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Provider Education

Provider Education. Cathy Munn MPH RHIA CPHQ Sr. Consultant. Basic ICD-10 Overview. Agenda. Status of ICD-10 Transition Who, What, Where, When & Why Industry Update Impact of the Change Providers Payers Translation Examples Arkansas DMS Remediation Update Next Steps & Resources.

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Provider Education

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  1. Provider Education Cathy Munn MPH RHIA CPHQ Sr. Consultant Basic ICD-10 Overview

  2. Agenda • Status of ICD-10 Transition • Who, What, Where, When & Why • Industry Update • Impact of the Change • Providers • Payers • Translation Examples • Arkansas DMS Remediation Update • Next Steps & Resources

  3. Who: The Healthcare Industry • ICD-10-CM (diagnoses) will be used by all providers in every health care setting • ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures • No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes • CPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visits

  4. What: ICD-10 CM/PCS • ICD-9-CM: International Classification of Diseases, 9th revision, Clinical Modification • US transitioned from ICD-8 to ICD-9 in 1979 • Annual updates • ICD-10: Developed by the World Health Organization as the nomenclature for all countries • ICD-10-CM: International Classification of Diseases, 10th revision, Clinical Modification – US only • ICD-10-PCS: International Classification of Diseases, 10th revision, Procedure Classification System – US only

  5. When: October 1, 20XX • Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013 • Dates of Service (outpatient) After 10/1/2013 • Dates of Discharge (Inpatient) After 10/1/2013 • House Bill 4302 passed on March 31, 2014 delays the implementation of ICD-10 until “no earlier than October 2015” • This is a Federal Mandate

  6. Where: Inpatient vs Outpatient • Systems will have to utilize both ICD-9-CM and ICD-10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim. • Inpatient discharges occurring on or after 10-1-20XX will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission. • Outpatient dates of service occurring on or after 10-1-20XX will use ICD-10-CM codes • There will be period of time when payers will be processing claims in both ICD-9 and ICD-10

  7. Why: Data Benefits of ICD-10 • Better data will be available for: • Measuring the quality, safety and efficacy of care • Designing payment systems and processing claims for reimbursement • Conducting research, epidemiological studies and clinical trials • Setting health policy • Operational and strategic planning and designing healthcare delivery systems • Monitoring resource utilization • Improving clinical, financial and administrative performance • Preventing and detecting healthcare fraud and abuse • Tracking public health and risk

  8. Other Competing Priorities

  9. ICD-10 Chapter Headings

  10. ICD-9 vs. ICD-10 Diagnosis Codes ICD-9 - E codes reference External Causes of Injury & Poisoning ICD-10 - E references the Endocrine System ICD- 9 - V codes reference Health Status & Contact with Health Services ICD-10 - V – Y codes reference External Causes of Morbidity

  11. Impact of ICD-10

  12. ICD-9 Procedure vs. ICD-10-PCS The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. There are also 7th digit designations (A or D) which identify initial or subsequent encounter for care.

  13. Code Translations • Asthma

  14. Code Translations • Otitis Media

  15. Code Translations • Congestive Heart Failure

  16. Impact on Provider Operations

  17. Clinical Documentation Resources • AHIMA Online Education Physician Series • Clinical Documentation for ICD-10: Principles & Practice • Short, self-paced training modules • Case-based, real life examples • Provides more than 200 bite-sized, on-demand, specialty-specific training modules that can be accessed anytime or anywhere with a mobile device – computer, tablet or smartphone • Delivers 3-5 minutes modules that cover physician’s 10 – 20 most commonly billed diagnoses & conditions making learning targeted and relevant to their practice specialty. • www.ahima.org\physicianICD10

  18. Training Resources • There are a wide variety of training opportunities and materials available through a variety of resources: • Professional Coding Associations – AAPC, AHIMA • Online Courses – ICD10 Monitor, Contexo University, Precyse, Nuance • Webinars – ICD10 Monitor, HCPro • Onsite Training – Train-the-Trainer approach, Coding Boot Camp • Arkansas Hospital Association – monthly coding classes • Non-Traditional - Partner with the HIM Department at a nearby hospital

  19. Akansas DHS Current Stated • Arkansas Medicaid has been working on ICD-10 for over two years • Completed • Operational assessment • Remediation of Medical Policy, Edits and Audits complete • Provider Manual Updates – HP coordinating revisions • Data Requirements – HP/MMIS, Xerox/ACS, integrated & stand alone systems • Ongoing • Remediation of Pharmacy Policy & Edits • Remediation of DHS reports, forms, and brochures • Provider Outreach • Meetings/Webcasts • Provider Bulletins • Newsletters • ICD-10 Website www.humanservices.Arkansas.gov/ICD10 • Internal & external testing to begin mid-year

  20. The Starting Point

  21. AMA ICD-10 Checklist • Create a checklist of all systems & work flow processes that currently use ICD-9 • Create a list of vendor contact information • Identify all staff who work with ICD-9 • Identify all possible work flow changes that will need to switch to ICD-10 • Identify the practice billing service (if applicable) • Identify the practice clearinghouse • Identify a contact for each of the practice’s payers

  22. AMA ICD-10 Checklist • Contact vendors to determine their ICD-10 implementation plans • Contact the practice’s billing service, if applicable, to identify their ICD-10 implementation plans • Contact payers to determine their ICD-10 implementation plans • Identify any internal work flow processes that will need to be change for ICD-10 http://www.ama-assn.org/resources/doc/washington/icd10-checklist.pdf

  23. Industry Website Resources • www.CMS.gov/ICD10 • www.CMS.gov/NPC • http://www.roadto10.org/ • www.AHIMA.org • www.AAPC.com • http://www.cms.gov/Medicare/Coding/ICD-10/Downloads/ICD10SmallandMediumPractices508.pdf • http://www.himss.org/ASP/topics_icd10playbook.asp • www.WEDI.org • www.humanservices.Arkansas.gov/ICD10

  24. CMS Resources

  25. CMS Resources

  26. CMS Road to I-10

  27. Additional ICD-10 Resources • White Papers (including but not limited to) • ICD-10 A Primer • ICD-10 Clinical Documentation • ICD-10 Physician Impact • ICD-10 Advantages • ICD-10 Specified or Unspecified http://healthdataconsulting.com/ • Checklists published by CMS for providers (small, medium and large) at: • http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html • http://www.roadto10.org/

  28. Websites to Watch

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