ICD 10 CM 9/4/2012. Course Objective: Objectives: Session 1 INTRODUCTION TO ICD 10 CM. Managers

(1)

ICD‐10‐CM

INTRODUCTION TO ICD‐10‐CM

for CA’s and Chiropractic Office

Managers

Course Objective:

Make the transition to ICD‐10‐CM as painless and

seamless as possible

• SESSION 1: Awareness

–What do you know, what do you need to know about ICD‐10?

• SESSION 2: Planning

–Develop an ICD‐10 transition plan for your office and practice.

• SESSION 3: Implementation

–Getting under the hood of ICD‐10, how it is similar and how it is different from ICD‐9, how to use it. Alaska Chiropractic Society 2012 Convention

Objectives: Session 1

Make the transition to ICD‐10‐CM as painless and seamless as possible

• Create awareness of ICD‐10‐CM

• For you, your staff, your DC’s

• Understand the why, what, when, who, how

• Alert you to resources available

• Reduce stress

(2)

ICD‐10‐CM

The Tip of the Iceberg

Alaska Chiropractic Society 2012 Convention

Sources

• ICD 10 Watch –http://www.icd10watch.com/ • HIMSS –http://www.himss.org/ASP/topics_icd10playbook.asp • National Center for Health Statistics –http://www.cdc.gov/nchs/icd/icd10cm.htm • CMS HIPAA Website 5010 http://www.cms.gov/ICD10/11a_Version_5010.asp#TopOfPage • AHIMA –http://www.ahima.org/icd10/ • ChiroCode –http://www.chirocode.com/ Alaska Chiropractic Society 2012 Convention

Resource/Reference List

• ICD‐10‐CM, is free from CMS

–Includes guidelines, instructions for use –https://www.cms.gov/ICD10/

C

i l ICD 10 CM

bli ti

• Commercial ICD‐10‐CM publications

–(Ingenix, AMA, ChiroCode, others)

• Montana Chiropractic Association

–Give us your email for ICD‐10 Updates Alaska Chiropractic Society

(3)

Dr. Simpson contact info.

• csimpson@chpgroup.com

• 503‐367‐0872

• The CHP Group

6600 SW 105

th

_Ave

Ste 115

Beaverton, OR 97008

Caveats

(…or, my lawyer says I have to say this.)

• Dr. Simpson has no financial COI

• Nothing here is intended as legal advice

• The information in this seminar is not a

id

b i

d f

warrantee to avoid your being prosecuted for

fraud and abuse

• The course is not intended to be full‐scale

training in the use of ICD‐10‐CM coding

(4)

Pop quiz

• Who invented the ICD?

• What is it used for?

• When did it start?

• Where do you use it in your practice?

• How will this change to ICD‐10‐CM affect you?

Why ICD‐10?

• ICD‐9‐CM badly needs to be replaced –System is 30 years old –Not descriptive enough –Terminology and classification of some conditions are outdated and obsolete • System is running out of space –Many sections are full. –Unable to keep pace with advances in medical technology –Outdated codes produce inaccurate and limited data –Unable to meet current or future health data needs • Lack of international comparability • Cannot support transition to interoperable health data exchange Bowman and Haugen HIMSS 09 Alaska Chiropractic Society 2012 Convention

ICD‐10 Provides better data for

• Measuring the quality, safety, and efficacy of care • Designing payment systems and processing claims for reimbursement • Conducting research, epidemiological studies, and clinical trials

• Setting health policySetting health policy

• Operational and strategic planning and designing healthcare delivery systems • Monitoring resource utilization • Improving clinical, financial, and administrative performance • Preventing and detecting healthcare fraud and abuse • Tracking public health and risks Bowman and Haugen HIMSS 09 Alaska Chiropractic Society

(5)

ICD‐10 requires conversion to HIPAA

5010

• Standard format for health care data transfer

• Required for any electronic billing

• Implementation date: March 31, 2012

• We assume you have this accomplished (and

you know what happens when you “assume”

anything…)

Will this impact me?

Yes!!

• Any electronic claims submission

• You are, or do business with HIPAA covered

entities, Medicare, Medicaid, private payers

h

(

k

’

)

• Expect others (e.g. PIP, workers’ comp) to

follow suit

Waanh!! I don’t wanna do this…!!

• If you never prepare a CMS 1500 form

• Never send an insurance company a bill

• Never bill Medicare or Medicaid

• Never submit an order (imaging, DME)

(6)

Questions??

No Impact on Use of CPT®

• CPT® will continue to be used for

–Reporting physician and other professional services services –Procedures performed in hospital outpatient departments and other outpatient facilities Alaska Chiropractic Society 2012 Convention

Implications: You and your DC

• Awareness • Education • Training –PractitionersPractitioners –Practice managers –Office staff Alaska Chiropractic Society

(7)

Implications: Your office

• Encoding Software • Billing / Financial • Productivity • ABN • Clinical Documentation Systemsy • Claims Submission Software • Utilization Management • Quality Management • Clinical Protocols • Medical Necessity • Laboratory • Dual systems Alaska Chiropractic Society 2012 Convention

Implications: Vendors

• Future applications and contracts: Will the

application be compliant with ICD‐10‐CM

standards?

