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This document summarizes a presentation on billing and coding now and into the future. It discusses upcoming changes like ICD-10 implementation and the transition. It compares ICD-9 and ICD-10 codes, highlighting increased specificity and details in ICD-10. Strategies are presented for coder and physician training to address documentation deficiencies before ICD-10. The importance of collecting accurate information and leveraging technology to improve revenue cycle management is also discussed.
E Porras
- 1. Billing and CodingNow and Into The Future! Presenter: Eduardo Porras CPC,CPMA AHIMA Approved ICD-10 CM/PCS Ambassador
- 2. The Constant isChange!
- 3. The Constant isChange! ❖ICD-10-CM ❖Meaningful Use ❖HIPAA Security Risk Analysis ❖Administrative Simplification
- 4. ICD-10: Managing Throughthe Transition
- 5. Why is ICD-9Being Replaced? ❖ICD-9-CM is out of date and running out of space for new codes. ! ❖Lacks specificity and detail ❖No longer reflects current medical practice ! ❖ICD-10 is the international standard to report and monitor diseases and mortality, making it important for the U.S. to adopt ICD-10 based classifications for reporting and surveillance. ❖ICD codes are the core elements of HIT systems, conversion to ICD-10 is necessary to fully realize benefits of HIT adoption.
- 6. Major Differences BetweenICD-9-CM and ICD-10-CM ICD – 9-CM ICD – 10-CM 13,600 codes 69,000 codes Code book contains 17 chapters Code book contains 21 chapters Consists of 3 to 5 characters Consists of 3 to 7 characters 1st 1st Only utilizes letters E and V Utilizes all letters (except U) Second, third, fourth, and fifth characters are always numeric Second character is always numeric Shorter code descriptions because of lack of specificity and abbreviated code titles Third, fourth, fifth, sixth, and seventh characters can be alpha or Longer code descriptions because of greater clinical detail and specificity and full code titles
- 7. Comparison of ICD-9-CM and ICD-10-CM ICD-9-CM Code • A - Category of code • B - Etiology, anatomical site, and manifestation A B ICD-10-CM code • A - Category of code • B - Etiology, anatomical site, and/or severity • C - Extension ▫ 7th character for obstetrics, injuries, and external causes of injury A B C
- 8. Comparison of ICD-9-CMand ICD-10-CM ICD-9-CM Codes Pressure ulcer codes 9 codes 707.00 – 707.09 Codes: 707.0 Pressure ulcer 707.00 - unspecified site 707.01 - elbow 707.02 - upper back 707.03 - lower back 707.04 - hip 707.05 - buttock 707.06 - ankle 707.07 - heel 707.09 - other site ICD-10-CM Codes Pressure ulcer codes 125 codes Code Examples:L89.0-L89.94 L89.131 – Pressure ulcer of right lower back, stage I L89.132 – Pressure ulcer of right lower back, stage II L89.133 – Pressure ulcer of right lower back, stage III L89.134 – Pressure ulcer of right lower back, stage IV L89.139 – Pressure ulcer of right lower back, unspecified stage L89.141 – Pressure ulcer of left lower back, stage I L89.142 – Pressure ulcer of left lower back, stage II L89.143 – Pressure ulcer of left lower back, stage III L89.144 – Pressure ulcer of left lower back, stage IV L89.149 – Pressure ulcer of left lower back, unspecified stage L89.151 – Pressure ulcer of sacral region, stage I L89.152 – Pressure ulcer of sacral region, stage II …
- 9. ICD 10 KeyStrategies ❖Coder Transition ❖Training ❖Dual coding environment ❖Physician Transition ❖Prospective deficiency analysis—note by note ❖Physician-specific, data-driven education
- 10. Coder Training ❖ Keyissues include training courses, but equally ramping up to productivity standards and confidence ❖ Future needs to meet: ❖ Coders will need to train in real environments with real notes/encounters and see where skill gaps exist ❖ Multiple passes –at first getting comfortable with coding, then testing productivity. See where the gaps exist and retrain specifically. ❖ Computer-assisted rules-based coding will greatly assist the transition ❖ Dual coding environment –specific notes, rules engine suggested codes, coders code, after-the-fact analyses of generic versus specific codes ❖ The Practice will want to be sure they understand revenue risk from non-specific coding prior to October.
