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ICD-­‐10	
  	
  
Disclaimer:	
  Nothing	
  that	
  we	
  are	
  sharing	
  is	
  intended	
  as	
  legally	
  binding	
  o...
 	
  	
  	
  About	
  Quirk	
  Healthcare	
  Solu8ons	
  
Based	
  in	
  South	
  Florida,	
  we	
  partner	
  with	
  
he...
WHY	
  IS	
  THIS	
  IMPORTANT?	
  
 	
  	
  	
  Quick	
  Overview	
  
October	
  1,	
  2014	
  hard	
  cut-­‐off	
  
Affects	
  all	
  en88es	
  covered	
  by	...
 	
  	
  	
  The	
  Healthcare	
  World	
  Ends	
  in	
  the	
  
Second	
   	
  Half	
  of	
  2014	
  
9/30/14	
  –	
  MU	...
 	
  	
  	
  In	
  Addi8on…	
  
•  Affordable	
  Care	
  Act	
  –	
  High	
  deduc8bles	
  already	
  
increasing	
  import...
WHAT	
  IS	
  ICD10?	
  
 	
  	
  	
  ICD-­‐10	
  Historical	
  Retrospec8ve	
  
 	
  	
  	
  ICD-­‐10	
  Regulatory	
  Mandates	
  
Federal	
  Mandate	
  Department	
  of	
  Health	
  and	
  Human	
  
S...
 	
  	
  	
  What	
  are	
  ICD-­‐10	
  Codes?	
  
•  Granular	
  code	
  set	
  developed	
  by	
  WHO	
  for:	
  
–  Inc...
Anatomy	
  of	
  ICD-­‐10	
  Diagnosis	
  Codes	
  
• 
• 
• 
• 
• 
• 

3–7	
  digits	
  
Digit	
  1	
  is	
  alpha,	
  inc...
 	
  	
  	
  ICD-­‐10	
  Adop8on	
  Maturity	
  Model	
  
HOW	
  DOES	
  ICD10	
  RELATE	
  TO	
  
SNOMED?	
  
 	
  	
  	
  What	
  is	
  SNOMED?	
  
•  Acronym	
  for	
  Systema8zed	
  Nomenclature	
  Of	
  
Medicine	
  –	
  Clinica...
 	
  	
  	
  What	
  is	
  SNOMED?	
  Con7nued	
  
•  Structured	
  into	
  19	
  “hierarchies”	
  which	
  define	
  
the	...
 	
  	
  	
  Why	
  is	
  it	
  important?	
  
•  MU2	
  criteria	
  expands	
  upon	
  MU1	
  requirements	
  
to	
  impr...
 	
  	
  	
  The	
  ICD-­‐10	
  /	
  SNOMED	
  Rela8onship	
  
•  SNOMED	
  CT	
  has	
  be`er	
  clinical	
  coverage	
  ...
WHAT	
  CAN	
  I	
  DO?	
  
 	
  	
  Leverage	
  the	
  Resources	
  Available	
  to	
  You	
  
•  Navicure’s	
  Free	
  ICD10	
  Comparison	
  Tool	
...
 	
  	
  	
  Op8mal	
  Plan	
  for	
  2014	
  
•  Developing	
  a	
  plan	
  for	
  2014	
  is	
  impera8ve	
  

Q1	
  
-­...
 	
  	
  	
  Op8mal	
  Plan	
  for	
  ICD10	
  

Impact	
  Analysis	
  

Needs	
  Assessment	
  

Project	
  Plan	
  

Bud...
 	
  	
  	
  Project	
  Considera8ons	
  
External	
  tes8ng	
  

Internal	
  tes8ng	
  

Provider	
  training	
  

Review...
 	
  	
  Training	
  
•  AHIMA	
  recommenda8on:	
  begin	
  no	
  more	
  than	
  six	
  months	
  
before	
  compliance	...
 	
  	
  Best	
  Prac8ces	
  
•  Find	
  diagnosis	
  search	
  tools	
  (in	
  EHR	
  or	
  Intelligent	
  
Medical	
  Ob...
QUESTIONS?	
  
Quirk	
  Healthcare	
  Solu8ons	
  
info@quirkhealthcare.com	
  
888-­‐WE-­‐QUIRK	
  
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Quirk Healthcare: Impacts of ICD-10

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Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.

