ICD-10: Practice Insight Readiness

Presented by:Jim Goerlich – VP of Sales

Agenda

Why ICD-10? Obstacles for ICD-10 Implementation Practice Insight Solution Benefits of the Practice Insight Product

TABLE OF CONTENTS

Why ICD-10?

1. Patient Care: Many improvements have been made to coding in ICD-10-CM. For example,• single code can report a disease and its current manifestation (i.e.,

type II diabetes with diabetic retinopathy). • In fracture care, the code differentiates an encounter for an initial

fracture; follow-up of fracture healing normally; follow-up with fracture in mal-union or nonunion; or follow-up for late effects of a fracture.

2. Increased Specificity: While an ICD-9-CM code may identify a condition of, for example, the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right ovary, left ovary, or bilateral condition of the ovaries.

3. Effect on Practice: The big differences between the two systems are differences that will affect information technology and software at your practice. **

**Source: http://www.aapc.com/icd-10/faq.aspx#why

Why ICD-10?

In short, ICD-10 can:

1. Improve the quality of care

2. Allow providers to code with higher specificity in order

3. Provide better service to patient.

Issue ICD-9-CM ICD-10-CM

Volume of codes approximately 13,600 approximately 69,000

Composition of codes Mostly numeric, with E and V codes alphanumeric. Valid codes of three, four, or five digits.

All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits.

Duplication of code sets Currently, only ICD-9-CM codes are required. No mapping is necessary.

For a period of two years or more, systems will need to access both ICD-9-CM codes and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM. Mapping will be necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits and outcomes studies.

ICD-10 Obstacles

There are 4 main obstacles that practices should prepare to experience: **

1) Training and Re-Training: Most organizations realize their support staff will be required to undertake additional training. a) Code Volume: biller’s required to learn how to utilize roughly 150,000

codes as opposed to the 18,000 associated with ICD-9. Tb) Impact: his additional training could take from 50 to 100 hours for each

biller.

2) Decreased Productivity:   In the short-term, the training period required for the ICD-10 transition:a) reduces physicians and staff time dedicated to their normal dutiesb) patient visits may take longer due to the increased detail of the code

standards.c) submission delays are likely because coders will need to ask questions of

physicians in order to verify information.**Source: http://www.mdbillingexpert.com/icd-10-obstacles/

ICD-10 Obstacles

3) Processing Overlap: a) October 1, 2014 - all claims go out in ICD-10. This is mandated by the

date of service and not the date of transmission. This means any claim with a date of service after October 1st, must go out in ICD-10 format.

b) Dual Claim Submission- If billers are behind they will be required to submit claims in both formats until they get caught up. As a result older claims could be in play for months after October 1st causing claims to be rejected, denied and appended.

4) Stalled Cash Flow: Fallout from the ICD-10 conversion will have an effect on the entire healthcare community likely causing a slowing in cash inflow. During the adjustment period there could be an increase in claim errors and delays.

**Source: http://www.mdbillingexpert.com/icd-10-obstacles/

Practice Insight ICD-10 Solution

Overview:

1. ICD-10 codes and CMS GEMs are loaded directly into the DX Search.

2. All possible scenarios for the ICD-9 to ICD-10 Diagnoses Search are listed in the GEMS Mapping Section.

3. The DX search contains a tree view for diagnosis that contain multiple matches in ICD-10. The tree view shows a parent-child relationship for the code.

4. Users have the ability to reverse search from ICD-10 to ICD-9.

5. The Description field works as a key word search in order to use the search as a stand-alone tool.

Benefits of the Practice Insight ICD-10 Solution

1) The Coding Perspective: You can gain an understanding of your practice’s situation with ICD-10 through the CMS General Equivalent Mappings (GEMs) data. GEMs bridge the language gap between ICD-9 and ICD-10 CM to help understand, analyze, and manage moving to the new code sets.

2) The Reimbursement Perspective: Having a solution that will allow you to identify the codes that have been billed on actual claim data helps the practice identify their most used and highest paid codes and focus on how these codes translate to ICD-10 in order to better predict the potential shift in reimbursement.

3) The Compliance Perspective: This tool along with the existing claim analytics will help the practice make sure that they are currently coding compliant and are prepared to become compliant BEFORE the payer begins adjudicating in ICD-10.

ICD10 Code Analysis Report

Graph

Description: Sorts ICD-9 Codes by Ratio DescendingBenefit: Focus on most used ICD-9’s that may have more

than 1 translation, so user can learn the new code set to determine the most relevant ICD-10 code.

Detail

Description: List most used ICD-9’s by Claim VolumeBenefit: Understand potential impact on revenue.

Question and Answer