1. ICD-10 Financial Risk Assessment and ICD-10 Analytics for Improved Revenue Cycle Data Quality Assessment Why you need it and how to Get Started

2. Agenda Revenue Cycle Clinical & Coding Systems & IT Education & Training Project and Technology Overview Approach Support & Timeline Next Steps hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Agenda 3. High Level Steps and Technology Approach What is RevCore? 1-3 Years Historical Claims Data Upstream Downstream Upload historical claims data Run it through the cloud- based application Receive the most comprehensive set of analytics on the market Summary financial risk information for the C-suite Financial impact data by physician and coder to prioritize training and staffing decisions Encounter-level analytics to help focus CDI, process, testing, and compliance activities Payor contract data organized by reimbursement variations Code-level analysis to drive more revenue-neutrality into remediation Trending capabilities and ICD-10 financial risk benchmark data hp://www.noworldborders.com/blog/ 2013/05/01/icd-10-crosswalk-using-analycs- aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 4. ICD-10 Financial Risk Assessment Overview hp://www.noworldborders.com/blog/ 2013/05/01/icd-10-crosswalk-using-analycs- aconable-informaon/ Areas with most financial risk Areas with most financial opportunity Areas with training / documentation emphasis What we need 2-3 years of claims data (Inpatient and OP/Professional) What you get BI analytics tool with pre- configured reports Areas of most risk and opportunity (physicians, coders, diagnosis/procedure codes, contracts) Strategic training and education focus Payer contract renegotiation strategy Targeted CDI and dual coding enablement Prioritized end to end test strategy ICD-10 RevCore Financial Analysis Foracompletenon-redactedversionofthispresentaon ContactUs 5. Proactively address Medical Necessity-based denials arising from unspecified and lesser specific coding in ICD-10 Reduce 3rd party physician audits (Ex: report level 4/5 E&M codes with unspecified diagnosis codes Avoid increased payor scrutiny Enable a more focused and structured program by prioritizing top risk areas hp://www.noworldborders.com/blog/ 2013/05/01/icd-10-crosswalk-using-analycs- aconable-informaon/ 6. Professional ClaimsICD-10 Risk Examples Otitis Media ICD-10 CM has an unspecified option H66.90, otitis media, unspecified, unspecified ear). This code will most likely raise a payer flag as physicians should state laterality and simply stating ear infection will not be sufficient Asthma ICD-10 CM has an unspecified option J45.90, unspecified asthma. Physicians should avoid this and they should document whether asthma is mild, moderate severe etc. hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 7. Profee ICD-10 Financial Risk Analysis Pinpoint ICD-10 financial risks based on billed and paid amounts due to unspecified / codes with complex maps in ICD-9 (by service line, department, physician etc.) Easier physician engagement (targeted list of codes for education and training) Estimate departmental backfill & productivity needs due to complexity of codes (ex: takes an additional 5 mins. per encounter for a no- map code in ICD-9) Analyze specific denial CAS codes based on medical necessity to update existing denial management practices accordingly hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 8. Analyzed complexity of principal diagnosis codes on outpatient claims Assigned a financial risk probability on each outpatient claim (ranges from 0% to 100%) Used Amount Billed & Paid to determine potential payments in ICD-10 Rolled up financial impacts across departments and physicians and coders Performed a code mapping and translations analysis Analysis Approach (Outpatient/Professional Claims) hp://www.noworldborders.com/blog/ 2013/05/01/icd-10-crosswalk-using-analycs- aconable-informaon/ Factors accounted for: Unspecified codes in ICD-9 Complexity of ICD-10 translation (One to One, One to Many, Combination, Cluster scenarios) Foracompletenon-redactedversionofthispresentaon ContactUs 9. Outpatient/Professional Risk Examples hp://www.noworldborders.com/blog/ 2013/05/01/icd-10-crosswalk-using-analycs- aconable-informaon/ ICD 9 (Principal Diagnosis) ICD 10 (Principal Diagnosis) 585.9 - Chronic kidney disease, unspecified N189 - Chronic kidney disease, unspecified Full risk as the unspecified code in ICD-9 maps 1:1 to an unspecified code in ICD-10 707.13 Ulcer of ankle L97309 - Non-pressure chronic ulcer of unspecified ankle with unspecified severity Full risk as the only option in ICD-10 is unspecified 823.82 - Closed fracture of unspecified part of fibula with tibia S82201A - Unspecified fracture of shaft of right tibia, initial encounter for closed fracture S82202A - Unspecified fracture of shaft of left tibia, initial encounter for closed fracture S82401A - Unspecified fracture of shaft of right fibula, initial encounter for closed fracture S82402A - Unspecified fracture of shaft of left fibula, initial encounter for closed fracture Full risk as all 4 options in ICD-10 are unspecified 729.1 - Myalgia and myositis, unspecified M609 - Myositis, unspecified M791 - Myalgia M797 Fibromyalgia Some risk as only 1 option in ICD-10 is unspecified, there are 2 more specific options to choose from Foracompletenon-redactedversionofthispresentaon ContactUs 10. Drive actionable