Rayellen.Kishbach@WoltersKluwer.com

Know.Right.Now

Presented by: Rayellen Kishbach

2015

ICD-10 Tools on MediRegs

During this session, we will explore: Utilizing electronic ICD-10-CM and ICD-10-PCS codebooks to

speed research/increase efficiency Feedback on new functionality in the ICD-10 CodeBook

Native coding in ICD-9 and ICD-10 and utilizing the GEMs maps using our ICD Explorer tool

American Hospital Association (AHA) and Medicare issuances (Manuals, PQRS, IOCE/MCE) related to ICD-10

Local & National Coverage under ICD-10 How to stay on top of ICD-10 changes with custom email

alerts

Session #1, Sept 9th - Coding Resources

During this session, we will explore: MS-DRG Grouping and Payment under ICD-10 with concrete

shift examples American Hospital Association (AHA) and Medicare

issuances (Manuals, NCD Coding Guidelines, IOCE, MCE) related to ICD-10

Local & National Coverage under ICD-10 How to stay on top of ICD-10 changes with custom email

alerts

Session #2, Sept 15th - Reimbursement Resources

Clarifications and QuestionsCMS Edits and Audits

• In place by 10/1/20151. Ombudsman

• NO2. Delay?

• If VALID ICD-10 code from the right family is submitted, Medicare will process and not audit valid ICD-10 codes unless such codes fall into the circumstances described in Questions 6 & 7.

3. What’s a “valid” ICD-10 Code?

• Yes. Not Valid vs. Lack of Specificity required by NCD/LCD or other edit

4. Will claim rejection provider reason?

• “Family of codes” is the same as the ICD-10 three-character category. Don’t report the category5. What’s a FAMILY of codes?

• In certain circumstances, a claim may be denied because the ICD-10 code is not consistent with an NCD/LCD edit (because current automated claims processing edits are not being modified as a result of the guidance. Also, code has to be valid

6. So, no claims denials based on specificity?

• NO. No denial as long as code is in the right family, and is valid.

7. Are the NCDs and LCDs being changed to include the whole family?

Clarification on Edits & Audits

• Knowing what you don’t know is half the battle. Customized alerts keep you informed about changes to ICD-10 coding, payment rates, coverage policy and more.

• Understand Federal and State rules changes in light of constant regulatory change.

• Support complete decision making with complete knowledge. Product integrates compliance, coding, payment, state and federal information.

ICD-10 and MediRegs

Coding Comprehensive electronic

codebooks for ICD-9-CM and ICD-10-PCS with archives

ICD Explorer for dual coding and translation

AHA ICD-10 Coding Handbook AHA Coding Clinic for ICD-10

Payment Integrated ICD-9 and ICD-10

MS-DRG Grouper with Provider Specific Payment Calculator

Upgrade to the MS-DRG Analyzer with Batch Grouping capabilities

Medical Necessity MAC LCDs and Coverage

Articles National Coverage

Determinations

Regulatory CMS Transmittals and

educational material Medicare Manuals IPPS Updates

Educational Webinars Industry expertise in free

webinars with archives of past recordings

Coding & Compliance Suite ICD-10 Resources

Special Products – Upgrade to the ICD-10 Batch Grouper and Payment Analyzer or get help with your ICD-10/MS-DRG Shift Analysis!

ICD-10 CodeBooks & Coding Tools

Personalize: Tailor your page for

more specific LCDs Store searches Bookmark useful pages

Use the left-hand navigation pane to get to all these great ICD-10 resources

ICD-10-CM• Guidelines appear right on

page – No Flipping through the book!

• Codes “exploded out” to the 7th character specificity – No guessing!

• Reportable codes shown in BOLD font

ICD-10-PCS• Familiar Table layout plus

Full code and description shown on screen

• Extensive Definitions and Keys

• Updated automatically with E-mail alerts!

• Save pages and searches to get to your specialty quickly

• Handy indexes from CMS integrated with the book help you understand quality reporting, HAC, HCC and more.

• Delivered with CMS and MAC documents, manuals, coverage determinations and more

Advantages of eBooks

ICD-10-CM CodeBook

• Chapter & Section instructions expand at the top of the page.

• All instructions and guidelines included

• 7th character specificity clearly spelled out

• Bolded code is a valid code

ICD-10 Explorer

ICD Explorer – GEMs Mapping

Here is a great tip: Go to Advanced Search.Search for ICD-10 TITLES ONLY.Store the search!

Coding Guidance Library

AHA Coding Clinic for ICD-10

Upgrade to Compliance & Regulation Suite – PLUS or Audit & Revenue Resource Center for AHA resources integrated in your subscription.

Are you TIRED of seeing this?

All Local Coverage Determinations and Articles are being re-written in ICD-10. Keeping up with the volume of data has become a challenge for CMS and for claims edit systems.

Our state-specific Local and National coverage search is fast, automatically updated, and contains the information you need to fully understand indications and limitations of medical necessity and coding rules.

Medical Necessity

Conversion/Coding Infrastructure Revsions to NCDs Maintenance Updates

• R1199OTN• R1388OTN • R1478OTN• R1537OTNAlso: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html

NCD Coding Guidelines

Coverage Research Simplified

Integrated procedure and

diagnosis coding

LCDs, articles, NCDs, Medicaid

Manuals

Research hundreds of references in one location

MS-DRG Grouper & Calculator

Rayellen KishbachCustomer Success, Healthcare Compliance & ReimbursementLegal & Regulatory Solutions U.S. Wolters KluwerPhone: 888.307.3540rayellen.kishbach@wolterskluwer.com

 

Questions?