Must Have Tips and Tools for the ICD-10 Transition

Transcription

1 Must Have Tips and Tools for the ICD-10 Transition

2 Agenda Navicure, Inc. ICD-10: On or off? Navicure Status and Testing Status Resources To Help You Prepare Navicure Tools and Products

3 Navicure, Inc. The Latest Congress delayed ICD-10 the last time: will Congress vote for another delay? The December 2014 Spending Legislation did not include an ICD-10 delay. Government Accountability Office (GAO) issued a report saying CMS efforts to prepare the industry: are on track. House Committee on Energy and Commerce held a hearing in February on Examining the ICD-10 Implementation Several members stated support for the Oct. 1, 2015 implementation date including Chairman Pitts.

4 Navicure, Inc. The Latest On March 26, 2015 the House passed by a wide margin, , the Medicare Access and CHIP Reauthorization Act, which permanently repeals SGR: at this time it does not contain ICD-10 delay language. Senate will vote mid-april on the legislation. Majority Leader McConnell is quoted as saying..there is every reason to believe it s going to pass the Senate by a very large majority. President Obama supports the legislation. Experts are unanimous that if this legislation doesn t delay ICD-10, then Oct 1, 2015 will stand.

5 Navicure, Inc. As Of Now No delay. The transition date to ICD-10 as announced by CMS in July 2014 is October 1, 2015.

6 Navicure, Inc. The Latest: Payers To date, payers are saying they will require ICD-10 beginning Oct 1, No exceptions, no delays Not optional Limited End-to-End testing on-going now with many payers. Navicure has been selected by ALL Medicare payers to participate in their national End-to-End test program.

7 Navicure Activity Continue monitoring CMS and payer announcements. Continue practice management vendor, client and payer outreach. Continue testing with as many clients, payers and vendors as they are capable.

8 Navicure Activity Use strategies that were successful in previous transitions like Monitor payer rejection rates and reasons Monitor payer denial rates and reasons Take proactive action with clients, vendors and payers to find and implement fast solutions 3-Ring customer service

9 Navicure Activity Participated in Medicare end-toend testing activities. Medicare limited the number of sites permitted to participate. Preliminary analysis Typical denials Typical patient responsibility Detailed review underway.

10 Steps Administrators Need To Take Now Identify leadership and make a plan Get your practice staff and physicians engaged Get your IT systems ready Create an education plan Set aside cash reserves or obtain a line of credit Navicure, Inc.

11 Why Talk About Engaging Clinicians and Staff? The transition to ICD-10 is an organizational challenge and requires participation from everyone. Administrators and project leaders must get practice staff and physicians engaged Navicure, Inc.

12 Everyone Is Needed Physicians and Clinicians Clinical documentation is essential for ICD-10 success. Coders Knowledge of ICD-10, medical policy, quality metric changes, enhanced anatomy, physiology, etc are critical Navicure, Inc.

13 Everyone Is Needed Administrators must Assess and mitigate risk Slower revenue cycles Increase cash reserves and lines of credit Productivity declines Correct and accurate coding Lack of specificity:» Laterality, location, severity, encounter type Service or IT vendor readiness Measure and monitor key operational and financial statistics Days in A/R Payer collection rates Charges and net revenue by physician Provider and coder productivity rates Navicure, Inc.

14 Everyone Is Needed Administrators Must review their revenue cycle to make sure it is ready for the assault ICD-10 will likely bring to ensure claims continue to be paid: Look at existing processes and make sure they will handle more volume and complexity, such as denials and clinical queries. Automate as much as possible. Collect patient responsibility amounts at time of service Consider payment plans for patients unable to pay in full Consider new tools to assist you in improving your revenue cycle: Real-time correction and resubmission Electronic ICD-10 and ICD-9 code book permitting fast code lookup, review and expert advice Automated ICD-10 and ICD-9 LCD/NCD edits review claims to ensure medical necessity Automated Denial Identification and Tracking Navicure, Inc.

