ICD-10: End-to-End Testing from a Collaboration Perspective An Orientation and Panel Discussion. April 18, 2013

Transcription

1 End-to-End Testing from a Collaboration Perspective An Orientation and Panel Discussion April 18, 2013

2 Randy Brittingham (Vendors) CPU Medical Management Systems, Inc. Curt Cvikota (Billing Services) The Cvikota Company Joseph Gonzalez (Clearinghouse) Secure EDI George Vancore (Payer) Florida Blue

3 Session Objectives 1. To increase your awareness and understanding of the challenges that ICD-10 brings to Physicians; Providers; Payers; Vendors; Clearinghouses and others in the Health Care industry. 2. To increase your understanding of the current state of ICD-10; recent regulatory decisions and industry perspectives. 3. To share insights into why collaboration between Physicians; Providers; Payers; Vendors; Clearinghouses and others in the Health Care industry is critical to a successful ICD-10 implementation.

4 Recent History and Current State of the Industry On February 16, 2012, the DHHS announced its intent to delay ICD-10. On April 9, 2012, the DHHS announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, On June 19, 2012, delegates at AMA's Annual Meeting adopted a policy to evaluate ICD-11 as an alternative to replace ICD-9. The AMA will conduct more research and will report back to their House of Delegates in May of On August 24, 2012, the OMB approved the DHHS request to postpone ICD-10 from October 1, 2013 to October 1, On April 11, 2013, WEDI completed its 2 nd ICD-10 Readiness Survey; results indicated a lack of preparedness on the part of providers, payers and vendors.

5 Regulatory Fundamentals In January 2011, the DHHS announced the final rules for new medical diagnosis and procedure code sets (ICD-10) under HIPAA-AS. The successful implementation of the new electronic transaction standard (HIPAA 5010) is a pre-requisite to the implementation of ICD-10. ICD-10 is intended to improve clinical data reporting, improve patient care quality, enhance claim processing and promote increased interoperability across all health care industry stakeholders. Significant impacts to provider billing and payment processing may be realized across the health care industry if stakeholders fail to collaborate, coordinate and communicate on their ICD-10 initiatives.

6 Regulatory Fundamentals (continued) The ICD-10 CM (Clinical Modifications) and ICD-10 PCS (Procedure Coding Structure) are the new medical diagnosis and procedure code sets under HIPAA-AS. These new code sets represent a fundamental overhaul to the current ICD-9 coding system. ICD codes are used to codify medical diagnoses and procedures, calculate and adjudicate coverage, compile medical statistics, assess quality of care and help manage clinical quality outcomes for patients. The current ICD-9 codes sets are outdated and do not reflect advances in medical technologies nor are they descriptive enough. 6

7 Regulatory Fundamentals (continued) As highlighted in the final rule, the new ICD-10 CM and PCS code sets are intended to: Provide greater flexibility to enable future capabilities. Provide more descriptive and robust categories for precise coding. Enable streamlined reimbursement processes. Provide richer medical data with higher degrees of details and quality for further analysis; help enrich clinical care profiles and patient outcomes. Maximize the value of clinical data and the business value of interoperability of e-health initiatives and the Electronic Health Record (EHR). 7

8 What s Changing? ICD-10 CM is the new medical code sets under HIPAA-AS for diagnosis reporting and replaces ICD-9 CM in all U.S. health care settings.

9 What s Changing? ICD-10 PCS identifies medical procedures for use in U.S. inpatient hospital settings only; does not replace CPT/HCPCS codes for outpatient services.

10 What s Changing? In addition to structural and content changes to the code sets, there are medical terminology changes that are also being implemented. A few examples follow:

11 Implementation Date? The implementation of ICD-10 is Service Date driven for outpatient services and Discharge Date driven for inpatient services!! So, how does this impact you? Do you need to co-exist between ICD-9 and ICD-10 after the mandated compliance date? What happens if a pre-authorization is issued under ICD-9 but the Service is not performed until after ICD-10 is implemented?

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13 Open Panel Questions and Discussion Thank You