ICD-10 GAP ANALYSIS PROPOSITION. Smart Solution to Fix the Revenue Impacted due to Doc GAPS. nxinc.com

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1 ICD-10 GAP ANALYSIS PROPOSITION Smart Solution to Fix the Revenue Impacted due to Doc GAPS

2 Overview: The U. S. Department of Health and Human Services (HHS) has nalized the adoption of the International Classi cation of Disease-10th Revision (ICD-10) code set, which would replace the current ICD-9 diagnosis and procedure codes. Under the HHS nal rule, the switch will be completed by October 1, The adoption of ICD-10 will also require the implementation of the next generation version of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards, known as As recommended by the National Committee on Vital and Health Statistics, 5010 must be completely implemented prior to the adoption of ICD-10 because the ICD-10 code set cannot operate with the current HIPAA transaction standards (4010). ICD-10 Changes :Overview ICD-9 CM (DIAGNOSIS) 5 DIGITS NUMERIC - 14,000 UNIQUE CODES ICD-10 CM (Diagnosis) 7 digits alphanumeric characters > 68,000 unique codes ICD-9 CM (PROCEDURE) 4 DIGITS NUMERIC -4,000 UNIQUE CODES ICD-10 CM (Procedure) 7 digits alphanumeric characters -72,000 unique codes In nx has developed a comprehensive roadmap for ICD-10 solution offerings to make the ICD-10 transition easier by providing analytics and business intelligence solution. Infinx ICD-10 Solution Offerings: ICD-10 DOCUMENTATION GAP ANALYSIS ICD-10 MEDICAL CODING ICD-9 AND ICD-10 SIMULTANEOUS CODING ICD-10 CODING AUDITS ICD-10 DENIAL EDITS

3 ICD-10 DOCUMENTATION GAP ANALYSIS Effects of Documentation Gaps UNSPECIFIED CODING INCREASED DENIALS INCREASED AR DAYS CHANGE IN REIMBURSEMENT SCHEDULES CASH COLLECTION DELAYS REVENUE IMPACT ON CASH FLOW Gaps in documentation can affect the claims adversely in the following aspects: Unspeci ed coding (which will occur in case of documentation gaps) is permissible for each patient only once in a year and repetition will result in denials. For certain incidences coding cannot be done without speci c documentation. In case of a gap, the le will remain pending till information is gathered affecting reimbursement schedules. The documentation gaps will cause cash collection delays due to increased account receivables and improper and returned claims. Many Payors may offer reduced reimbursement rates or delays in reimbursements resulting in negatively affecting revenues and cash ows.

4 Infinx GAP Analysis Methodology: GAP Analysis by Documentation Gaps with Reason GAP Analysis by Modality. INFINX GAP ANALYSIS METHODOLOGY: CODE SET ANALYSIS DOCUMENTATION ANALYSIS IDENTIFY DOCUMENTATION GAPS CATEGORIZE DOCUMENTATION GAPS INFINX GAP ANALYSIS Result GAP ANALYSIS & DASHBOARD FEEDBACK REPORT REVENUE IMPACT ANALYTICS GAP ANALYTICS & RECOMMENDATION REPORTS Infinx GAP Analytics Toolkit In nx has developed an analytical tool that helps in identifying different cases causing the documentation gap in-order to code more speci c and appropriate ICD-10 code. In nx has a proprietary tool developed for ICD-10 documentation analytics which enables our coders in identifying different cases causing the documentation gap in-order to code more speci c and appropriate ICD-10 code and classify them by gap reason as well as provide corrective feedback. This tool also automates the data analytics required to display the analytics dashboard The following are the functions of Infinx GAP Analytics Tool Kit: Provides critical insights of the existing clinical documentation gaps that hamper coding as per ICD-10 requirement Analytical dashboard showing trends classi ed by gap reasons and modalities Enables consultative approach with proper knowledge documentation providing corrective feedback to further improve their clinical documentation Analytics providing insights on revenue impacted due improper documentation.