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Quirk Healthcare: Impacts of ICD-10

  1. 1. ICD-­‐10     Disclaimer:  Nothing  that  we  are  sharing  is  intended  as  legally  binding  or  prescrip7ve  advice.  This   presenta7on  is  a  synthesis  of  publically  available  informa7on  and  best  prac7ces.  
  2. 2.        About  Quirk  Healthcare  Solu8ons   Based  in  South  Florida,  we  partner  with   healthcare  providers  and  organiza8ons,  helping   them  develop  strategies  and  systems  for   naviga8ng  the  new  landscape  of  the  healthcare   industry.  Our  clients  have  enjoyed  remarkable   success,  including  award  of  the  Medicare   Advantage  5-­‐star  ra8ng  by  the  Centers  for   Medicare  &  Medicaid  Services  (CMS).    
  3. 3. WHY  IS  THIS  IMPORTANT?  
  4. 4.        Quick  Overview   October  1,  2014  hard  cut-­‐off   Affects  all  en88es  covered  by  HIPAA   14,000  ICD-­‐9  codes  grow  to  68,000  ICD-­‐10  codes   Version  5010  standards   Significant  changes  to  clinical  and  revenue  cycle   systems     •  Complex  conversion  to  updated  codes   •  System  upgrades  to  expand  data  fields  for  longer   codes     •  Staff  retraining  on  new  versions  and  codes   •  •  •  •  • 
  5. 5.        The  Healthcare  World  Ends  in  the   Second    Half  of  2014   9/30/14  –  MU  A`esta8on  Period  Ends  For   Providers  Who  Have  Not  A`ested  for  MU   10/1/14  –  ICD10  Implementa8on   12/31/14  –  MU  A`esta8on  Period  Ends  For   Providers  Who  Have  A`ested  Before    
  6. 6.        In  Addi8on…   •  Affordable  Care  Act  –  High  deduc8bles  already   increasing  importance  of  self  pay  and   impac8ng  prac8ces’  bo`om  lines   •  Medicare  Reimbursement  Cuts   •  Sequestra8on   •  PQRS  Penal8es  and  Scoring  Publica8on  
  7. 7. WHAT  IS  ICD10?  
  8. 8.        ICD-­‐10  Historical  Retrospec8ve  
  9. 9.        ICD-­‐10  Regulatory  Mandates   Federal  Mandate  Department  of  Health  and  Human   Services  Final  Rule  CMS-­‐0013-­‐F  Published  January   2009   HIPAA  5010   Transac8on  formats  for  payors   and  providers   January  1,  2012   ICD-­‐10   Diagnosis  and  procedure  codes   for  clinical  transac8ons   October  1,  2014  
  10. 10.        What  are  ICD-­‐10  Codes?   •  Granular  code  set  developed  by  WHO  for:   –  Increased  clinical  accuracy   –  Improved  disease  tracking   –  Disease  trending   •  More  ICD-­‐10  codes  compared  to  ICD-­‐9   ICD-­‐9   14,000  diagnosis  codes   4,000  procedure  codes   5  digit  numeric  codes   ICD-­‐10   68,000  diagnosis  codes   87,000  procedure  codes   7  digit  alphanumeric  codes  
  11. 11. Anatomy  of  ICD-­‐10  Diagnosis  Codes   •  •  •  •  •  •  3–7  digits   Digit  1  is  alpha,  including  O  and  I  but  no  U   Digit  2  is  numeric   Digits  3–7  are  alpha  (not  case  sensi8ve)  or  numeric   Decimal  is  aker  third  digit   Examples:   –  A78  –  Q  fever   –  A69.21  –  Meningi8s  due  to  Lyme  disease;  and   –  S52.131a  –  Displaced  fracture  of  neck  of  right  radius,  ini8al   encounter  for  closed  fracture  
  12. 12.        ICD-­‐10  Adop8on  Maturity  Model  
  13. 13. HOW  DOES  ICD10  RELATE  TO   SNOMED?  
  14. 14.        What  is  SNOMED?   •  Acronym  for  Systema8zed  Nomenclature  Of   Medicine  –  Clinical  Terminology   •  Interna8onal  standard  for  comprehensive  clinical   terminology   •  Available  at  no  cost  through  the  Na8onal  Library   of  Medicine   •  Enables  providers  and  EHRs  to  communicate  in   common  language   –  Increased  quality  of  pa8ent  care  across  special8es   –  Improved  accuracy  of  pa8ent  data  analysis  
  15. 15.        What  is  SNOMED?  Con7nued   •  Structured  into  19  “hierarchies”  which  define   the  clinical  concept   •  Broken  down  into  increasing  granularity     •  Very  specific  clinical  concepts  to  define  pa8ent   condi8on   •  More  complex  than  ICD-­‐10  hierarchy  
