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ICD-10 Implementation, Benefits and Plan of Action for Internal Medicine
The document outlines the implementation of ICD-10 codes, set to start on October 1, 2014, emphasizing greater clinical specificity compared to ICD-9. It details the operational changes, anticipated challenges during the transition such as delayed reimbursements, and the need for thorough staff training on new coding practices. Additionally, it provides an overview of the benefits of ICD-10, including improved claims efficiency and enhanced documentation requirements for providers.
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ICD-10 Implementation, Benefits and Plan of Action for Internal Medicine
- 1. ICD-10 Implementation, New Features,Benefits, and Our Plan of Action for Internal Medicine Web: www.vocisinc.com Sales: 866 365 3909 Email: contact@vocisinc.com
- 2. ICD-10-CM/PCS COMPLIANCE DATE Implementation scheduledfor 1st October 2014 Testing of these codes starts effective January 2014
- 3. BENEFITS OF ICD-10-CM ICD-10-CMincorporates much greater clinical detail and will be more specific than ICD-9-CM. For example : ICD-10 for Right knee pain-M25.561 and Left knee pain-M25.562 where as ICD-9 for Right or Left knee pain – 719.46 Reducing the need for attachments to explain the patient’s condition Improving clinical, financial, and administrative performance Preventing health care fraud and will be more informative Once coding is completed , ICD-10 makes claim submission more efficient
- 4. Difference ICD-9 ICD-10 Consists of 3– 5 characters Consists of 3 – 7 characters 1st character is alpha or numeric 1st character is always alpha Shorter code description as not specific and abbreviated codes Longer code description as more specific and detailed codes 13,600 codes 69,000 codes Eg. Rotator cuff sprain and strain is Eg. Rotator cuff sprain and strain is 840.4 S43.429A Eg. Hip Pain : 719.45 Eg. Hip Pain : M25.559 Eg. Rotator cuff sprain and strain is Eg. Rotator cuff sprain and strain is 840.4 S43.429A
- 5. ICD 9 DIAGNOSIS ICD 10 Hypertension Hypertension,unspecified 401.9 I10 Hypertension, uncontrolled 401 I10 DM type 2 Diabetes 250 E11.9 DM type 1 250.02 250.01 E11.65 E10.9 DM type 1, uncontrolled 250.03 E10.65 DM type ii, Uncontrolled Neoplasm Malignant neoplasm, lung 162.9 C34.90 Metastatic neoplasm liver 197 212.3 C78.00 D14.30 Benign neoplasm, lung
- 6. Frequently Used Codes– VOCIS observation VOCIS checked the documentation for the most often used codes in your practice Diagnosis ICD 9 ICD 10 Hypertension 401.9 I10 Chronic pain syndrome 338.4 G89.4 Congestive heart failure 428.0 I50.9 Long term medication V58.69 Z79.899 Fatigue 780.79 R53.1 Constipation 564.00 K59.00 Allergic rhinitis 477.9 J30.9 Back pain 724.5 M54.9 Continued…
- 7. Diagnosis ICD 9 ICD 10 Diabetes- Type II 250.00 E11.9 Hyperlipidemia 272.4 E78.5 Degenerative Disc Disease Lumbar Spine 722.52 M51.36 Anxiety 300.00 F41.9 Depression 311 F32.9 Chronic pain 338.29 G89.29 Anemia 285.9 D64.9 Atrial Fibrillation 427.31 I48.91 Coronary Artery Disease 414.00 I25.10 Cerebral Vascular Accident Degenerative Disc Disease Cervical Spine 434.91 I63.50 722.4 M50.30 Hypothyroidism 244.9 E03.9
- 8. ICD-10 impact onRevenue Cycle Management VOCIS anticipation Delayed reimbursement from government during ICD-10 implementation as this is in the transition phase, some delays can be expected Account Receivable days may increase by 20 to 40 percent post implementation through a transition period As per survey “Workgroup for Electronic Data Interchange” (WEDI) – (the leading authority on the use of Health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system) estimates that rejection and denial rates may increase by 100 – 200 percent during the same period Continued…
- 9. VOCIS Plan ofAction We have already started training for our staff on ICD-10 implementation via attending Webinars and trainings arranged by AAPC Will keep educating the Providers on the updates and changes for ICD-10 implementation ICD-10 codes is already imported in the billing software so that the testing can be started at the earliest and to get familiar with new codes – Testing starts effective Jan 2014 Generally we accept 45-60 days in AR as quite reasonable, but we would have to be more aggressive , more goal oriented. In actual words its time to challenge the process VOCIS planned to focus on the AR a bit early so that the denials can be captured on time and can be worked accordingly. This will fasten the payment process. Continued…
- 10. Few of theAR reporting will help to manage the accounts Daily and weekly revenue Zero to 30 days, separated by payer Outstanding days Insurance verification for all the patients/accounts will be checked before billing the claim to insurance. This will ensure that we are billing the claim to the right insurance and will speed up the payment process and at the same time will reduce the denials
