About the Speaker. Mark Roth PCLS Vice President of Operations

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2 About the Speaker Mark Roth PCLS Vice President of Operations Joined PCLS in 2009 VP of Operations in 2011 Responsible for the strategic planning and development of the laboratory and business operations Serves on the Risk, Compliance, and Reimbursement committees B.S. in Biology from UNC Chapel Hill Completing M.B.A. from the Wharton School at the University of Pennsylvania (2015)

3 About PCLS State-of-the-art 120,000 sq. foot building located in the Carolinas Full-service laboratory in the fields of Toxicology, Cardiology, Cytology, Pathology, Genetics and Gastro-Interology.

4 Certifications To ensure the most effective patient management and secure data, our quality system meets or exceeds requirements of: Centers for Medicaid and Medicare Services (CMS), College of American Pathologists (CAP), and the Clinical Laboratory Improvement Amendments (CLIA) International Standard ISO/IEC 15189:2012 General Requirements for the Competence of Testing and Calibration Laboratories

5 2015 ICD-10 Conversion

6 ICD-9 and ICD-10 ICD-10 (International Classification of Diseases 10 Ed) Diagnosis Code updates go into effect on Oct 1, 2015 Currently uses outdated obsolete terminology producing inaccurate and limited data Inconsistent with current medical practice

7 Advantages of ICD-10 Improved ability to measure healthcare services More sensitivity when refining grouping & reimbursement methodologies Enhanced ability to conduct public health surveillance Reduce need to include supporting documentation w/ claims Improved ability to conduct research Better identifies fraud and abuse

8 Basic Structure of ICD Extension Severity 54 Category Body Etiology Part of of of the Affected Specificity Disease Illness

9 ICD-10: Huge Impact on Productivity and Reimbursement Prevailing estimate of productivity loss is between 30-50%; one study put the estimate closer to 70% CMS estimates in the early stages of implementation: Denial rates will rise by % Days in A/R will grow by 20-40% Claims error rates also will go up: CMS predicts claims error rates will be more than 2X higher with ICD-10 Claims error rates could reach a high of 6-10% in comparison with the average 3% error rate with ICD ICD-10 Transformation: Five Critical Risk-Mitigation Strategies, Healthcare Information and Management Systems Society, 2011

10 ICD-10: Huge Impact on Productivity and Reimbursement Due to complexity of the new coding system and coders unfamiliarity with its ins and outs, coding backlogs are projected to balloon by at least 20%, impeding the flow of cash. A typical turnaround time for claims processing of 45 to 55 days could end up being extended another 10 to 20 days

11 PCLS s ICD-10 Implementation Strategy Preparation Update Internal Systems (Billing, EMR, LIS) Education Educate Personnel, Distribute Educational materials to Customers, Test System updates Execution Execute processes for conversion Monitoring Monitor success of project

12 PCLS s ICD-10 Implementation Strategy Preparation Education Execution Monitoring

13 Error Processing on the XIFIN Client Portal

14 XIFIN Error Processing Portal Non-reimbursed tests due to errors on initial submission i.e. misspelling, outdated info, missing info, etc. XIFIN Error Processing (EP) on Client Portal created for the practice level to correct errors after initial denial PCLS Processors collect 60% of PCLS samples; account for 1/4 of the errors PCLS rollout EP on the Client Portal to Processors and monitor success of error correction and subsequent reimbursements

15 Client Portal Automation No Phone Clean Requisitions Paid Claims

16 Client Portal Automation Select Correct Submit

17 Auto-Push Errors from XIFIN RPM to Client Portal Diagnosis Specificity Demographic Errors Insurance Information Payer Authorizations Referral Information Request for Supporting Documentation

18 Auto-Push Errors from XIFIN RPM to Client Portal

19 Results from PCLS Error Processing on the Client Portal

20 PCLS Client EP Portal 105 PCLS Processors assigned portal access Monitored use for nine weeks Login Activity % Errors Corrected Types of Errors

21 Errors Worked on the Client EP Portal Weeks 1-11

22 Billed & Expect Amounts Worked on Client EP Portal Weeks 1-11

23 Client EP Portal: Breakdown of Errors

24 XIFIN ICD-10 Code Assist

25 XIFIN EP Portal for ICD-10 Launch PCLS clients now familiar with error correction process in EP portal Allows for easy transition to ICD-10 switch Introduction of ICD-9 ICD-10 assist tab in the portal allows the physician to either: correct an error on the back end look up the correct code on the front end Portal allows us to monitor clients with most mistakes so we can re-educate and re-train where necessary

26 ICD-10 Decision Code Assist Informed Physicians Clean Requisitions Paid Claims

27 Conclusions ICD-10 conversion will create a high denial rate; impacting both productivity and reimbursement Implementation plan is necessary for a successful conversion Utilization of XIFIN Client Portal allows PCLS to train, prepare, educate and monitor our success during the conversion ICD-10 Code Assist will allow for front end corrections so PCLS gets reimbursed on first claims submission

28 Thank You