Agenda Agenda Placeholder ICD10 Are You Prepared Agenda

Agenda • Agenda Placeholder ICD-10 Are You Prepared? • Agenda Placeholder February 26, 2013

Our Presenter – Betty Gomez w Betty Gomez § VP of Regulatory Strategy § Zir. Med’s Industry Liaison § 21 Years of Health Care EDI Experience

Webinar Topics • • ICD-10 Background – Final Rule Why is the Industry Going to ICD-10? Comparing ICD-9 to ICD-10 Understanding the Global Impact of ICD-10 Timeline Preparing for ICD-10 – Provider Focus Industry Readiness – Where We Stand Today Raintree Product Readiness

ICD-10 Background • January 16, 2009, the Federal Government issued a new HIPAA rule requiring the adoption of ICD-10 -CM diagnosis codes and ICD-10 -PCS procedure codes for all dates of service on or after October 1, 2013. • April 9, 2012, the Office of the Secretary, HHS (Health and Human Services) proposed a rule to change the ICD-10 compliance date to October 1, 2014. • Compliance with 5010 is necessary prior to implementing ICD-10.

What is ICD-10? • A coding system for: —Diagnosis ICD-10 -CM —Procedures ICD-10 -PCS • Affects: —All Providers in every healthcare setting (Diagnosis) —Inpatient Hospitals (Procedure Codes) —It is NOT CPT or HCPCS • It Replaces, and is much more Granular than ICD-9 • Compliance Date: Oct 1, 2014

Imagine…

Single Implementation Date for all Users September 30 English October 1 German (AND English)

Greater Granularity = More Codes

Why Move To ICD-10? More precise Better Fraud Detection ICD-9 is 25 years old Better Quality of Care Population Health Analysis Greater Accuracy in Reimbursements

DIAGNOSIS CODE STRUCTURE From X X X 3 -5 characters in length To X X X 3 -7 characters in length X X

ICD-9 -CM ICD-10 -CM 3 -5 characters in length 3 -7 characters in length Digit 1 may be alpha or numeric Digits 2 -5 are numeric Digit 1 is alpha Digits 2 -3 are numeric Digits 4 -7 are alpha or numeric Lacks laterality Allows laterality and bilaterality Does not support interoperability Supports interoperability 842. 01 –Wrist Sprain and Strain of Carpal S 63. 511 A –Sprain of Carpal Joint of Right Wrist

Example - Diagnosis Old 365. 71 New H 40. 1211 H 40. 1221 H 40. 1231 H 40. 1291 H 40. 1311 H 40. 1321 H 40. 1331 H 40. 1391 H 40. 1411 H 40. 1421 H 40. 1431 H 40. 1491 Mild Stage Glaucoma Low-tension glaucoma, right eye, mild stage Low-tension glaucoma, left eye, mild stage Low-tension glaucoma, bilateral, mild stage Low-tension glaucoma, unspecified eye, mild stage Pigmentary glaucoma, right eye, mild stage Pigmentary glaucoma, left eye, mild stage Pigmentary glaucoma, bilateral, mild stage Pigmentary Glaucoma, unspecified eye, mild stage Capslr glaucoma w/pseudxf lens, right eye, mild stage Capslr glaucoma w/pseudxf lens, left eye, mild stage Capslr glaucoma w/pseudxf lens, bilateral, mild stage Capslr glaucoma w/pseudxf lens, unspecified eye, mild stage

PROCEDURE CODE STRUCTURE X From X X X 3 -4 numbers in length To X X X 7 numbers in length X X

ICD-9 -CM VOL 3 ICD-10 -PCS 3 -4 numbers in length 7 alpha-numeric characters in length Based on outdated technology Generic terms for body parts Reflects current usage of medical technology and devices Lacks description of methodology and approach for procedures Provides detailed descriptions of methodology and approach for procedures 47. 01 - Laparoscopic appendectomy 0 DBJ 4 ZZ - Excision of Appendix, Percutaneous Endoscopic Approach

Example - Procedure Old 84. 01 New 0 X 6 N 0 Z 0 0 X 6 N 0 Z 1 0 X 6 N 0 Z 2 0 X 6 N 0 Z 3 0 X 6 P 0 Z 0 0 X 6 P 0 Z 1 0 X 6 P 0 Z 2 0 X 6 P 0 Z 3 0 X 6 Q 0 Z 0 0 X 6 Q 0 Z 1 Finger Amputation Detachment at Right Index Finger, Complete, Open Approach Detachment at Right Index Finger, High, Open Approach Detachment at Right Index Finger, Mid, Open Approach Detachment at Right Index Finger, Low, Open Approach Detachment at Left Index Finger, Complete, Open Approach Detachment at Left Index Finger, High, Open Approach Detachment at Left Index Finger, Mid, Open Approach Detachment at Left Index Finger, Low, Open Approach Detachment at Right Middle Finger, Complete, Open Approach Detachment at Right Middle Finger, High, Open Approach

Understanding the Global Impact of ICD-10 • THIS IS A BUSINESS ISSUE WITH LARGE IMPACTS • Impacts Include Many Entities: • Providers, payers, vendors, employers, schools, agents • Members/patients, business associates/trading partners • Workers’ compensation, state agencies • Transplant/disease registries, etc.

