GE Healthcare ICD-10 preparation and new problem search: Centricity Practice Solution customers Hilari Scott, Product Manager, Revenue Cycle November 21, 2013
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Today s discussion What is ICD-10? What does ICD-10 mean to my practice? How does Centricity Practice Solution v11 support ICD-10? How do I plan for ICD-10? How will my Clinical and Revenue Cycle workflows change? What Documentation is available?
What is ICD-10?
CMS Regulatory Requirement International Statistical Classification of Diseases and Related Health Problems, 10th Revision ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 CM = Clinical Modification (Diagnosis Codes) ICD-10 PCS = Procedural coding system (Hospital only) ICD-9-CM ICD-10-CM 3-5 Digits in length 3-7 Digits in length Mostly only numeric Alpha-numeric 14,025 codes 90,000+codes
Increase in the level of specificity R46.1 = bizarre personal appearance R46.0 = very low level of personal hygiene W22.02XA = walked into lamppost, initial encounter W22.02XD = walked into lamppost, subsequent encounter V91.07XA = burn due to water-skis on fire W59.21 = bitten by turtle
What does ICD-10 mean to my practice?
Potential challenges with ICD-10 1. Clinical documentation (much more specificity) 2. Shortage of experienced and trained coders 3. Productivity decrease (coders and clinicians) 4. Training expenses (coders) 5. Potential for increased reporting requirements 6. Increased claim denials (provider errors and payer processing errors) Source: http://go.ingenix.com/webinars/himss/resources/pdf/ingenix_icd-10approachespitfalls_wp_100-1366.pdf
ICD-10 areas of impact Need to identify all current locations of the implementation of ICD-9 codes the ICD-10 codes will take their place. This includes Practice management/emr systems Encounter forms/superbills Paper and Electronic claim formats Payer contracts Public health and quality reporting protocols Interface capabilities Nothing herein shall be construed as legal advice. Please consult your own advisers as necessary.
Determine your ICD-10 go-live date Don t let the regulation date drive your business Let the system do the work Train your teams to meet your timeline for ICD-10 Set the system date to your date code in ICD-10 System will send your selected ICD-10 or ICD-9 codes based on system settings Healthcare professionals are responsible for making independent clinical decisions and appropriately billing, coding, and documenting their services.
How does CPS v11 support ICD-10?
Centricity Practice Solution v11 ICD-10 both PM and EMR Regulatory compliance Intelligent cross-mapping of terms, with side-by-side view New smart/easy term searching, based on the power of MQIC Pre-population of possible ICD-10 matches Standalone CPS EMR on SQL Bringing new commercial flexibility to net new stand-alone EMR opportunities New Account Summary & Billing Notes Generally available since December, 2012. Just under 500 customers live on v11 as of September 2013 The base mapped ICD-10 is intended as a starting point and educational tool. It is not intended to determine what ICD-10 code users will select after their ICD-10 transition date. Coding decisions are the sole responsibility of the customer.
Practice flexibility for ICD-10 coding 1. New Search Engine 2. Familiarize Clinicians and Coders = Display ICD-9 to ICD-10 base mapped code 3. Decision effort for claims = Mapped ICD-10 to ICD-9
Custom lists remain but display both ICD-9 and their base mapped ICD-10 Existing ICD-9 problems are mapped to the base ICD-10 Practices need to review custom problem lists Some codes will not have a base ICD-10
CPS 11 or 12 & Custom Problem Lists Prior to Upgrading to CPS 11/12 or CEMR 9.8 Practices will need to decide on their Problem List strategy 1. Update or create new ICD-10 Custom Lists for the ICD-10 transition date (this will limit the return results in both the smart search and the full search to only the codes in this list) 2. Begin using the smart search
Problem Search Pre CPS11/CEMR 9.8
Introducing the Smart List. A new form of custom list Search results are based on usage data collected from MQIC. The most often used descriptions (synonyms) for the most often used codes. You can search by Description or by Code The Smart List also learns which problems users edit more than once and updates the priority in the search result Tool is being built to customize priority of codes
You have a choice Custom Problem List vs. Smart Search Smart Search Find codes by commonly used descriptions. Search by Description or by Code Train the search by modifying codes with unique descriptions No need to maintain custom list content Custom Problem List Limit the codes returned to those your practice Coders have approved for the list Search by Description or by Code Maintain Custom List based on coding changes.