15 Navicure, Inc. Start Now Lets staff become experts with process changes and new IT solutions. Improvements today help your costs and improve revenue today. You have time to think about how to mitigate risks, such as: Reduced and delayed revenue Reduced productivity

16 Navicure, Inc. Start Now You have time to install improvements to your revenue cycle before the expected increases in rejections and denials to keep the cash flowing. Real-time correction and resubmission Electronic ICD-10 and ICD-9 code book permitting fast code lookup, review and expert advice Automated ICD-10 and ICD-9 LCD/NCD edits review claims to ensure medical necessity Automated Denial Identification and Tracking

17 Navicure, Inc. Start Now So you can test. To prove that a process, a person or a system works and meets requirements and works as expected. ICD-10 testing contains three types: Clinical testing: do we have accurate and complete clinical documentation? Financial: what impact will ICD-10 have on reimbursement Operational: are systems and process ready for ICD-10 You must be ready in order to test with external partners. You can create commonly seen scenarios based on mix of patients, conditions, health plans, procedures, contracts, etc. You can test Medical Necessity.

18 Tools to include in your preparation Navicure, Inc.

19 ICD-10 Hub ( Navicure, Inc.

20 ICD-10 Analyzer: Start Here Navicure, Inc.

21 ICD-10 Analyzer: Jump Start Your Transition Navicure, Inc.

22 ICD-10 Analyzer: Jump Start Your Transition Navicure, Inc.

23 Free Educational Resources WHO ICD-10 Self-Help Training Tool training/

24 Free Resources: WHO ICD-10 Overview WHO ICD-10 Introduction Tool

25 Free Resources: WHO ICD-10 Trailing Tool

26 Free Resources: WHO ICD-10 Learning Tool WHO ICD-10 Introduction Tool

27 Free Resources: CMS Coding Guidelines CMS ICD-10-CM Official Guidelines for Coding and Reporting d10cm-guidelines-2015.pdf

28 Free Resources: CMS Planning Tool CMS Planning Tool The website includes: o An Overview of ICD-10 o Physician Perspectives o Webcasts o Frequently Asked Questions o Quick References o Template Library o Live Events Calendar o Build Your Action Plan

29 ICD-10 Resources CMS ICD Hub MGMA WHO (World Health Organization) Final Rule Final CMS ICD-10-CM Official 2013 Coding Guidelines Navicure, Inc.

30 Michael Handley Client Solutions

31 Key Benefits to Providers Replace cumbersome and potentially expensive codebooks Online tools provides easily-searched source for CPT/HCPCS, Modifier, ICD-9, and ICD- 10 data Enables your coders to work more efficiently; no longer a need to go to multiple sources Need for digital coding data source will be amplified with ICD-10 transition Reduce A/R Days Avoid claim rejections and denials with accurate coding Use extensive coding research tool to troubleshoot denied claims for speedy resolution Ensure Compliance Most complete source for up-to-date CMS guidelines, including LCD and NCD policies Frequently updated database; you will always have the latest Count on accurate reimbursement View CMS pricing percentiles to help determine competitive pricing strategy Receive expert coding advice Coding staff available to answer specific coding questions Online users forum gives practices access to colleagues in other medical practices 33

32 Code Source: Click and Go, See Code Details - Code Details, Go to Chapter, Revision History

33 Code Source: Quickly access LCD & NCD policies - No longer have to go to CMS website to try to find relevant LCD and NCD policies

34 Code Source: Quickly access reference documents - No longer have to go to multiple websites for referencing documents - OIG, Coding Clinics, PQRS, CMS and more

35 Code Source: Quickly access CMS Reimbursement - Check Medicare Reimbursement/GPCI for specific codes - Shows modifier/no modifier reimbursement information

36 Code Source: Concurrent Diagnosis - See which concurrent diagnosis get paid the most frequently

37 Code Source: ICD-10 Crosswalk - ICD-10 Crosswalk See related codes

38 Code Check Code Check helps you with the following: Correct Coding Initiative (CCI) bundling edits, and tests up to 50 CPT/HCPCS codes for CCI bundling edits. Pro Part B- Enter full CMS1500 claims to perform a single check for CCI and Medical Necessity issues.

39 Browse Code Books Online - Quick Access to Online Code Books updated regularly when coding guidelines change.

40 Clinic and User Favorites - Users can create and utilize Favorites for common codes used at the practice and add in specific notes. - Administrators can push out Clinic Notes to Users to use certain codes to ensure claims will be paid the first time.

41 User Forum - Access to Online User Forum to share, post and gain expert advice from professional coders and colleagues from other practices.

42 If your practice would like to sign up for Navicure Code Source: Cost: $468 per annual license/ billed monthly at $39.00 per license At end of webinar survey, please select yes to sign up and next steps will be sent to your

43 Navicure, Inc. Ken Bradley VP of Strategic Planning Navicure Michael Handley Client Solutions Navicure