intelligence Are easy to read/interpret Provide drill down capabilities Are easily customizable to the audience Can translate into remediation strategies that drive revenue neutrality Management Reports hp://www.noworldborders.com/blog/ 2013/05/01/icd-10-crosswalk-using-analycs- aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 11. Project Overview Revenue Cycle Clinical & Coding Systems & IT Education & Training ICD-10 Financial Risk Assessment Inpatient Claims Analysis Hospital OP and Professional Claims Analysis Deliverables (Several reports) Inpatient Financial Risk / Opportunities Outpatient Financial Risk / Opportunities Professional Financial Risk / Opportunities Physician and Coder Training and Education Analysis Reports Online secure portal access Customized dashboards and insights hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ ProjectScopeandHigh-LevelDeliverables Foracompletenon-redactedversionofthispresentaon ContactUs 12. Inpatient claims Outpatient claims Professional claims In-Scope hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ ScopeofClaims 13. Data Gatheringduring which we obtain 12-36 months of historical claims data using HIPAA EDI transactions (837 I and P). Reimbursement Simulationduring which we run the RevCore reimbursement simulator and perform: Simulations of the target ICD-10 state MS-DRG v30 model calculations Additional proprietary calculations within the tool suite Advanced Analyticsthrough which we: Determine future state reimbursements Identify the top, highest risk codes Establish physician and coder training priorities Identify areas for operational improvements Approach hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ ProjectScopeandHigh-LevelDeliverables Foracompletenon-redactedversionofthispresentaon ContactUs 14. Duration of claims to be sent (12, 24, 36 months) Format of claims (837/835 transactions OR proprietary format or mix of both) Additional data considerations: Updates to Product line configuration Decision Support / Service Line Data to enable reporting at a service line level hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 15. Client Role Responsibilities Allocation IT Analyst Provide needed data extracts 2-4 hours Key Department Administrators Review and approve department specific outputs and assumption Review analytics layouts on portals and provide customization requirements (if any) 1-2 at the end of draft review 1-2 hours at the end of the final deliverable review ICD-10 Project Lead Coordinate project activities Review and approval all deliverables/outputs 2-4 hours/week Conemaugh support hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ TeamRoles,Est.TimeCommitment Foracompletenon-redactedversionofthispresentaon ContactUs 16. week 1 2 3 4 5 Obtain historical claims data X Review data and gather clarifications X Confirm data and start analysis X X Perform reimbursement simulation for Inpatient and outpatient claims X X Perform Review of Draft Outcomes X Review and prepare analysis X Review and sign off X Timeline hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 17. Schedule and Results hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Foracompletenon-redactedversionofthispresentaon ContactUs 18. Next Steps Revenue Cycle Clinical & Coding Systems & IT Education & Training Confirm resources to work with and detailed data requirements No World Borders key contact points Obtain relevant data from provider hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ NextSteps 19. LLIISSTT OOFF RREEPPOORRTTSS AANNDD DDEELLIIVVEERRAABBLLEESS Appendix hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ 20. List of Reports and Deliverables hp://www.noworldborders.com/blog/2013/05/01/icd-10- crosswalk-using-analycs-aconable-informaon/ Outputs/Reports InpaentReimbursement SimulaonsDecisionSupport Overallorganizaonalnancialimpactsummaryreport Reimbursementsummaryreport(ICD9toICD10Min/Max/Average) Reimbursementvarianceimpactreportsin(%)beforeandaer Totalcodetranslaonsreport FinancialImpactsummarybyMDC ImpactanalysisbyMDC ImpactanalysisbyMS-DRG ImpactanalysisbyServiceTypes/Departments ImpactanalysisbyPhysiciansandCoders ImpactanalysisbyPayercontractsandbreakoutbyMedicare,Commerciallinesofbusiness InteracveanalycaldashboardgroupingDepartments,MDC,DRGShis,Encounters,PhysiciansandCoders Top5DRGsatriskofreducedreimbursement* Top5DRGswherethereisopportunitytoenhancereimbursement* Top10DRGsbyclaimvolumeandclaimdollar* DRGshisintop5MDCs* Topprincipaldiagnosisandprocedurecodeswithmostdollarriskandopportunityforreimbursementenhancement* DRGvariaonsummaryreport(claimsreportwheremulpleDRGswerepossible) DRGmismatchreportidenfyingareasofexposuretopriorizecoding,documentaonandoperaonalacvies Topcodes/encounterswiththepotenalforappealsanddenialsinICD-10* Topcodes/encounterswiththepotenalforincreaseddecisionsupportandCDIprograms* Revenueriskexposureindollars OutpaentReimbursement SimulaonsDecisionSupport Outpaent:nancialriskanalysis Outpaent:codetranslaonsreport Producvityandtrainingimpactsbydepartments,servicelines Priorizedphysicianandcodertrainingareas ProducvityImpactAnalysis CountofimpactedFTEsandrolesbyalldivisions Organizaonalresourceandbackllplan PhysicianandCoderTrainingand EducaonAnalysis PhysicianandcodertrainingareaswithmaximumexposuretonancialriskbyDRG,MDC,andprocedurecodes Recommendedtrainingplanbyrole Foracompletenon-redactedversionofthispresentaon ContactUs