When searching for problems The problem list drop down search will display both ICD-9 and its mapped base ICD-10. Smart search will return common descriptions based on MQIC data.
Custom list drop down results will be limited to the custom list content Example: CCC Abdominal Pain Custom List will display 5 results in the drop down. Notice that the same diagnosis is repeated multiple times for 789.00. The search works by searching on the first characters of the description or the code from the custom list. Returning the first results that match Since 789.00 is in the custom list with 3 descriptions that begin with Ab it takes up the first 3 spots in the return.
Custom list drop down options When using a custom list you can click the down arrow to display the rest of the list
There are options are available to make results return without using the down arrow Enter more of the description to return results based on the descriptions in the custom list Customize the descriptions and remove duplicate descriptions in the custom list so the return will provide less duplicates For example entering abdominal pain, eliminates some of the duplicate code results
How does the search learn? If a user is using the Smart Search and they select a code from the list then modify the description more than once that description will move higher in the priority order on the search.
Full search content is determined by a users default custom list Users can switch between custom lists options from the New Problem Dialog to change the content in the full search. Default Custom Lists can be associated From Options Preferences, Patient Chart, Custom Lists
Full search results returned based on the ability to match inputs with results Input abd Results returned Chapters that contain descriptions or codes that begin with abd Input abdominal pain Results returned codes with descriptions beginning with abdominal pain If more than 60 matches return the Find Problem Dialog returns the Chapters containing the results
Familiarizing clinical users with ICD-10
Existing problem lists will display both ICD-9 & the base mapped ICD-10 The base mapped ICD-10 is intended as a starting point and educational tool. It is not intended to determine what ICD-10 code users will select after their ICD-10 transition date.
Managing patient problem list transition to ICD-10 Practices will need to have a policy/process in place to update patient problem lists for the ICD-10 transition date Practices may choose to review the problem lists for patients scheduled in advance to determine the appropriate ICD-10 problem Practices may choose to create Custom Problem Lists, modify the descriptions for the ICD-10 problems and add an identifier such as a * to indicate a problem is ICD-10.
Formal descriptions vs. custom descriptions Custom descriptions will display in the Problem List. The formal ICD descriptions will display when the user hovers the mouse over a code. The formal ICD descriptions will display when by passing the smart search and using full search. Once a selected users can modify the description in the patient problem list.
Indicators are provided in the drop down search for inactive billing codes Inactive codes (from the PM) appear grayed out in the Smart List and in Custom Lists on the EMR If selected and linked to a service order this will create problem with the charge retrieval. The code will link to the claim as question marks.
How do I plan for ICD-10?
You need to decide whether to load ALL ICD-10 Codes or only Chapters CAUTION: 1. When large ranges of codes are loaded It is time intensive we recommend this be done after hours 2. Be sure to associate all specialties you will bill for before loading 3. If you decide not to load all Codes, note that they may still show up in the clinical search but they will not be active for billing The PM Load Code Feature in Administration has been updated to support ICD-10
Tool for understanding chapter content http://apps.who.int/classifications/icd10/browse/2010/en#/a00.1
Ranges of codes may appear smaller than they actually are i.e. There are 8264 codes in the range from M00-M99 User can sort by codes range and filter and display results by Code Type
ICD-9 problems will be mapped to the base ICD-10 code http://www.ama-assn.org/resources/doc/washington/crosswalking-between-icd-9-and-icd-10.pdf
Practice Management Administration The Find Diagnosis dialog now returns both ICD-10 & ICD-9 codes User can filter and display results by Code Type
Practice Management Administration Administration codes used for claim filing are identified as ICD-9 or ICD-10 Existing codes in the CPS database will reflect as ICD-9 after the upgrade
Practice Management Administration Administration codes used for claim filing are identified as ICD-9 or ICD-10 When adding a new code, the user will have the option to select ICD-9 or ICD- 10. Once the code is saved, the field cannot be updated.
