ICD-10: Prepare, Implement, and Train

Transcription

1 ICD-10: Prepare, Implement, and Train Source Medical Solutions, Inc. October 2013 For more information, please visit or call

2 1 Executive Summary There are numerous documents regarding ICD-10, however very few focus specifically on outpatient rehabilitation. This paper is designed to help fill this gap and provide new insights on the ways your clinic can prepare for the October 1, 2014, ICD-10 deadline. This paper will cover the following topics: ICD-10 overview How you should prepare for ICD-10 as an outpatient rehabilitation provider Implementation Training How technology can help

3 2 Contents Executive Summary... 1 Contents... 2 ICD-10 Overview... 3 Preparing for ICD-10: A Provider Focus... 5 ICD-10 Implementation... 6 How Technology Can Help - TherapySource... 8 Recommendations for Success... 9 Resources... 9

4 3 ICD-10 Overview What ICD-10 is a coding system for medical diagnoses and inpatient procedures. In the United States, ICD-10 includes: ICD-10 CM for diagnosis coding ICD-10 PCS for inpatient procedure coding For this white paper, we will focus on ICD-10 CM for the outpatient rehabilitation market. Why ICD-10 is much more granular than its predecessor, ICD-9. ICD-9 only produces limited data about patients medical conditions and hospital inpatient procedures. ICD-9 is over 30 years old, has outdated terms, and is inconsistent with current medical practice. Its structure limits the number of new codes that can be created. When The big date is Wednesday 10/1/14. Outpatient services are based on the Date of Service and inpatient services are based on the Date of Discharge. Compliance with 5010 is necessary. Who All HIPAA-covered entities must use ICD-10 for information they transmit electronically. ICD-9 Limitations ICD-10 Benefits Unable to capture all pertinent information related to a diagnosis (i.e. Low Back Pain ) Codes are not always optimal or reflective of a patient s condition Claims data is difficult to analyze because of the code set limitations Decision making for healthcare policies lacks important analytical information Improved explanation of the patient s condition; increased granularity can improve practice management decisions Improved analysis of claims data to support policy, utilization, and compliance decisions Better support for strategic planning by payers and providers Improved data for research purposes and public health decisions

5 4 ICD-9-CM X X X X X Category Etiology, Anatomic Site, Manifestation 3-5 characters First character can be alpha or numeric Second, third, fourth and fifth characters are numeric At least three characters ICD-10-CM X X X X X X X Category Etiology, Anatomic Sites, Manifestation Extension 3-7 characters First character is alpha All letters but U are used Second and third characters are numeric Fourth, fifth, sixth and seventh characters can be alpha or numeric S X X 6 X 4 4 X 9 X 0 X A This example of an ICD-10-CM code is for the injury of digital nerve of right index finger, initial encounter. As you can see, an ICD-10-CM code provides far greater specificity than current ICD-9 codes. In fact, there are several ICD-10 codes that would require multiple ICD-9 codes to code the same diagnosis using ICD-9.

6 5 Category Etiology, Anatomic Site, Severity Extension X X X X X X X Note: Utilize no less than 4 characters Example: Sprain of the ankle S possible ICD-10 codes for Sprain of the ankle, compared to 5 ICD-9 codes for Sprain of the ankle Preparing for ICD-10: A Provider Focus Create a cross-functional team Prepare for and address the clinical, financial and information system needs. Create a strategy and objectives Manage the ICD-10 transition for the facility. Identify the needs and action plans for the transition Education and resources o Utilize education and training resources provided by WHO, CDC, CMS, AHIMA, APTA and payers Financial impact and payer preparation Documentation improvement Vendor preparation Financial preparation Identify costs associated with ICD-10 changes in your practice, business processes and system, including upgrades with your current vendors. Potential ICD-10 costs include updates to practice management systems, new coding guides and resources and staff training. Design and prepare a budget to cover the implementation and transition expenses. Plan for additional resources both staff and financial to respond to denied claims. Consider establishing a line of credit to cover cash flow issues that may arise.

