 Will vendors be ready?

2 Payer readiness

3 Training & knowledge retention

4 Cut in productivity

5 Planning for payment disruption

Get your upgrade date

12

2014 2015

2Q 3Q 4Q 1Q 2Q 3Q 4Q

Payer Testing

FamiliarizationPlanning / Impact Assessment

Interface Testing (Orders, Labs, EHR)

Payer Readiness

Upgrade date?

Sample ICD-10 Deployment Timeline

1

CMS End-to-End Testing Dates

What is supposed to happen

DATE OF SERVICEPOST-

COMPLIANCE ICD-10

ONLY ICD-10 REQUIRED

Get paid regardless of payer status

13

Only ICD-9 required

Date of servicePre-compliance

ICD-9

2

ICD-10 Enforcement Date

What’s likely to happen

DATE OF SERVICEPOST-

COMPLIANCE AND PAYER

READINESS ICD-10

ICD-10 AND ICD-9 Required

Pre October 1, 2015

Focus on training and learning

14

Coding and Documentation(Specialty-Specific)

Technology systems

Providers

Clinical Staff

Administrative Clerical

Management

Billing Staff

Role-based learning needs for the ICD-10 transition

3

there is no substitute for real

practice

A smart EHR will bolster productivity

16

Healing TypeEncounter TypeBody Part

M84.361 M84.362M84.361

SM84.362

GM84.362

SM84.369

SM84.369

K

M84.369A

M84.361K

M84.362A

M84.361P

M84.361A

M84.369D

M84.369P

M84.361D

M84.362K

M84.362D

M84.362P

M84.369S

M84.369G

M84.361G

Stress fracture of tibia 21 Possible Codes

4


17

• Unspecified tibia and fibula

• Tibia and fibula• Right tibia• Left tibia


M84.361 M84.362M84.361

SM84.362

GM84.362

SM84.369

SM84.369

K

M84.369A

M84.361K

M84.362A

M84.361P

M84.361A

M84.369D

M84.369P

M84.361D

M84.362K

M84.362D

M84.362P

M84.369S

M84.369G

M84.361G


4


18

• Initial encounter• Subsequent

encounter




M84.361 M84.362M84.361

SM84.362

GM84.362

SM84.369

SM84.369

K

M84.369A

M84.361K

M84.362A

M84.361P

M84.361A

M84.369D

M84.369P

M84.361D

M84.362K

M84.362D

M84.362P

M84.369S

M84.369G

M84.361G


4


19

• Routine healing• Delayed healing• Nonunion• Malunion

• Initial encounter• Subsequent

encounter



M84.361P Stress fracture, right tibia, subsequent encounter for fracture with malunion


M84.361 M84.362M84.361

SM84.362

GM84.362

SM84.369

SM84.369

K

M84.369A

M84.361K

M84.362A

M84.361P

M84.361A

M84.369D

M84.369P

M84.361D

M84.362K

M84.362D

M84.362P

M84.369S

M84.369G

M84.361G


4

Change isn’t cheap…

20

http://www.ama-assn.org/resources/doc/washington/icd-10-costs-for-physician-practices-study.pdf

Typical Small Practice

Typical Medium Practice

Typical Large Practice

Training $2,700-3,000 $4,800-7,900 $75,100

Assessment $4,300-7,000 $6,535-9,600 $19,320

Software upgrades

$0-60,000 $0-200,000 $0-2,000,000

Process remediation

$3,312-6,701 $6,211-12,990 $14,874-31,821

Testing $15,248-28,805 $47,906-93,098 $428,740-880,660

Productivity loss $8,500-20,250$72,649-166,649

$726,487-1,666,487

Payment Disruption

$22,579-100,349

$75,263-334,498

$752,630-3,344,976

TotalUp to $226,105

Up to $824,735

Up to $8,018,364

5

We provide five integrated services that deliver immediate value to providers

22

Improved clinical care and patient outcomes

Population Health Management

Documentation and workflow efficiency

athenaCommunicator® Patient Engagement

athenaCollector® Practice Management

athenaClinicals®

Clinical Performance

athenaCoordinator®

Population Health

Epocrates®

Point of Care Medical Applications

athenahealth’s award-winning services can help you thrive through change

23“2014 Best in KLAS Awards: Software & Services,” January, 2015. © 2015 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

#1 Practice

Management System

(1-10, 11-75 physicians)

#2 Practice

Management System

(over 75 physicians)

#2 EHR

(over 75 physicians)

#2 Patient Portal

#2 Overall

Physician Practice Vendor

2014 Best in KLAS

• 64,000+ providers on athenaNet®

• Clients ranging from 1 to 5,000+ providers

• 50 states and 112 medical specialties

• $14 billion in client collections per year

• Acquired Epocrates March, 2013

24

Software Knowledge Service

• Ranked #1 Most Usable EHR by KLAS

• Single instance of continuously updated software

• ICD-10 upgrade pushed out February 22, 2014 at no additional cost

• Practice coding tools for coders and providers

• Tracking payer, clearinghouse, and interface readiness

• Managing ICD-9/10 codes based on payer readiness

• Using clinical terminology (SNOMED) to present ICD-10 codes intelligently at the point of care

• Working directly with payers and clearinghouses to define and execute a comprehensive testing schedule

• Behave like a 59,000 provider health organization for priority access to payers

• Supporting client readiness through ICD-10 Readiness Center and Coaching

US Patent # 7,720,70

1

And we were also ranked as the most likely to keep up with regulations

25

© 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

How confident are you in your RCM vendor’s ability to keep up with regulatory and government demands?

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% athenahealth Kareo NextGen Cerner eClinicalWorks

1

1

5

2

1

1

2

5

9

6

2

2

4

5

20

Pre

lim

inary

Data

Confident

Very Confident Unsure

Unconfident

Very Unconfident

In summary, address key areas to mitigate business continuity risk

26

Assess impact of ICD-10 throughout patient workflow

Know your vendors’ readiness plan

Practice early and often on real patient data in your PM and EHR post 10/1 environment

Identify and address gaps in payer readiness

Payer and interface testing

Plan for cash flow disruption

1

2

3

4

5

6

Healthcare

ICD-10 Checklist