Practice Management Administration When ICD-10 is selected, two rows of ICD-9 codes are displayed 1. CMS Reimbursement default ICD-9 code(s) 2. Related ICD-9 code(s) used by your practice. (Users may change the mapped code in the default Admin. Setup if the GEMS mapped code is determined not to be acceptable for all payers )
Practice Management Administration Administration codes used for claim filing are identified as ICD-9 or ICD-10 All Administration modifications to the Related ICD-9 Codes are logged in the Activity Log for the Visit.
Practice Management Administration Charge Sets are separate for ICD-9 or ICD-10 Charge sets will be updated to store ICD-9 or ICD-10 codes.
Practice Management Administration The System Date determines whether visits/claims will contain ICD-9 or ICD-10 This date does not exist in CEMR This date does not determine whether the clinical search pulls ICD-9 or ICD-10
Practice Management Administration Insurance Carrier Date will determine whether the claim sends an ICD-10 or an ICD-9 code electronically or paper Provides the ability to designate payers that are not yet ready for ICD-10 codes
Changes to the Visit Diagnosis Entry ICD-10 will be sent based on system date ICD-9 Related codes will be sent based on payer date One single search field for Code, Description, and ICD Code Ability to override the Related ICD-9 Codes on a per diagnosis basis. Users can edit on a claim by claim basis.
Changes to the Activity log Visit Diagnosis Entry All Visit specific modifications to the Related ICD-9 Codes are logged in the Activity Log for the Visit.
Changes to the Visit Diagnosis Entry When the description is over 2 lines, the user can hover over the description to view any long descriptions that exceed the screen display.
Practice Management Find Diagnosis Search Visit and Case Management User is able to search by Code, Description, or ICD Code
Practice Management Find Diagnosis Visit and Case Management Search is automatically filtered by Visit Date, Case Date, or Charge Set type Both ICD-9 & ICD-10 codes are returned in the search to facilitate learning of new codes User can enter key Notes to display in search results
Practice Management Reports have been updated with ICD-10 All reports that reference ICD codes display ICD-9 and/or ICD-10 codes. The criteria has been updated to allow the user to filter by either ICD-9 or ICD-10 codes. Superbills have been updated to show both ICD-9 and ICD-10 codes.
Practice Management Reports have been updated with ICD-10 Reports For reports that contain Diagnosis as criteria, the user can designate a selection of codes, All ICD- 9, or All ICD-10 codes
Practice Management Reports have been updated with ICD-10 Reports For reports that display Diagnosis in output, the user can select to display an identifier for ICD-9 codes
Practice Management Reports have been updated with ICD-10 Reports When checked, ICD-9 codes in the report contain an identifier - the specific identifier is reported in the footer of the report output
Claim Submission for ICD-10 Claims CMS 1500, UB 04, and UB 04EX have been updated to support ICD-10 codes. The forms will print either ICD-9, ICD-10, or Related ICD-9 codes based on the Visit Date and the Payer ICD-10 Implementation date. EDI Plug-ins will be updated in a service pack release prior to the October 1, 2014 deadline for ICD-10 implementation.
