WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to...

WELCOME

Confidential & Proprietary

Affinity ICD-10 Testing

Confidential & Proprietary

Revenue Cycle Team

October 30, 2014

3 | Confidential & Proprietary

Agenda Impact of ICD-10 Delay Affinity ICD-10 Revenue Cycle Overview Release Timelines Regulatory Discussion

But First……. John in 2009

Where to

start?

Foundational “Truths”

•After 10/1/15 – 100% of coding is ICD-10 •Payer’s lack of compliance is a billing problem - not a coding problem

•Payer is not ready: Reimbursement Mapping Table(s) used

Affinity ICD-10

Impact of ICD-10 Delay

2015-2016 – Impact of ICD-10 Delay

Legislative Mandate

336 Days…240 weekdays

The clock is ticking…

Estimated 1 BILLION Dollars……

2015-2016 – Impact of ICD-10 Delay User Group User Ballot Client Communication

2015-2016 – Impact of ICD-10 Delay WEDI Survey • Top ICD-10 Provider concerns:

1. Accurate claims and adjudication process 2. Increase in denied claims and appeals 3. Increased operational costs (training/proper use of

ICD-10 codes) 4. Impact of DRG reimbursement

• Payer & Provider Preparedness As of August, over 50% of payers and ≈ 33% of

providers have started external testing

QuadraMed Business Intelligence

Affinity ICD-10

Med Learn Matters 8858 – 8/22/14 Transmittal R1423OTN

• Defines testing weeks – acknowledgement testing only 11/17/14 – 11/21/14 3/2/15 – 3/6/15 6/1/15 – 6/5/15

Med Learn Matters SE1409 – 7/31/14 • Mentions End-to-End testing (test 835s) Limited group of Providers Additional details about the end-to-end testing process will

be disseminated at a later date in a separate MLN Matters article.

Affinity ICD-10

System wide updates to support ICD-10 – M12 • Registration • MRA/DRG • Patient Accounting/EDI

Facility Editable Implementation Date Support billing with both code sets

• Support via Reimbursement Mapping Table ICD-10 Codes “translated” to ICD-9 Codes

• Control at the Payer level • New “versioned” ICD file supporting both code sets

Affinity ICD-10

ICD-10 ICD-9

Full ICD-10

Description

Encoder updates • Nuance integration update • 3M interface update

Testing capabilities – testing in “Live” • Test MRA ICD-9 Live/ICD-10 Test

• v5010/ICD-10 test claims Interface specific configuration • Outbound….ICD-9, ICD-10 or both

Query migration services

Affinity ICD-10

Each client is responsible for reviewing your custom queries/reports to determine if changes need to be made for M12 ICD-10 changes How many queries have you written/modified at your site that use the ICD Diagnosis or Procedure code fields? How do you identify queries that need to be reviewed? • Services Identify queries needing review Assess queries needing changes QuadraMed engagement to make changes

ICD-10 Query Impact Overview

M12SP1 Product

M12SP1 ICD-10 Train/Test ICD-10 Effective Date:

1/1/14

M12SP1 Support ICD-10 Effective Date:

10/1/15

M12SP1 Live ICD-10 Effective Date:

10/1/15

ICD-10 Primary Code Set

ICD-9 Primary Code Set

Affinity ICD-10

Please keep current on releases

Support ICD-10 Pilot DRG grouper (Update 2) • Used with testing utilities in “Live” only • Grouping done in “encoder” – 3M/Nuance • Pricing done in Affinity Ongoing updates to the ICD-9/ICD-10 and Reimbursement Mapping Tables Use of ICD-9 Grouper post ICD-10 date (Update 3) • Support DRG grouping using mapped ICD-9s post date

ICD-10 Updates

22 | Confidential & Proprietary 22 | Confidential & Proprietary

ICD-10 testing success stories? • What went well…. • What didn’t go so well….

Testing with Clearinghouses? • Ability to connect to multiple Payers? • Guidance

Anyone sign up for end-to-end testing?

