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Impact on Providers
Presented By: Superia Inc.
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
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 Code
Flatulence, eructation, and gas pain R14.0 Abdominal distension (gaseous)
R14.1 Gas pain
787.3 R14.2 Eructation
R14.3 Flatulence
Abdominal pain, unspecified site
789 No Code
ICD 10 Compliance-How it will impact the
providers?
• 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.
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
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
ICD-10 Q&A Session
Thank You
Superia Inc.
info@superiainc.com

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ICD10 Impact On Providers

  • 1. Impact on Providers Presented By: Superia Inc.
  • 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. 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 Code Flatulence, eructation, and gas pain R14.0 Abdominal distension (gaseous) R14.1 Gas pain 787.3 R14.2 Eructation R14.3 Flatulence Abdominal pain, unspecified site 789 No Code
  • 4. ICD 10 Compliance-How it will impact the providers? • 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. 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. 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