Added the Ability to Track ICD-10 vs ICD-9 per claim Submission Visit Claims Tab Diagnoses Filed on the Visit are now displayed on the Claims tab for Paper & Electronic claims filing types
Interfacing with third party systems Practices will need to coordinate the transition date with their third party vendors Importing Charges The system will accept both ICD-9 and ICD-10 within the HL7 file. Based on the Visit date, the correct ICD code will be imported into the Visit..For example: System date is 10/1/2014 HL7 message received with ICD-9 code for charges DOS 10/1/2014 System imports the ICD-9 code with??? since it is expecting an ICD-10 for all DOS 10/1/2014 and greater Exporting Orders CPS send both ICD-9 and ICD-10 codes associated to a service order via HL7. For example: Service Order is placed with a problem associated of Abdominal Pain. The message will contain the ICD-9 and ICD-10 linked with the code
Mel Symbols have been updated for Encounter Forms MEL_CHANGE_PROBLEM MEL_REMOVE_PROBLEM New Symbol New Symbol LIST_ASSESSMENTS MEL_ADD_ASSESSMENT MEL_ADD_MEDICATION MEL_ADD_ORDER MEL_ADD_PROBLEM ORD_INDICATIONS ORD_WITH_DIAG ORDERS_AFTER ORDERS_ALL ORDERS_NEW ORDERS_PRIOR PROB_AFTER PROB_LIST_CHANGES PROB_NEW PROB_PRIOR PROB_REMOVED PROBLEM_CUST_LIST Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10 Updated for ICD-10
How will my clinical and revenue cycle workflows change?
Clinical Workflow Summary 1. Providers will be able to utilize smart search or custom lists 2. Providers can become familiar with mappings of commonly used codes 3. When an organization determines their ICD- 10 go live date providers will be need to select ICD-10 codes when ordering services
How will my Revenue Cycle workflows change? Enterprise ICD-10 Implementation Date controls data entry
How will my Revenue Cycle workflows change? Carrier ICD-10 Implementation Date controls whether to use ICD-10 or Related ICD-9 Codes when billing the claim The Carrier ICD-10 Implementation date cannot be prior to the Enterprise ICD-10 Implementation date: it can only be equal to or later.
How will my Revenue Cycle workflows change? Visit Date prior to the Enterprise ICD-10 Implementation Date The user will still key ICD-9 codes like today all searches should be using the ICD-9 codes and all results will be filtered by ICD-9 codes
How will my Revenue Cycle workflows change? Visit Date on or after the Enterprise ICD-10 Implementation Date and Carrier ICD-10 Implementation Date The user will key and search by ICD-10 codes the ICD-10 codes will be billed on the claims.
How will my Revenue Cycle workflows change? Visit Date on or after the Enterprise ICD-10 Implementation Date but not past the Carrier ICD-10 Implementation Date The user will still key ICD-10 codes, but claims will be filed with the Related ICD- 9 Codes.
How will my Revenue Cycle workflows change? When more than one Related ICD-9 code exists The Diagnosis linking is updated on the Visit the first related diagnosis is still Diagnosis 1, but rather than the second ICD-10 code being Diagnosis 2, the second Related Code becomes Diagnosis 2 for the Visit
How will my Revenue Cycle workflows change? The Diagnosis Code(s) filed on the Visit are reflected on the Claims tab CMS1500 Output reflects Related ICD-9 Codes Claims tab reflects the Related Codes as well
How will my Revenue Cycle workflows change? Approval edits have been added to prevent the wrong code version from being filed on the Visit
In summary, how will my Revenue Cycle workflows change? All Charge entry will require an ICD-10 code for all visits entered with a Date of Service after the Administration Date Administrators will need to establish an ICD-10 Transition Date for the whole organization
What is Account Summary? A tool to support Financial Counselors in a practice by providing a centralized place to review account information and troubleshoot guarantor account status.