7 6 Plan and evaluate cash reserves Documentation preparation Assess quality of current medical record documentation to identify improvement opportunities. o Documentation to support ICD-10-CM detail may be better than expected. Medical record review sampling techniques could include: o Random samples o Sampling by clinical specialty o Top diagnoses o Diagnoses known to represent documentation problems today ICD-10 Implementation October 1, 2014 is the compliance deadline for implementation of ICD-10-CM (diagnoses). ICD- 10-CM (diagnoses) will be used by all providers in every healthcare setting. ICD-10 will not be accepted on claims for services prior to the implementation date. Compliance with 5010 is necessary. CPT/HCPCS codes will not be impacted. All HIPPA-covered entities must use ICD-10 for information they transmit electronically. Be sure to communicate with your vendors, payers and clearing house partners Inquire about costs involved to transition to ICD-10. Ask when upgrades or new systems will be available. Will they provide training? Monitor clearinghouse and payer policies and websites for information on their transition activities. Some lessons can be learned from ICD-10 transitions from other countries, such as the 2001 implementation in Canada: slower filing, confusion, more denials and a temporary revenue drop. It will be necessary for coders to have access to detailed documentation to assist with coding claims. Don t forget to communicate with all stakeholders before, during and after the ICD-10 implementation. ICD-10 Transition Track the productivity of both your clinicians and billers to make sure there isn t any decrease. Monitor patient satisfaction during the transition period to make sure patient - centered quality care remains a focus.

8 7 Closely track claim billing cycles and A/R days. Stay on top of denial rates and payments against contracted rates. Identify the level of education needed for each of your staff members (front office, clinicians, billing and any additional staff). Pick the best training options: o Coding books o Mapping tools o Associations o Online courses o Class training o Webinars Develop the skills necessary to support ICD-10 implementation within your practice: o Provide training to appropriate staff on the ICD-10 code sets, associated coding guidelines, General Equivalence Mappings (GEMs), or other preferred ICD-10 mapping tools. o Relay the importance of accurate coding among staff. o Identify knowledge and training champions to serve as points of contact for your office staff on ICD-10. Train on clinical documentation improvement initiatives: o Prioritize the clinical conditions most commonly encountered in your practice. o Identify new documentation concepts that will be required to support ICD-10 with a focus on the most common conditions you see. Train on the software enhancements. Start formal training at least 6 months prior to the implementation date (April through September 2014). Make sure you have an effective training program, so that all of your staff members are experts by October.

9 8 How Technology Can Help - TherapySource Technology can play an important role in making the transition easier in times of regulatory changes and rules. TherapySource has been tailored to streamline the transition by providing: Improved search capability Support for both ICD-9 and ICD-10 after October 1 st Ability to create preferred diagnosis codes and preferred diagnosis code sets Ability to control which code set sent to billing system Audit capability for ICD-9/ICD-10 based on Date of Service Improved Search Capability Eliminate the need to perform an alpha search and then search the tabular list for the diagnosis code or description. TherapySource allows you to create your own keywords to make it easier to find your top diagnosis codes. As you engage in ICD-10 preparations and set up preferred codes and codes sets, be sure to research and find your top keywords. Ability to Support Both ICD-9 and ICD-10 Codes Not all payers will be ready to switch to ICD-10 on October 1st. So it will be necessary to submit ICD-9 to some, 10 to others. TherapySource will support payers that don t transition on Oct 1 and define the appropriate diagnosis code set at the payer level. You can also provide automatic claim splitting for ICD-9 and ICD-10 codes based on date of service. Create Preferred Diagnosis Codes and Preferred Diagnosis Code Sets Define your own ICD-10 subset of codes down to the payer level Define the default preferred diagnosis code sets down to the payer level Assist with Non-Covered Entities that transition at a later date Control which Code Set is Sent to the Billing System You have control over how and when to send. For example, if you have patients in August and September- and if you know there s a high probability that you ll see them in October- begin adding the ICD-10 codes to those patients clinical documentation. You have control in the system to only send ICD-9s until September 30 th and, effective October 1 st, you can only send ICD-10s. Audit Capability for ICD-9/ICD-10 based on Date of Service TherapySource can verify the right code has been selected based on the defined parameters and the Date of Service. TherapySource also provides enhanced diagnosis code reporting.

10 9 Recommendations for Success Start Preparing Now If you haven t started preparing for ICD-10, you need to begin now! Develop a project plan, create an ICD-10 team, and pick a champion (or multiple champions). If you haven t communicated directly with your payers, or built a budget, you need to do that now. Set your resources for 2014 so, with effective planning, you can budget for the transition before and after, and your staff won t be caught off guard. Resources World Health Organization: CMS: Centers for Disease Control (CDC): AHIMA: APTA: Source Medical Client Portal: