Certification Period Episode Certification Period Benefit Period. Assessment Date

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1 What you need to know in DeVero about the CMS ICD requirements. The wait is finally over! You ve learned about the change to ICD 10 codes for years and know the deal, but for those who need a reminder: ICD-9 codes are being phased out and replaced by ICD-10 effective October 1, Seems simple enough, but there are finer points to the new rule affecting clinical documentation and billing for patients with episodes that span the October 1, 2015 date. Below, you will find details for how the ICD 10 transition will be managed in DeVero. First, to best set the landscape, a few notes to keep in mind when reading this documentation and an overview of the rules. General Notes: Throughout this documentation, we ve taken the liberty in generalizing certain terms across all lines of business. Please use the below table to translate as needed: DV Documentation Generic Term Home Health OASIS Home Health Non OASIS Hospice Industry Specific Term Industry Specific Term Industry Specific Term Certification Period Episode Certification Period Benefit Period Assessment OASIS Non OASIS HIS Admission / Recertification of Terminal Illness (2nd 90 and 60 Day) Date Assessment Completed M0090 Assessment Date A0220 / Date Assessment Completed Certification Start Date Episode Start Date Certification Start Date Benefit Period Start Date While the requirement to use ICD 10 codes formally takes effect on 10/01/2015, remember: Patients with certification periods spanning 10/1/2015 are required to document both ICD 9 and ICD 10 aka Dual Coding. o For Home Health, the cert start date for which cert periods will span 10/1/2015 is 8/03/2015. o For Hospice Dual, the cert start date for which cert periods will span 10/1/2015 is 7/04/2015 for 90 Day Periods and 8/03/2015 for 60 Day Periods. The following information is being provided as a general overview. While Home Health and Hospice requirements are similar, we have created separate guides for the two service lines. Important DeVero Dates: Dual Coding Worksheet Added to Sites by 8/03/2015 Assessment Update to OASIS C1 ICD 10 version by 10/1/2015 DeVero ICD 10 Transition Webinars begin week of 7/13/2015

2 ICD 10 Overview: The DeVero functionality and workflow designed to accommodate the transition to ICD 10 is based on CMS requirements. Following are key points to keep in mind under the new ICD 10 rule: For certification period start dates prior to August 3, 2015, ICD 9 code sets are required. For certification period start dates on and after October 1, 2015, ICD 10 code sets are required. The above are the simplest use cases: o When a patient begins service and is assessed prior to 8/03/2015, and the current episode does not span 10/01/2015, ICD 9 codes are required. o When a patient begins service and is assessed after 10/01/2015, and has no current episode that spans 10/1, ICD 10 codes are required. It gets more complicated, when certification or assessment dates span 10/01/15 and require Dual Coding. Three factors affect how ICD-10 must be used on certification periods for Home Health services that span October 1 st and require Dual Coding: 1. The claim From date (Certification Start Date); 2. The assessment completion date; and 3. The claim Through date In the event of the above use case, the patient is eligible for the dual coding, where both ICD 9 and ICD 10 codes need to be documented to complete billing. To learn more on the specifics of the new requirements, please visit the CMS website or reference: Now that we ve covered the basics, let s dive into the details on what this means to your world in DeVero! There are 3 components you need to know about in order to transition to ICD 10 in DeVero: 1. Clinical Assessment Documentation 2. Dual Coding Worksheet 3. Billing Export On the following pages, each of the above will be detailed with key points and workflow recommendations to ease into ICD 10 seamlessly.

3 Clinical Assessment Documentation - New Forms + Feature DeVero will release the updated ICD 10 assessment forms to all sites at no cost by 10/1/2015.* Line of Business Form(s) Updated for ICD 10 Home Health OASIS Home Health Non OASIS SOC OASIS ROC OASIS Recert OASIS ROC/Recert OASIS SOC Non OASIS ROC Non OASIS Recert Non OASIS ROC/Recert Non OASIS Hospice HIS Admission Recertification of Terminal Illness (2nd 90 and 60 Day) ICD 9 and ICD 10 assessment versions will be available for a period of time to accommodate the rule.** Upon release of the ICD 10 assessment forms, users will continue to see one link per assessment form on menus, but will be required to enter the Date Assessment Completed before creating the above forms: Date Assessment Completed will drive creation of the Assessment form based off CMS criteria: Date Assessment Completed Assessment Form Version 9/30/2015 and Prior ICD 9 10/1/2015 and After ICD 10 Upon entry of the Assessment Date, the appropriate version of the assessment form (ICD 9 or ICD 10) will automatically be created. Users will document in the same fashion they do today. ICD Codes and all OASIS elements will reflect what s required based on the version created (Validation, Grouper, M00, Form Content, Export Data). Plan of Care mapping will also be accounted for, regardless of the form version created. If the incorrect version of the assessment is selected (based on Assessment Date ), the form can be changed to a correct version by an office admin user with access to Edit Patient Chart. In the event a form version is changed, update the Assessment Date and re-validate the assessment to address any questions that didn t apply to the other version. *ICD 10 Assessment versions will be available no later than 10/1/2015, but date is subject to occur prior. DeVero to confirm form release dates in follow up correspondence. **The version function will be retired at a future date. At that time, users will not be prompted on creation of the form and will automatically be directed to the C1 version in all cases.

4 Dual Coding Worksheet - New Form + Feature For patients with certification periods spanning 10/01/2015, a new form, the Dual Coding Worksheet, will be made available to satisfy the billing requirement to include ICD 9 and 10 codes on the RAP and Final Claim. The worksheet will be used in conjunction with assessments to document ICD codes. DeVero will release the Dual Coding Worksheet form to all sites at no cost by 8/3/2015.* The worksheet will be added to all clinician user menus who have access to create an Assessment form containing diagnosis, as well as the Office Admin and Super Admin menus to accommodate the new rule.** When it comes to Dual Coding for Home Health, the requirement is based on the Certification End Date spanning 10/1 and the Date the Assessment was completed. Dual Coding Worksheet + Assessment Determine the Assessment Form Version and dual coding requirement: Date Assessment Certification End Assessment Form Dual Coding Completed Date Version Sheet 8/2/2015 and Prior 9/30/2015 and Prior OASIS C1 - ICD 9 No 8/3/2015 to 9/30/ /1/2015 and After OASIS C1 - ICD 9 Yes 10/1/2015 and After 10/1/2015 and After OASIS C1 - ICD 10 No Denotes Dual Coding Window Remember, if Patient Chart Certification End Date is past 10/1/15 Assessment and Date Assessment Complete is between 8/3/15 and 9/30/15 Create a Dual Coding Worksheet!

5 Billing Export - Function The Billing Module Systems will support both ICD 9 and ICD 10 codes as appropriate for the RAP and Final Claims. The use of ICD 9 or ICD 10 is based on the same criteria used to determine if a Dual Coding Worksheet is needed. Date Assessment Certification End Assessment Form Dual Coding Completed Date Version Sheet RAP Final Claim 8/2/2015 and Prior 9/30/2015 and Prior OASIS C1 - ICD 9 No ICD 9 ICD 9 8/3/2015 to 9/30/ /1/2015 and After OASIS C1 - ICD 9 Yes ICD 9 ICD 10 10/1/2015 and After 10/1/2015 and After OASIS C1 - ICD 10 No ICD 10 ICD 10 Denotes Dual Coding Window When a Dual Coding Worksheet is not required, the diagnosis on the assessment forms (ICD 9 or ICD 10) will pull into the billing module as they normally do; upon completion of the assessment document. When a Dual Coding Worksheet is required, the diagnosis will pull into the billing system as they normally do, but in addition, the codes on the Dual Coding Worksheet will also export on completion of the form. Note: The agency is required to create the Dual Coding Worksheet when needed. Once the Assessment and/or the Dual Coding Worksheet are completed and exported to the billing module, the system will programmatically determine which codes should appear on the RAP and Final Claim, based on the CMS requirements and certification period date ranges. Exporting Dual Coding Worksheets Once it s been determined a patient requires a Dual Coding Worksheet, follow the below steps to export to the billing module: 1. Create the Dual Coding Worksheet and document ICD 10 codes. 2. Complete the form. 3. System will automatically export the diagnosis from the worksheet to the billing module. 4. Upon successful export, the worksheet will be marked as Diagnosis Exported - DE. If the export was not a success, the form will not have the DE mark applied. Best Practice Recommendations o While both clinicians with access to assessment forms containing diagnosis and Office/Super Admin users will have the Dual Coding Worksheet, it s required the office complete the worksheet to export for billing. o There will be columns on the Dual Coding Worksheet for ICD 9 and ICD 10. Both can be filled in, but it s advised to only fill in the column for codes not included on the assessment. o When filling out the Dual Coding Worksheet, the corresponding assessment will need to be referenced in order to view the codes documented. Open the form in another tab or window for easy reference. o Complete the Assessment prior to filling out the Dual Coding Worksheet to confirm codes selected on the Assessment are finalized.

6 Clinical Assessment Documentation + Dual Coding Worksheet + Billing Export Workflow Diagram Visual overview of the ICD 10 components and Hospice workflow in DeVero