What is Billing Notes Security? Date time Stamps Security Enabled Audit capabilities to track users and changes Ability to archive
New Billing Notes Financial Tab in Registration Charges Tab of Billing visit
What should practices be doing? Determine when your practice can adopt an ICD-10 compatible version of the product Confirm you are hardware ready Make sure you have a plan to train internal staff on ICD-10 this could include but is not limited to: Understanding internal process changes Identifying current common ICD-9 usage that will need more specificity in ICD-10 Tracking payer adoption of ICD-10 via CEDI Gateway
What versions are compliant for which regulatory requirements? Version CPS Version EMR GA Date 9.5 9.5 Oct 2010 10 Oct 2011 11 Dec 2012 12 9.8 ETA 2013 Regulation Meaningful Use (MU) 2011 edition 5010(CPS) ICD 10(CPS) ICD 10(EMR) MU2014 edition (Stages 1 & 2) NOTE Prior versions not certified for MU1 or MU2 in 2014
Confirm you are hardware ready You can upgrade to CPS 11 From (PM04, CPS 2006, CPSv9.5, CPSv10) If upgrading from CPS 10 client machines must be running Microsoft Windows at a minimum, which also implies that MSN Internet Services 9 is the minimum version for the web browser Versions Prior to 10 refer to the CPS 11 Systems planning guide: http://centricitypractice.gehealthcare.com/downloads /cps_11/system_planning_requirements.pdf
Documentation and Training Training Portal www.cpstraining-gehc.com/joomla Release Notes http://centricitypractice.gehealthcare.com/downloads /cps_11/cps_release_notes.pdf What s New http://centricitypractice.gehealthcare.com/downloads /cps_11/whats_new.pdf
Three ICD-10 services designed to meet the specific needs of direct customers Accelerator 360 Customized An interactive, web-based education and optimization program Education of regulation and operational requirements Review of ICD-10 reports, including any needed configuration, and results interpretation. A combination of virtual sessions and 2 day on-site planning Education of regulation and operational requirements Workflow mapping review of required coding, data exchange, set up and claims management Training plan Pre and Post Go-Live planning A comprehensive full service program that provides a complement of services based on customer needs Accounts for custom needs around workflow, and can include review and testing of interfaces. Aimed at organizations with 30 or more providers and/or multi-specialty practices. VAR customers: contact your VAR representative for available services
1. Do you ever wonder if you are underutilizing your current system? You are not alone 2. Do you want to know how you can better utilize your system in order to meet your current needs? 3. Was the last time you upgraded your system the first time you had it installed? 4. Do you ever wonder if potential improvements are really worth the cost? If you have answered yes to any of the above questions, we are here for you.
Centricity Practice Solution Productivity Assessment (for Direct Customers) IMPROVED PERFORMANCE Identifying opportunities to improve system utilization and cost reductions allows business and technical performance to thrive. ENHANCED CARE By pinpointing your staff s needs, training to improve efficiency and productivity will help lead to enhanced patient care and satisfaction. EASE OF FUTURE PLANNING We will help you recognize where your biggest opportunities exist, allowing ease of future planning. Service Highlights Financial Analysis Benchmark your practice s performance against national averages and best-performing practices Visit Lifecycle Analysis & Workflow Review Examine visit statuses which are a necessary driver of the billing workflow and compare your processes to top performers. System Configuration Review Examine overall system configuration and settings to identify underutilized functionality and identify setup errors or inconsistencies that may result in additional manual effort or inefficiencies. 80% of surveyed customers are highly likely to implement productivity assessment recommendations. RevenueCycleConsulting@ge.com
Centricity EDI Services Centricity EDI Services is a proven all-payer clearinghouse solution and proactive services offering that is currently helping over 1900 Centricity revenue cycle management customers reduce costs, reduce A/R days and maximize profitability Key business benefits: Maximize financial performance and profitability Reduce costs and improve billing efficiency Insight for improving revenue cycle performance
Hosted ClaimsManager One of the best ways to reduce rejections & denials is to prevent them before they occur! Hosted ClaimsManager is a pre-claim, clinical editing solution and proactive claim analysis service that identifies and resolves posting errors that would later result in a rejection or a denial. Reduce clinical rejections and denials before they negatively impact financial performance Reduce costs associated with addressing rejected or denial claims Support regulatory compliance by evaluating claims against specified coding rules while detecting Medicare Correct Coding Initiative edits Support regulatory compliance by comparing claims to local payer coding regulations and guidelines
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