ICD-10 Timeline • Analyze the impact ICD-10 will have on your practice • Review payer contract for diagnosis • Talk with vendors regarding upgrades for ICD-10 • Schedule software upgrades • Monitor payer alerts and readiness. • Prepare for testing with payers and/or clearinghouse. ASAP • Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years. Beyond 2013 ASAP • Budgeting for ICD-10 impacts such as, system upgrades and training 2014 • Coder/biller training • Review practice readiness

Care Flow Assessment Claim Submission Documentation Coding Treatment Documentation

Major Provider Impacts • Clinical Documentation —Practitioners! • Coding • Business Processes —Superbills / Day Sheets • PM/HIS/EHR Systems 77% Indicate Top Challenge • • Medical Policies Contracting Staffing / Staff Training Denials, Audits, Revenue Disruption —Need Generous Lines of Credit For Physicians • Physicians deal with diagnosis not codes • Learn new ICD-10 codes • Learn how to use an index • Create a new job aid or superbill (Professional Providers get paid on CPT code not DRG)

Preparing for ICD-10 Provider Focus • Identify the Needs and Action Plans for the Transition • Education and resources • Information Systems inventory and gap analysis • Vendor preparation • Documentation improvement • Financial impact and payer preparation • AHIMA Published a Checklist About Preparing for ICD-10: http: //www. ahima. org/downloads/pdfs/resources/checklist. pdf

ICD-10 Project Plan • Phase 1 Assessment Implementation Plan Development and Impact • Phase 2 Risk Mitigation and Implementation Preparation • Phase 3 “Go Live” Preparation • Phase 4 Post-implementation Follow Up

Industry Readiness • The Workgroup for Electronic Data Interchange (WEDI) conducted an industry ICD-10 readiness survey in February 2012 – • Results showed that health care entities were falling behind recommended timelines for implementing ICD-10 code sets by 10/1/13. • Responses indicated some progress had been made, but not keeping up with milestones. • Industry is falling behind • New proposed rule to implement ICD-10 on October 1, 2014 instead of 2013. • WEDI sent out a new survey in January 2013

Zir. Med Strategy Value-Add Solutions and Services Outsourced Analytics ● Education ● Consulting ● Code Translation Helping Providers Prepare Webinars ● Playbook ● Assessments ● Get-Well Plans ● Pilots ● Testing Getting Zir. Med Prepared Organization ● Remediation ● Internal Training ● Staffing ● Measuring Success

Helping Providers Prepare • • • Awareness Webinars Assessments Get-Well Plans Pilots End-to-End Testing Resource Center ICD-10 Survival Tool Kit Internal Education

Value-Add Services and Solutions • • Analytics Data Translation Education Consulting

Analytics • Insights Analytics —Utilized in the early planning timeframe (early 2013) —Show Code Usage in the facility —Show code usage extrapolates into ICD-10 codes —Show 80/20, 90/10, 99/1 code usage for prioritization of focus —Show top revenue impacts • Transition Analytics —Utilized after Transition (after Oct 1, 2014) —Show impact of ICD-10 on claims outcomes via remits analysis

Zir. Med ICD-10 Timeline • • • Set up ICD-10 Resource Center Zir. Med Survival Tool Kit Webinars System Remediation National Pilot ICD-10 Testing • Code translation Tool • Testing Portal • Begin testing with Providers and Payers 1 QTR 2013 • Maintain dual codebases for ICD-9 and ICD-10 for approximately 2 years. Beyond 3 QTR 2013 2 QTR 2013 • Education & Consulting Offerings • ICD-10 Analytics 2014 • ICD-10 Transition Analytics – June • Oct 1 st start submitting ICD-10 codes

Raintree Product Readiness Supported Versions: - Can create claims with ICD-10 now - 9. 3 and higher will support ICD-10 - Standard ICD-10 tables available Q 2 2013 Work with us on new ICD-10 features! - Bariatric User Group: Richard Harwell - Therapy User Group: Kathryn Rigda - Standard/Billing User Group: Clayton Case http: //usergroups. raintreeinc. com

Takeaways • ICD-10 is a Provider Initiative. Zir. Med is here to help, but we cannot solve this for them like we did 4010 / 5010 • The impact on ICD-10 to providers is very real • Providers need to be making progress NOW towards ICD-10 readiness

In Conclusion • • ICD-10 is just a more mature ICD-9 ICD-10 is inevitable Work for physicians is negligible ICD-10 cost for offices can be small Work for institutions is worthwhile Good preparation is critical Communication is vital Embrace it; Don’t postpone it

Resources • • Zir. Med ICD-10 Resource Center – Support Center CMS Website: http: //www. cms. hhs. gov/ICD 10/ AHIMA Website: http: //www. ahima. org/icd 10 WEDI: http: //www. wedi. org