WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to...
Transcript of WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to...
WELCOME
Confidential & Proprietary
Affinity ICD-10 Testing
to
Affinity ICD-10 Testing
Confidential & Proprietary
Revenue Cycle Team
October 30, 2014
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Agenda Impact of ICD-10 Delay Affinity ICD-10 Revenue Cycle Overview Release Timelines Regulatory Discussion
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But First……. John in 2009
Where to
start?
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Foundational “Truths”
•After 10/1/15 – 100% of coding is ICD-10 •Payer’s lack of compliance is a billing problem - not a coding problem
•Payer is not ready: Reimbursement Mapping Table(s) used
Affinity ICD-10
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Impact of ICD-10 Delay
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2015-2016 – Impact of ICD-10 Delay
Legislative Mandate
336 Days…240 weekdays
The clock is ticking…
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2015-2016 – Impact of ICD-10 Delay
Estimated 1 BILLION Dollars……
to
$6.6B
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2015-2016 – Impact of ICD-10 Delay
$
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2015-2016 – Impact of ICD-10 Delay User Group User Ballot Client Communication
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2015-2016 – Impact of ICD-10 Delay WEDI Survey • Top ICD-10 Provider concerns:
1. Accurate claims and adjudication process 2. Increase in denied claims and appeals 3. Increased operational costs (training/proper use of
ICD-10 codes) 4. Impact of DRG reimbursement
• Payer & Provider Preparedness As of August, over 50% of payers and ≈ 33% of
providers have started external testing
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QuadraMed Business Intelligence
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Affinity ICD-10
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Affinity ICD-10
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Med Learn Matters 8858 – 8/22/14 Transmittal R1423OTN
• Defines testing weeks – acknowledgement testing only 11/17/14 – 11/21/14 3/2/15 – 3/6/15 6/1/15 – 6/5/15
Med Learn Matters SE1409 – 7/31/14 • Mentions End-to-End testing (test 835s) Limited group of Providers Additional details about the end-to-end testing process will
be disseminated at a later date in a separate MLN Matters article.
Affinity ICD-10
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System wide updates to support ICD-10 – M12 • Registration • MRA/DRG • Patient Accounting/EDI
Facility Editable Implementation Date Support billing with both code sets
• Support via Reimbursement Mapping Table ICD-10 Codes “translated” to ICD-9 Codes
• Control at the Payer level • New “versioned” ICD file supporting both code sets
Affinity ICD-10
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Affinity ICD-10
ICD-10 ICD-9
Full ICD-10
Description
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Encoder updates • Nuance integration update • 3M interface update
Testing capabilities – testing in “Live” • Test MRA ICD-9 Live/ICD-10 Test
• v5010/ICD-10 test claims Interface specific configuration • Outbound….ICD-9, ICD-10 or both
Query migration services
Affinity ICD-10
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Each client is responsible for reviewing your custom queries/reports to determine if changes need to be made for M12 ICD-10 changes How many queries have you written/modified at your site that use the ICD Diagnosis or Procedure code fields? How do you identify queries that need to be reviewed? • Services Identify queries needing review Assess queries needing changes QuadraMed engagement to make changes
ICD-10 Query Impact Overview
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M12SP1 Product
M12SP1 ICD-10 Train/Test ICD-10 Effective Date:
1/1/14
M12SP1 Support ICD-10 Effective Date:
10/1/15
M12SP1 Live ICD-10 Effective Date:
10/1/15
ICD-10 Primary Code Set
ICD-9 Primary Code Set
Affinity ICD-10
Please keep current on releases
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Support ICD-10 Pilot DRG grouper (Update 2) • Used with testing utilities in “Live” only • Grouping done in “encoder” – 3M/Nuance • Pricing done in Affinity Ongoing updates to the ICD-9/ICD-10 and Reimbursement Mapping Tables Use of ICD-9 Grouper post ICD-10 date (Update 3) • Support DRG grouping using mapped ICD-9s post date
ICD-10 Updates
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ICD-10 testing success stories? • What went well…. • What didn’t go so well….
Testing with Clearinghouses? • Ability to connect to multiple Payers? • Guidance
Anyone sign up for end-to-end testing?
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REVENUE CYCLE OVERVIEW
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GA of Affinity M12 (July 2012) • ICD-10 ready release • Built in testing capabilities • Supports payer billing adoption (or lack of) M12 Service Pack 1 delivered on-time • Therapy Cap solution delivered QuadraMed Business Intelligence (QBI) GA Q412 • 3 sites live QuadraMed Contract Management (QCM) migration to .NET Access Quality Manager (AQM) live at Hunterdon M15 in development/QA
Affinity Accomplishments
QuadraMed
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Customers Believe It
Industry Leading Solutions
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Customers Believe It
Industry Leading Solutions
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Industry Leading Solutions
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Release Timeline
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Release Timeline ICD-10 10/1/15: Roll Out Strategy CMS ICD-10 Industry Adoption 10/1/15
Affinity Release M12 (GA July 2012) – Cache 2011 M12SP1 (GA April 2013)
Update Releases scheduled as needed Affinity Release M15 (projected GA Q115)–HealthShare
Major releases (M12/M15) locked down thru ICD-10 migration
Update Releases scheduled as needed ICD-10 implementation 10/1/15 Affinity Release M16 (projected GA Q416)
Return to predictable yearly cycle
Subject to Change
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2014 Q2 Q3
2015 Q1
GA
Q4
Major Activities: ICD-10: Preparation & testing Prepare for “Go Live” Update releases as necessary
GA
ICD-10 Update Special Release
ICD-10 Update Special Release
M12SP1U1
ICD-10 Update Special Release
M12SP1U3
GA
Release Timeline Affinity 2014 Projected Schedule
Subject to Change
GA
QCM 14.0
GA
QCM 14.1
GA
QBI 1.2
Please keep current on releases
M15 to Beta
Beta
M12SP1U2
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2015 Q2 Q3
2016 Q1 Q4
M15 GA
EDI / ICD-10 Updates RCM/ERM/ACW Updates Rapid OP Admit Denials Workflow APC Batch Automation Delete/Hide Payer User Ballot Enhancements …..
GA
GA
QBI 2.0
ICD-10 Update Special Release
GA
If necessary
GA
QCM 15.1
QCM 15.0
Subject to Change
10/1/15 ICD-10 Implementation
ICD-10 Update Special Release
GA
If necessary
Major Activities: ICD-10: Preparation & testing Prepare for “Go Live” Update releases as necessary
Please keep current on releases
Release Timeline Affinity 2015 Projected Schedule
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Key Milestones • EDI Transaction sets v5010 – required for ICD-10 1/1/12 Addenda pending
• Therapy Caps – Released Q413 • National Health Plan Identifier (HPID) - 11/7/16?? • Operating Rules for EDI (CARC/RARC) – 2013 - ongoing • Medicaid movement to APR-DRG - ongoing • Migration to ICD-10 10/1/15 • Bundled Inpatient billing post discharge – 2013 • 275 Additional Information to Support a Health Care Claim
or Encounter (NPRM – Sept 2005) - Now post ICD-10 1/1/17??
HIPAA Watch
Subject to Change
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Propensity to Pay Tools • Credit Score used in collections • Charity Assessment enhancements • Patient Liability Estimation
Appeals Management GUI Uplift User Ballots Business Intelligence (QBI) – ongoing
• Payer Scorecard • DNFB Reporting
Contract Management (QCM) – ongoing Regulatory Updates - ongoing
On the Horizon – 2016 & 2017
Subject to Change
Questions