5 GAP Analysis Workflow Mechanism: SAMPLE REPORTS TAKEN FROM CLIENT DETAIL ANALYSIS OF THESE REPORTS CODE FILES IN ICD-9 CODE FILES IN ICD-10 INFINX GAP ANALYSIS METHODOLOGY IDENTIFY TOTAL NO OF FILES WITH GAPS DUE TO IMPROPER DOCUMENTATION SHARE ANALYTICS REPORTS& CORRECTIVE FEEDBACK REPORT WITH CLIENT RUN GAP ANALYTICS WITH INFINX GAP ANALYTICS TOOL CATEGORIZE FILES BASED ON GAP REASONS ANALYZE & CATEGORIZE THE FILES BASED ON THE GAP REASONS Infinx GAP Analysis Program Schedule: In nx has build three solutions (Solution I, Solution II, Solution III) for its clients to help them with the GAP Analysis Solution Solution I Solution II Solution III Pre- ICD GAP Analysis & Feedback Post ICD-10 ICD-10 Coding + GAP Analysis GAP Analysis Weekly Audit

6 Infinx Team The In nx team will be headed by our senior coding consultant who brings comprehensive expertise in ICD-10 analytics solutions. She is also a certi ed ICD-10 and ICD-9 coder with years of experience leading coding teams across specialties with special focus on radiology. The team will also comprise of experienced and certi ed senior coders who are well trained in In nx ICD- 10 documentation analytics methodology. This team is also well trained in ICD-10 coding methodology with practiced expertise in radiology. ICD-10 TRAINED CODING TEAM ICD-10 CERTIFIED BY AAPC MINIMUM 6 MONTHS HANDS ON EXPERIENCE IN CODING ABILITY TO CODE FOR RADIOLOGY, E&M, SURGERY, PATHOLOGY CPC CERTIFIED CODERS AUDITORS (1st Level Audit) ICD-10 CERTIFIED BY AAPC MINIMUM 2YRS EXPERIENCE HANDLING VARIOUS SPECIALTIES & MODALITIES CPC CERTIFIED CODERS ICD-10 CERTIFIED BY AAPC SPECIALIZED AUDITORS (2nd Level Audit) MINIMUM 3YRS EXPERIENCE IN CODING ACROSS VARIOUS SPECIALTIES MINIMUM 6 MONTHS EXPERIENCE IN CLINICAL DOCUMENTATION & GAP ANALYTICS EXPERTS (3rd Level Audit) CPC CERTIFIED CODERS ICD-10 CERTIFIED BY AAPC CPC-H CERTIFIED CIRCC CERTIFIED CCS CERTIFIED TOTAL 8 YRS OF EXPERIENCE IN CODING ACROSS VARIOUS SPECIALTIES MINIMUM 1 YR OF EXPERIENCE IN CLINICAL DOCUMENTATION & GAP ANALYTICS

7 Program Fee Structure Solution I Pre- ICD GAP Analysis & Feedback Program Includes CD-10 Coding Analysis GAP Analytics and Dashboards Feedback Report Resources Included Certi ed ICD-10 coders Auditor Specialized GAP Analysis Trained Auditors Solution II Post ICD-10 ICD-10 Coding + GAP Analysis Program Includes Daily ICD-10 Coding Daily GAP Analysis and Dashboards Daily Feedback Recommendation Report Resources Included Certi ed ICD-10 coders Auditors Specialized Auditors Experts Solution III GAP Analysis Weekly Audit Program Includes GAP File Analysis GAP Analytics and Dashboards Feedback Report Resources Included Certi ed ICD-10 coders Auditor Specialized GAP Analysis Trained Auditors Note * This estimate includes all manpower, technology and data management costs.

8 In nx is a global business process management & technology solutions company providing integrated portfolio of outsourcing solutions in the areas of Healthcare RCM, Pharmacy, Document Management and Software. It is part of Tandon Group Company, Founded in 1979 with principal of ce in San Jose, CA with state-of-the-art facilities in Mumbai, Navi Mumbai, Hyderabad, Chennai and Burgur in India California, USA Mumbai, India Chennai, India Hyderabad, India In nx Services Pvt. Ltd. In nx Services Pvt. Ltd. In nx Services Pvt. Ltd. In nx Services Pvt. Ltd Stevens Creek Blvd., Suite 275,San Jose, CA P: +1 (408) F:+1(408) Unit No.1, SDF-1, SEEPZ SEZ Andheri (East). Mumbai India P: +91 (22) F:+91 (22) Plot No. B27, Phase II, Z o n e B, M E P Z S E Z, Sanatorium, Tambaram, Chennai. India P: +91 (44) F:+91 (44) Level - 1, Tower- 2, SEZ IT Park,(Raheja's Mind space - South), Hardware Park, Srisailam Highway, Maheswaram- Mandal, Dist. - Ranga Reddy. Hyderabad Phone: Disclaimer This document is the copyright of In nx Services All information presented in this document is a result of the research, analysis conducted by the authors of In nx and represents their interpretation from various aspects. This document cannot be published by a third party for commercial uses and is for educational purpose only.