THE CLOCK IS TICKING ON THE TRANSITION TO

THE CLOCK IS TICKING ON THE TRANSITION TO ICD-10 WILL YOUR PRACTICE BE READY? Entire Presentation Copyright 2014.

PHYSICIANS ARE NOT ON BOARD

WHAT IS THIS? ICD-9 • International Classification of Disease, 9 th Revision. • A list of 14, 000 numerical codes used for a specific diagnosis. • In use for 30 yrs. • Inadequate for further expansion of current medical science.

ICD-10 • An entire new coding system with 69, 000 codes. • The number of new codes for any physician depends upon their specialty • i. e. Orthopedics – 747 to 17, 099! • 13 codes for different injuries cause by spacecraft

ICD-9 : ICD-10 TWO COMPLETELY DIFFERENT CODING “LANGUAGES”

ICD-9 COMPARED TO ICD-10

OCTOBER 1, 2015? • Unknown whether HHS will delay again… • Affects EVERY healthcare provider covered by the Health Insurance portability and Accountability Act (HIPAA) in the USA. • Even those medical practices that are CASH ONLY

WHY IS THIS A BIG DEAL? BECAUSE NO CLAIM WILL BE PAID IF IT DOES NOT USE THE PROPER CODING SYSTEM. • BEFORE Oct 1 - All claims for services and facility discharges will be processed using ICD-9 • AFTER Oct 1 - All claims for services and facility discharges will be processed using ICD-10. • This means that for a time after October 1, physicians, staff and billing personnel will be required to work within both coding systems as they submit claims.

GENERAL EQUIVALENCY MAPPING (GEMS) = “TRANSLATOR”

TRANSLATING BETWEEN “LANGUAGES” English (ICD-9) “House” Spanish (ICD-10) “Casa”

TRANSLATION IS NOT ALWAYS 1: 1 English (ICD-9) Spanish (ICD-10) “EL” “The” El Hombre “LA” La Mujer

MULTIPLE CHOICES TO MORE SPECIFICALLY DESCRIBE THE PATIENT’S CONDITION ICD-9 ICD-10 • 707. 14 • L 97. 401 – L 97. 429 • I 70. 234 - I 70. 744 • “ulcer of lower limb, heel or mid-foot” • • Laterality (L vs. R)? Skin breakdown? Fat exposed? Muscle breakdown?

PHYSICIANS WILL NEED TO DOCUMENT IN MORE DETAIL

ICD VS. CPT? ? • ICD = International Classification of Disease (diagnosis) • i. e. “bronchitis” • CPT = Current Procedural Terminology (treatment) • i. e. = Antibiotic prescription • The only coding changes for PROCEDURES will be for those that are in a facility (hospital, surgery center, etc)

PREPARING FOR THE TRANSITION 1. Appoint a Transition Coordinator (or team) • Responsible for all aspects of the transition • Should be allotted the time to attend to all the details. • Communicate plan and timeline to all office/professional staff • Convey the importance of this change in providing patient care

PREPARING FOR THE TRANSITION 2. Establish a Plan • Refer to CMS timelines • Identify tasks to be completed and in what order. • Assign start and completion dates for each task • Create a budget • Learn the required resources (i. e. GEM)

PREPARING FOR THE TRANSITION 3. List Every Place Codes are Used • • Coding manuals Medical records Superbills Practice Management and Billing Systems Physician Orders Authorizations/pre-certifications Locations Outside the Primary Practice Site

PREPARING FOR THE TRANSITION 4. Authorize a Budget • • • Software upgrades Licensing costs Hardware procurement Staff training Revision of forms Work flow changes

PREPARING FOR THE TRANSITION 5. Begin Training • Obtain ICD-10 coding books early in 2015 • Look up/translate most commonly used ICD-9 codes • Begin “double-coding” as many patient encounters as possible (i. e. document both in “English” and “Spanish”) • Many EMRs are already loaded with both sets of codes (like EMRx!). If so, review those codes with every patient encounter.

PREPARING FOR THE TRANSITION • Begin 6 -9 months before transition date. • Many online sources for training • Certified coders may see many ICD-10 coding modules integrated into the CEUs they must take to maintain certification

PREPARING FOR THE TRANSITION Communicate Early with Vendors! EMR/Practice Management System • Is the practice’s EMR ready with the ICD-10 codes? If not, when they will be? • What costs are involved? • How much tech support will they provide? • How will those updates be installed into the system? (cloud-based vs. serverbased)

PREPARING FOR THE TRANSITION Communicate with Vendors • Clearinghouses • Coding services • Billing services • If their software is not up to date, they cannot process claims!

PREPARING FOR THE TRANSITION • All affiliated practice locations – hospitals, ASCs • All referral medical facilities – labs, radiology

PREPARING FOR THE TRANSITION • Communicate with the Insurance Companies! • Rules for coverage • Rules for authorization • They will expect office personnel to be “bi-lingual”

PREPARING FOR THE TRANSITION • Set up a Testing Schedule with all parties involved (office staff, coders, billers, clearinghouses, insurance companies) long before October 1 st • You want to assure the entire system front to back end works smoothly so there are no rejections of claims!

PREPARING FOR THE TRANSITION • Submit pre-October 1 st claims ASAP to keep them from getting caught up in the deluge of glitches that will likely occur after that date.

PREPARING FOR THE TRANSITION Emergency Fund • Cash Reserves • Lines of Credit • Smoothes practice management during possible delays in reimbursement.