  16. 16.        Why  is  it  important?   •  MU2  criteria  expands  upon  MU1  requirements   to  improve  and  u8lize  HIT  and  EHRs   –  Provides  consistent,  collabora8ve  care     –  Interoperability  between  EHRs  and  need  for   understanding  each  other   •  Use  of  common  language   •  Problem  list  
  17. 17.        The  ICD-­‐10  /  SNOMED  Rela8onship   •  SNOMED  CT  has  be`er  clinical  coverage  than  ICD   •  Number  of  codes:   –  SNOMED  CT  (Clinical  finding):  100,000   –  ICD-­‐9-­‐CM:  14,000   –  ICD-­‐10-­‐CM:  68,000   •  ICD  focus  is  sta8s8cal   –  Less-­‐common  diseases  subsumed  under  general  categories   –  Aker-­‐the-­‐fact  codes   •  SNOMED  CT  is  clinically-­‐oriented   –  Used  during  care   –  Clinical  relevance  and  user-­‐friendliness   •  Clinically  coded  data  generates  ICD-­‐10  code  for  billing  
  18. 18. WHAT  CAN  I  DO?  
  19. 19.      Leverage  the  Resources  Available  to  You   •  Navicure’s  Free  ICD10  Comparison  Tool   •  AMA  and  MGMA  Offering  Training  Guides  and   Classes   •  Intelligent  Medical  Objects  ICD9  to  ICD10   Conversion  for  Exis8ng  Problem  Lists  
  20. 20.        Op8mal  Plan  for  2014   •  Developing  a  plan  for  2014  is  impera8ve   Q1   -­‐  Finalize  Plan  for  2014   -­‐  Upgrade  to  ICD10  and  MU2   2014  Complaint  Version   -­‐  Implement  PQRS   -­‐  Review  Budget  to  Ensure   You  Have  Reserves  for  ACA   and  ICD10  Impacts   Q2   -­‐  Test  ICD10  with   Clearinghouse  and  Payers   -­‐  First  Try  at  MU  for  2014   Q3     -­‐  Train  Providers  and  Staff  on   ICD10   -­‐  Make  Up  Quarter  for  MU             Q4   -­‐    ICD10  Implementa8on   -­‐  Increase  CBO  Staffing  for   Managing  Resolu8on  of  Payer   Issues            
  21. 21.        Op8mal  Plan  for  ICD10   Impact  Analysis   Needs  Assessment   Project  Plan   Budget   Conversion     • Iden8fy  current  systems   and  work  processes  that   use  ICD-­‐9  codes   • Talk  with  payers  about   effect  of  ICD-­‐10   implementa8on  on   provider  contracts     • Workflow  and  business   process  changes   • Staff  training   • Prac8ce  management   vendor  accommoda8ons   • Implementa8on  plan   with  clearinghouses,   billing  services,  and   payers   • Inventory  systems  and   workflows   • Con8ngency  plan  for   failed  go-­‐live   • Time  and  costs  related  to     implementa8on   • Training   • IT/IS  upgrade   • Assistance  from  outside   vendor/consultant   • Poten8al  produc8vity   loss   • Transac8on  tes8ng    using   ICD-­‐10  codes   • Historic  data  conversion   • Review  coded  data  for   claims  reimbursement   consistent  with  ICD-­‐9   rates  
  22. 22.        Project  Considera8ons   External  tes8ng   Internal  tes8ng   Provider  training   Review  system   customiza8ons   Core  team  training  
  23. 23.      Training   •  AHIMA  recommenda8on:  begin  no  more  than  six  months   before  compliance  deadline   •  Approximately  16  hours  for  ambulatory  coders  and  50   hours  for  hospital  coders   –  Physician  prac8ce  coders  should  learn  ICD-­‐10  diagnosis  coding   only   –  Hospital  coders  should  learn  both  ICD-­‐10  diagnosis  and  ICD-­‐10   inpa8ent  procedure  coding   •  Specialty-­‐specific  ICD-­‐10    training   •  ICD-­‐10  coding  training  integrated  into  creden8al   maintaining  CEUs   •  ICD-­‐10  resources  and  training  materials  available  through   CMS,  professional  associa8ons,  and  socie8es  
  24. 24.      Best  Prac8ces   •  Find  diagnosis  search  tools  (in  EHR  or  Intelligent   Medical  Objects).  Paper  Superbills  and  Cheat   Sheets  will  no  longer  work.   •  Begin  coding  in  ICD10  before  the  deadline  and  let   Navicure  downcode  for  you.   •  Keep  in  close  contact  with  payers  who  aren’t   ready.  Work  with  Navicure  to  con8nue   downcoding  aker  10/1/14  for  these  payers.   •  Understand  that  not  all  payers  will  be  ready  and   your  A/R  will  be  impacted.  
  25. 25. QUESTIONS?  
  26. 26. Quirk  Healthcare  Solu8ons   info@quirkhealthcare.com   888-­‐WE-­‐QUIRK  

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