Practical Guide to ICD 10: You won t be using all those codes Goals for Today General Overview of ICD 10 CMS has made ICD 10 hard Many practices are under prepared Scare tactics make it worse Goals for Today General Overview of ICD 10 CMS has made ICD 10 hard Many practices are under prepared Scare tactics make it worse Understand Impact to YOUR Practice 1
Goals for Today General Overview of ICD 10 CMS has made ICD 10 hard Many practices are under prepared Scare tactics make it worse Understand Impact to YOUR Practice Physician Productivity and Revenue Cycle Compliance vs Productivity Goals for Today General Overview of ICD 10 CMS has made ICD 10 hard Many practices are under prepared Scare tactics make it worse Understand Impact to YOUR Practice Physician Productivity and Revenue Cycle Compliance vs Productivity Q&A ICD 10 is Difficult 1 Day Conversion Current conversion date of Thursday, October 1, 2015 2
ICD 10 is Difficult 1 Day Conversion Current conversion date of Thursday, October 1, 2015 Large Change for Physicians Cannot slow down No time or desire for lengthy training ICD 10 is Difficult 1 Day Conversion Current conversion date of Thursday, October 1, 2015 Large Change for Physicians Cannot slow down No time or desire for lengthy training 100% of Cash Flow is At Risk All HIPAA Covered Entities No uniformity on Medical Necessity across payers Practice Preparation ICD 10 is not just a Coding Project 3
Practice Preparation ICD 10 is not just a Coding Project ICD 10 is not just an IT Upgrade Practice Preparation ICD 10 is not just a Coding Project ICD 10 is not just an IT Upgrade ICD 10 has to be a Strategic Initiative Practice Preparation ICD 10 is not just a Coding Project ICD 10 is not just an IT Upgrade ICD 10 has to be a Strategic Initiative Largest Risks of ICD 10: Decrease in Physician Productivity Decrease in Revenue Cycle Efficiency 4
Costs of Transitioning to ICD 10 ICD 10 Scare Tactics ICD 10 Scare Tactics V91.07XD Burn dues to water skis on fire, subsequent encounter E837.4 Explosion, fire or burning in watercraft injuring skier 5
ICD 10 Scare Tactics V91.07XD Burn dues to water skis on fire, subsequent encounter E837.4 Explosion, fire or burning in watercraft injuring skier V95.40XA Unspecified Spacecraft accident injuring occupant, Initial Encounter E845.0 Accident involving spacecraft injuring occupant of spacecraft ICD 10 Scare Tactics V91.07XD Burn dues to water skis on fire, subsequent encounter E837.4 Explosion, fire or burning in watercraft injuring skier V95.40XA Unspecified Spacecraft accident injuring occupant, Initial Encounter E845.0 Accident involving spacecraft injuring occupant of spacecraft ICD 10 Specialty Impact Specialty ICD 9 Codes ICD 10 Codes Low Risk 1 to 1 Moderate Risk 2 10 High Risk 11+ Cardiology 243 836 139 89 16 Family Practice 291 1,243 146 127 17 Internal Medicine 300 1,430 151 128 22 OBGYN 268 1,521 134 113 22 Ophthalmology 276 1,276 77 184 14 Orthopaedics 179 6,008 26 107 48 Pediatrics 170 844 78 79 13 6
ICD 10 Specialty Impact Specialty ICD 9 Codes ICD 10 Codes Low Risk 1 to 1 Moderate Risk 2 10 High Risk 11+ Cardiology 243 836 139 89 16 Family Practice 291 1,243 146 127 17 Internal Medicine 300 1,430 151 128 22 OBGYN 268 1,521 134 113 22 Ophthalmology 276 1,276 77 184 14 Orthopaedics 179 6,008 26 107 48 Pediatrics 170 844 78 79 13 ICD 10 Specialty Impact Specialty ICD 9 Codes ICD 10 Codes Low Risk 1 to 1 Moderate Risk 2 10 High Risk 11+ Cardiology 243 836 139 89 16 Family Practice 291 1,243 146 127 17 Internal Medicine 300 1,430 151 128 22 OBGYN 268 1,521 134 113 22 Ophthalmology 276 1,276 77 184 14 Orthopaedics 179 6,008 26 107 48 Pediatrics 170 844 78 79 13 Sample ICD 10 Conversion Analysis 7
ICD 9 Superbill American Academy of Family Practice American Academy of Family Practice ICD 10 Superbill ICD 10 Superbill American Academy of Family Practice American Academy of Family Practice ICD 10 Superbill Superbill Problems with ICD 10 Real Estate Limitation 8
Superbill Problems with ICD 10 Real Estate Limitation Different (longer) Descriptions Superbill Problems with ICD 10 Real Estate Limitation Different (longer) Descriptions Destruction of Physician Muscle Memory ICD 10 Options Hire Certified Coders Salary Range $47,421 $64,807 + Benefits Shortage of Coders + Increasing Demand AAPC Recommends 60 70 Hours of Training 20% Decrease in Productivity in ICD 10 9
ICD 10 Options Hire Certified Coders Salary Range $47,421 $64,807 + Benefits Shortage of Coders + Increasing Demand AAPC Recommends 60 70 Hours of Training 20% Decrease in Productivity in ICD 10 Mandate EHR Use for All Physicians Too Many Clicks Disliked by Physicians in ICD 9, Hated in ICD 10 Fundamental Problem of Code Search ICD 10 Options Hire Certified Coders Salary Range $47,421 $64,807 + Benefits Shortage of Coders + Increasing Demand AAPC Recommends 60 70 Hours of Training 20% Decrease in Productivity in ICD 10 Mandate EHR Use for All Physicians Too Many Clicks Disliked by Physicians in ICD 9, Hated in ICD 10 Fundamental Problem of Code Search Electronic Superbill Designed to look like the paper superbill Gets billing team the right code the first time Code Search Example 10
Code Search Example 11
ICD 10 Superbill ICD 10 Superbill ICD 10 Superbill 12
