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Icd 10 Compliance Impact on Providers


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Icd 10 Compliance Impact on Providers

  1. 1. Impact on Providers Presented By: Superia Inc.
  2. 2. Agenda• ICD 10 Compliance-An Introduction• ICD 10 Compliance-How it will impact the providers?• How to comply with ICD 10?• Superia ICD 10 Compliance Service• Q&A session
  3. 3. ICD 10-An Introduction • ICD-10 CM & PCS is an upgrade of the US-developed clinical modification (ICD-9-CM) of Diagnosis and Procedure Codes, first adopted in 1979. • Department of HHS has ruled that all coding must be done in ICD-10 starting Oct 1, 2013. • ICD-10-CM volume is 69000 alphanumeric codes compared to ICD-9-CM volume of 13,600 numeric codes • ICD-10-PCS volume is 72000 alphanumeric codes compared to ICD-9-PCS volume of 4000 numeric codes.ICD-9-CM Code ICD-10-CM CodeFlatulence, eructation, and gas pain R14.0 Abdominal distension (gaseous) R14.1 Gas pain787.3 R14.2 Eructation R14.3 FlatulenceAbdominal pain, unspecified site789 No Code
  4. 4. ICD 10 Compliance-How it will impact theproviders? • Complexity and volume (5 times) in the coding will demand changes to existing “Superbills”. • Practice management Systems, Insurance Coverage Systems, Billing Systems will have to changed • An inability to comply with implementation may result in massive fines and rejected claims • According to Delloite, significant changes in reimbursement patterns may impact provider cash flow for a considerable period of time. • Significant changes to Health Plans, documentation requirements, coverage considerations. • Across-the-board training to clinical and admin staffs for learning the new codes and relearning of code relationships.
  5. 5. How to comply with ICD-10? • Evaluating all clinical, financial and business systems that currently use ICD-9 codes. • Overall Risk and Impact Assessment. • Gap Analysis between current and future state. • Compliance Project Plan • Identification of capital cost, one time cost and recurring cost and budget for it. • Compliance Implementation • Conduct internal testing • Payer system integration • Conduct external testing • Start Parallel processing • Complete Transition
  6. 6. How to comply with ICD-10?-Suggested timeline byCMS Phase 1: Implementation plan development and impact assessment. Timeline: 1st qtr 2009 – 2nd qtr 2011 Phase 2: Implementation preparation Timeline:1st qtr 2011 – 2nd qtr 2013 Phase 3: “Go live” preparation Timeline: 1st qtr 2013 – 3rd qtr 2013 Phase 4: Post-implementation Follow-Up Timeline: 4th qtr 2013 – 4th qtr 2014
  7. 7. Superia ICD-10 Compliance Service • Assessment and Planning Services- A combination of tools, processes and services for ICD-10 assessment and planning • Impact Analysis- An automated tool will provide comprehensive assessment of home grown applications • Remediation Service- Includes a dual remediation approach with application remodeling and enhancement, data migration and post- implementation support and maintenance • Testing-Complete manual and automated testing to ensure 100% implementation. • Implementation Translator-Tool to help your organization to do parallel processing. • Training-Training to help your staff in learning the new codes and it’s usage in the new system
  8. 8. ICD-10 Q&A Session
  9. 9. Thank You Superia Inc.