- 11. Physician Training The Problem ❖Physicians have learned how to document at the detailed level over the last 20 years ❖ More detailed information required to get to the most specific codes ❖ Organizations have meaningful revenue risk with ICD-10 if documentation is not up to the new standard ❖ No physicians want to worry about this now, but every physician will need to adapt Needed approach ❖Note-by-note and ICD-by-ICD analysis of the specific changes each physician needs to make ❖Data-driven training with physicians – their documentation, their deficiencies, needed changes ❖ “Small footprint” discussions over time—topic-by-topic rather than allat-once. Aggregated plan between now and October ❖Follow-up data analysis to determine effect of training and to structure additional interactions
- 12. Needed Documentation Deficiency Analysis ❖Step1: Data Processing ❖Take historical notes and code for ICD10 ! ❖Compare—at the note level—specific language in note with documentation needed for specific ICD10 code ! ❖Determine gaps overall and by doctor ! ❖Group training activity into themes or specific areas so that effective and granular training can be performed
- 13. Needed Documentation Deficiency Analysis ❖Step2: Data Analysis and Aggregation ❖Determine patterns by physician, modality ! ❖Isolate highest impact deficiencies ❖Frequency ❖Value ❖Based on identified deficiencies, collate examples of deficient documentation
- 14. Needed Documentation Deficiency Analysis ❖Step3: Reporting and training ❖ Overall patterns ❖ Physician-specific reporting ❖ Work with physicians one on one or in relevant focus groups to train ! ❖ Analyze and repeat as necessary to ensure the new concepts stick ! ❖ Utilize existing coding management and teams to conduct the training (they are the ones who do it normally anyway)—but you have to free up their time to do so
- 15. Be Prepared forthe ICD-10 Migration
- 16. Be Prepared forthe ICD-10 Migration ❖Are you in good hands?? ❖MGMA Research Finds ! ❖More than 52 percent of doctors indicated they had not heard from their practice management system vendor regarding when software changes would be available to the practice. ! ❖Almost 50 percent had not heard from their EHR vendor.
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- 19. Revenue Cycle: Overview SCHEDULING GU LA TIO NS REGISTRATION INSURANCE VERIFICATION RE CASHPOSTING POINT OF SERVICE COLLECTIONS PROGRAM ADMINISTRATION R ME STO IONS CU AT CT PE EX POST PAYMENT REVIEW SELF PAY COLLECTIONS CULTURE PEOPLE FINANCIAL CLEARANCE CUSTOMER SERVICE PROCESS TOOLS FINANCIAL COUNSELING MEDICAL RECORDS CDM/CHARGE CAPTURE YO CDMP PA Y G LO O HN C TE CASE MGMT/QUR BILLING RS DENIALS MANAGEMENT THIRD PARTY FOLLOW- UP "19
- 20. Getting Paid forthe Services That are Provided. The first time!
- 21. Getting Paid forthe Services That are Provided. The first time! ❖Step One: Automate ❖ Automating Coding and Claims ❖ Automating the Clearinghouse ❖ Automating Eligibility ❖ Automating Denial Management ❖ Automating Self-Pay Collections ❖Step Two: Analyze ❖ Business Intelligence Tools ❖ Benchmarking ❖Step Three: Detect and Fix ❖Step Four: Refine and Repeat
- 22. Importance of CollectingAccurate Information
- 23. Importance of CollectingAccurate Information ! ❖ It starts with the collection of comprehensive and accurate financial data. ! ❖ Garbage in, garbage out! Collecting accurate demographic and billing information should not be limited to new patients ! ❖ Another headache for practices is monitoring patients with aged balances who keep coming in for additional services ! ❖ Untimely submission of insurance claims and poorly designed patient statements will thwart collection efforts ! ❖ Failure to analyze collection performance can be a major headache
- 26. Leverage Technology toEase the Pain!
- 27. Leverage Technology toEase the Pain! ! ❖Technology is your friend! Use it wisely. ❖A lonely writer who develops an unlikely relationship with his newly purchased operating system that's designed to meet his every need.
- 28. Thank you! Presenter: EduardoPorras CPC,CPMA AHIMA Approved ICD-10 CM/PCS Ambassador
- 29. If you wouldlike more information on this topic or other ways to increase your reimbursements, contact us directly. ! Call us: 1-877-AVISENA E-Mail: marketing@avisena.com Visit us at www.avisena.com