ICD 10 Superbill ICD 10 Superbill ICD 10 Superbill 13
Revenue Cycle with Payers BIG Impact to MD first time in history electronic superbill is faster than paper! AND Big impact to reimbursement and staffing levels for billing teams Revenue Cycle with Payers BIG Impact to Physician first time in history electronic superbill is faster than paper! AND Big impact to reimbursement and staffing levels for billing teams CPT codes must have an appropriate dx for reimbursement ICD 9 ICD 10 Cat and Mouse game with insurance companies This dx goes with this CPT If this dx was primary If a patient presents with this dx, we always Non uniformity across payers Revenue Cycle with Payers BIG Impact to Physician first time in history electronic superbill is faster than paper! AND Big impact to reimbursement and staffing levels for billing teams CPT codes must have an appropriate dx for reimbursement ICD 9 ICD 10 Cat and Mouse game with insurance companies This dx goes with this CPT If this dx was primary If a patient presents with this dx, we always Non uniformity across payers ICD 9 this evolved over time, never static but do reach an equilibrium 14
Revenue Cycle with Payers BIG Impact to Physician first time in history electronic superbill is faster than paper! AND Big impact to reimbursement and staffing levels for billing teams CPT codes must have an appropriate dx for reimbursement ICD 9 ICD 10 Cat and Mouse game with insurance companies This dx goes with this CPT If this dx was primary If a patient presents with this dx, we always Non uniformity across payers ICD 9 this evolved over time, never static but do reach an equilibrium ICD 10 is massive one day earthquake that will disrupt this equilibrium Revenue Cycle with Payers BIG Impact to Physician first time in history electronic superbill is faster than paper! AND Big impact to reimbursement and staffing levels for billing teams CPT codes must have an appropriate dx for reimbursement ICD 9 ICD 10 Cat and Mouse game with insurance companies This dx goes with this CPT If this dx was primary If a patient presents with this dx, we always Non uniformity across payers ICD 9 this evolved over time, never static but do reach an equilibrium ICD 10 is massive one day earthquake that will disrupt this equilibrium Aftershocks of changes to reimbursement for 3, 6, 12 months of rapid change Revenue Cycle with Payers BIG Impact to Physician first time in history electronic superbill is faster than paper! AND Big impact to reimbursement and staffing levels for billing teams CPT codes must have an appropriate dx for reimbursement ICD 9 ICD 10 Cat and Mouse game with insurance companies This dx goes with this CPT If this dx was primary If a patient presents with this dx, we always Non uniformity across payers ICD 9 this evolved over time, never static but do reach an equilibrium ICD 10 is massive one day earthquake that will disrupt this equilibrium Aftershocks of changes to reimbursement for 3, 6, 12 months of rapid change The volume of changes will be significant. What, who, how will you manage? What happens if you don t? 15
Closed Loop Denial Prevention Denied Claim / New Policy Closed Loop Denial Prevention New Rule Built Rule fires for all employees every time Compliance vs Productivity Compliance Productivity Compliance vs Productivity Compliance Submit claims with ICD 10 codes Productivity Workflow optimized for ICD 10 16
Compliance vs Productivity Compliance Submit claims with ICD 10 codes Providers staying late to answer coding questions Productivity Workflow optimized for ICD 10 Provider productivity maintained Providers focused on patients not coding Compliance vs Productivity Compliance Submit claims with ICD 10 codes Providers staying late to answer coding questions Patient satisfaction suffered Billing department working overtime Hire more employees to deal with additional work Productivity Workflow optimized for ICD 10 Provider productivity maintained Providers focused on patients not coding Billing department receives correct ICD 10 code the first time Billing tools to respond to changes in payer adjudication algorithms Compliance vs Productivity Compliance Submit claims with ICD 10 codes Providers staying late to answer coding questions Patient satisfaction suffered Billing department working overtime Hire more employees to deal with additional work No additional revenue Eroding profitability Productivity Workflow optimized for ICD 10 Provider productivity maintained Providers focused on patients not coding Billing department receives correct ICD 10 code the first time Billing tools to respond to changes in payer adjudication algorithms Improved practice profitability 17
Questions Most practices use what portion of the ICD 9 code set? 2% 5% 7% 10% True/False ICD 10 is optional for some practices? How many pages would an ICD 10 superbill be? 2 5 8 10 True/False Will unspecified codes be risky in ICD 10? July 1, 2015 AOA Webinar: Tips for ICD 10 Preparation Download the slides and click on the image to listen to the webinar. Article: Practical Guide to ICD 10 Download the slides and click on the image to read the online article. 18
Contact Information Matthew Menendez VP of Sales and Marketing White Plume mmenendez@whiteplume.com www.whiteplume.com/icd10 19