[email protected] Know.Right.Now Presented by: Rayellen Kishbach 2015 ICD-10 Tools...
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Transcript of [email protected] Know.Right.Now Presented by: Rayellen Kishbach 2015 ICD-10 Tools...
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: [email protected]
Questions?