- 11. Additional Information New claimform/CMS-1500 named 02/12 form (sample on next page)will be used, with more columns to add the ICD-10 codes which results in more accurate payment flow from the insurance side The current claim form/CMS-1500 has the limitation of using only 4 ICD-9 codes During the training period we will bill ICD-9 and ICD-10 simultaneously to the insurance on the same claim form to ensure that we are billing correct codes The version 02/12 form will likely be accepted by Medicare in January of 2014, but providers can still use the old forms until April 1, 2014, when only the 02/12 form will be accepted
- 13. Suggestions - Important forProviders Providers will need to improve documentation because unless they are as specific as possible, coding staff will never be able to assign the right code which might lead to billing complications Front desk should always discuss the patient responsibility before treatment and COPAY should be collected on the day of service also patient should be informed of the left over balance after the insurance pays : will be Patient’s responsibility ICD-10 implementation may require the need for financial back up OR line of credit to offset cash flow challenges due to government glitches Continued…
- 14. NEW FEATURES INICD-10-CM Laterality (Left, Right, Bilateral) Examples: H16.013 – Central corneal ulcer, bilateral; and C50.511 – Malignant neoplasm of lower-outer quadrant of right female breast; L89.012 – Pressure ulcer of right elbow, stage II. Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations Examples: K57.21 – Diverticulitis of large intestine with perforation and abscess with bleeding; E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema; and Continued…
- 15. Character “x” isUsed as a 5th Character Placeholder in Certain 6 Character Codes to Allow for Future Expansion and to Fill in Other Empty Characters (For Example, Character 5 and/or 6) When a Code That is Less Than 6 Characters in Length Requires a 7th Character Examples: T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter; and T15.02xD – Foreign body in cornea, left eye, subsequent encounter Inclusion of Clinical Concepts That Do Not Exist in ICD9-CM (For Example, Underdosing, Blood Type, Blood Alcohol Level) Examples: T45.526D – Underdosing of antithrombotic drugs, subsequent encounter; Z67.40 – Type O blood, Rh positive; and Y90.6 – Blood alcohol level of 120 – 199 mg/100 ml. Continued…
- 16. A Number ofCodes Are Significantly Expanded (For Example, Injuries, Diabetes, Substance Abuse, Postoperative Complications) Examples: E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy; F10.182 – Alcohol abuse with alcohol-induced sleep disorder; and T82.02xA – Displacement of heart valve prosthesis, initial encounter
- 17. Who We Are In2000, A group of Healthcare Industry veteran talents teamed up to launch, 'Vocis', an organization with a difference, that specialized in making medical groups more competitive for today's world Advised and owned by Physicians A BBB Accredited; Practice Management Company based in Louisville KY, involved in Medical Credentialing, Billing, Collections, Transcription, Practice Marketing, Virtual Receptionist, and Practice Set up for independent NPs, PTs, and MDs Successfully providing services to over 150 satisfied customers all over US Experienced team of AAPC Certified Coders, Billing Specialists, AR Analysts, Denial Management Specialists, Quality Analysts and backed by experienced team of Software, Network and Hardware Engineers State-Of-Art IT infrastructure center comprises of HP PCs, High speed internet leased line with assured 24/7 connectivity, Network & Server monitoring, Data Back-up & Remote storage facility and 100% power back-up
- 18. We Offer Fee ScheduleReview and Analysis Eligibility and Benefit Verification Assistance with Provider Enrollment Electronic and Paper Claims Submission Account Receivables Secondary Insurance Billing Inbound/Outbound calling Worker’s Comp and No Fault Patient Demographics Entry Authorization Request and Tracking Charge Entry – All Specialties Posting of Insurance and Patient Payments Patient Statement Denial Review and Management Customized management reports Web: www.vocisinc.com Sales: 866 365 3909 Email: contact@vocisinc.com Medical Coding
- 19. Pricing The pricing structurefor VOCIS’s billing and coding services is straightforward, and calculated as a percentage of your organization’s monthly net collections. To the contrary, the pricing is determined by a detailed analysis of your organization’s key characteristics, finances and other data. “We charge just amount” 4 to 8% of collected
- 20. Contact Us Sales 866 3653909 General Information Phone – 502 638 4285 Web – vocisinc.com Email – contact@vocisinc.com