• What is the plan for ICD‐10?

p

–Upgrade or replacement? –Timeline for testing? –“Go live” Production? –Cost? Alaska Chiropractic Society 2012 Convention

Implications: Vendors

• Future applications and contracts: Will the application be compliant with ICD‐10‐CM standards? standards? • What is the plan for ICD‐ 10? –Upgrade or replacement? –Time line for testing? –“Go live” ‐> Production? –Cost in time and $$?

(8)

Questions??

ICD‐10 Time Line

• Work on ICD‐10 began in 1983, completed in 1992 • ICD‐10 has > 155,000 different codes (~17,000 codes available in ICD‐9)

• ICD‐10 includes both diagnoses(CM) and procedures(PCS) for

in‐patient

• CPT® will continue for outpatient services

• CPT® will continue for outpatient services • ICD‐10 adoption was relatively swift in most of the world • ICD‐10 code sets will be effective in US October 1, 2014 • A first draft of ICD‐11 (!!) is expected in 2010 Wikipedia http://en.wikipedia.org/wiki/ICD#ICD‐106/2009 Alaska Chiropractic Society 2012 Convention Alaska Chiropractic Society

(9)

Breaking News!!

• The AMA has urged House Speaker John

Boehner to stop the switch to the new

diagnosis coding sets known as ICD‐10.

American Medical News 2/6/12

• The acting head of the Centers for Medicare

and Medicaid Services said today the agency is

considering extending its timeline for ICD‐10

code conversion compliance.

Health Information Week 2/12/12 Alaska Chiropractic Society 2012 Convention

HHS Announces ICD‐10 Delay

http://www.medpagetoday.com/PracticeManagement/InformationTechnology/32095?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source= WC&eun=g998d0r&userid=998&email=csimpson@chpgroup.com&mu_id=

• In afact sheetannouncing a proposed rule that

sets a deadline of Oct. 1, 2014 to comply with the ICD-10 system

• HHS believes the change in the compliance date for ICD‐10…would give providers and other covered entities more time to prepare and fully test their systems… • …it did not HIT firms that have been working to meet the 2013 deadline. Alaska Chiropractic Society 2012 Convention

DHHS Proposed Rule

Finally, this rule proposes to change the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD‐10‐CM) for diagnosis coding, including the Official ICD–10–CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure , , Coding System (ICD–10–PCS) for inpatient hospital procedure coding, including the Official ICD–10–PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014. http://www.ofr.gov/OFRUpload/OFRData/2012‐08718_PI.pdf

(10)

Standards compliance date

• HHS proposes that covered entities must be in

compliance with ICD‐10 on October 1, 2014.

• The proposed rule, CMS‐0040‐P, may be

viewed at

www ofr gov/inspection aspx

viewed at

www.ofr.gov/inspection.aspx

.

• A news release on the proposed rule may be

viewed at

http://www.hhs.gov/news.

Meanwhile, back at the AMA…

Last week, the American Medical

Association

sent a letter

to acting CMS

Administrator Marilyn Tavenner asking the

federal government to further delay the

compliance date for the transition to ICD‐10

code sets to

Oct. 1, 2015

,

Modern

Healthcare

reports (Conn, Modern Healthcare,

5/11)

Read more:http://www.ihealthbeat.org/articles/2012/5/14/ama‐calls‐for‐further‐delay‐to‐icd10‐compliance‐deadline.aspx#ixzz1uxEpWbf8 Alaska Chiropractic Society 2012 Convention

…but

• Don't cancel your next ICD‐10 steering committee meeting. • Stopping ICD‐10 in its tracks would literally take an act of Congress. It's a federal law, and would require more than Tavenner's support or opposition. • …keep your ICD‐10 initiatives going. There are too many unknowns now. ‐ICD 10 Watch http://www.icd10watch.com/blog/icd‐10‐timeline‐its‐revision‐not‐destruction Alaska Chiropractic Society

(11)

Associations Speak Out on New ICD‐

10 Date

• MGMA is pleased that CMS is looking at a one‐year extension of ICD‐10 • The AMA says postponement of ICD‐10 “is the first of many steps that regulators need to take to reduce the number of costly time‐consuming regulatory burdens

costly, time consuming regulatory burdens • AHIMA prefers no delay in ICD‐10, notes that the extension is the shortest possible time of one year. AHIMA also calls for continued focus on ICD‐10 implementation http://www.healthdatamanagement.com/news/cms‐icd‐10‐hipaa‐accountable‐care‐health‐plan‐identifier‐44307‐1.html Alaska Chiropractic Society 2012 Convention

Don’t stop!

• Healthcare providers need to work on

productivity and clinical documentation.

• That requires someone to understand ICD‐10

codes

and distribute that knowledge to the staff.

• Starting training now becomes very compelling if

the knowledge is used to improve ICD‐9 coding,

productivity and reimbursements. Some sort of

return on investment can be gained sooner than

later.

http://www.icd10watch.com/blog/why‐icd‐10‐training‐should‐start‐sooner‐later Alaska Chiropractic Society 2012 Convention

Consequences of Inadequate Preparation

• Coding & billing backlogs • Increased claims rejections and denials • Increased delays in processing authorizations processing authorizations and reimbursement claims • Improper claims payment • Compliance issues • Decisions based on faulty data