REVENUE CYCLE OVERVIEW

GA of Affinity M12 (July 2012) • ICD-10 ready release • Built in testing capabilities • Supports payer billing adoption (or lack of) M12 Service Pack 1 delivered on-time • Therapy Cap solution delivered QuadraMed Business Intelligence (QBI) GA Q412 • 3 sites live QuadraMed Contract Management (QCM) migration to .NET Access Quality Manager (AQM) live at Hunterdon M15 in development/QA

Affinity Accomplishments

QuadraMed

26 | Confidential & Proprietary 26

Customers Believe It

Industry Leading Solutions

Customers Believe It

Release Timeline

Release Timeline ICD-10 10/1/15: Roll Out Strategy CMS ICD-10 Industry Adoption 10/1/15

Affinity Release M12 (GA July 2012) – Cache 2011 M12SP1 (GA April 2013)

Update Releases scheduled as needed Affinity Release M15 (projected GA Q115)–HealthShare

Major releases (M12/M15) locked down thru ICD-10 migration

Update Releases scheduled as needed ICD-10 implementation 10/1/15 Affinity Release M16 (projected GA Q416)

Return to predictable yearly cycle

Subject to Change

2014 Q2 Q3

2015 Q1

Major Activities: ICD-10: Preparation & testing Prepare for “Go Live” Update releases as necessary

ICD-10 Update Special Release

M12SP1U1

M12SP1U3

Release Timeline Affinity 2014 Projected Schedule

Subject to Change

QCM 14.0

QCM 14.1

QBI 1.2

M15 to Beta

M12SP1U2

2015 Q2 Q3

2016 Q1 Q4

M15 GA

EDI / ICD-10 Updates RCM/ERM/ACW Updates Rapid OP Admit Denials Workflow APC Batch Automation Delete/Hide Payer User Ballot Enhancements …..

QBI 2.0

If necessary

QCM 15.1

QCM 15.0

Subject to Change

10/1/15 ICD-10 Implementation

If necessary

Major Activities: ICD-10: Preparation & testing Prepare for “Go Live” Update releases as necessary

Release Timeline Affinity 2015 Projected Schedule

Key Milestones • EDI Transaction sets v5010 – required for ICD-10 1/1/12 Addenda pending

• Therapy Caps – Released Q413 • National Health Plan Identifier (HPID) - 11/7/16?? • Operating Rules for EDI (CARC/RARC) – 2013 - ongoing • Medicaid movement to APR-DRG - ongoing • Migration to ICD-10 10/1/15 • Bundled Inpatient billing post discharge – 2013 • 275 Additional Information to Support a Health Care Claim

or Encounter (NPRM – Sept 2005) - Now post ICD-10 1/1/17??

HIPAA Watch

Subject to Change

Propensity to Pay Tools • Credit Score used in collections • Charity Assessment enhancements • Patient Liability Estimation

Appeals Management GUI Uplift User Ballots Business Intelligence (QBI) – ongoing

• Payer Scorecard • DNFB Reporting

Contract Management (QCM) – ongoing Regulatory Updates - ongoing

On the Horizon – 2016 & 2017

Subject to Change

Questions

WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to...

Documents

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ICD-10 Overview - Georgia Department of Community Health | · ICD-10 Overview The 411 on ICD ... services and others must transition to ICD -10 • ICD-10 pros and cons – discussed

ICD-10 Procedure Coding System (ICD-10-PCS) 2017 ... - Belgiumsmarticd10.health.belgium.be/ICD-10-PCS/2017/... · (ICD-10-PCS) 2017 Tables Addenda ICD-10-PCS Tables that have changed

ICD-10: Steps For Building an ICD-10 Plan

Overview of ICD-10-CM and ICD-10-PCS

ICD-10 Implementation: From “ICD-10?” to “I Can Do …...ICD-10 Implementation: From “ICD-10?” to “I Can Do-10!” Prepared For: Managed Long Term Services and Supports

ICD-10 IMPLEMENTATION REVIEW - medicalschemes.com Codings/ICD-10TaskTeamRevi… · icd-10 implementation review january 2004 – march 2010 national task team on icd-10 implementation

Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS Challenges

Kamus ICD-10 & ICD-9

Top 20 Orthopedic ICD-9 to ICD-10 Code sphysicianstrategygroup.com/wp-content/uploads/2015/07/ICD9-10Orthopedic.pdf · Top 20 Orthopedic ICD-9 to ICD-10 Code s 10 10 10 10 10 10 10

ICD-9 — ICD-10 Conversion - ChiroUpchiroup.com/wp-content/uploads/2014/11/ICD-10-FINAL.pdf · ICD-9 — ICD-10 Conversion Version 2. A message to our peers,-ful. ... Right G56.01

Overview of ICD-10-CM & ICD-10-PCS166.78.170.144/sites/default/files/Why ICD-10.pdf · 2013. 10. 24. · Overview of ICD-10-CM & ICD-10-PCS. Presented By: Stacey Chevious, BA, AHI,

ICD-10 Provider Training - Amerigroup · ICD-10-CM Provider Training The ICD-10 Provider Training is a presentation containing six sections reviewing ICD-10 coding and ... •The

ICD-10: What Every Hospital Executive Should Prepare For? · ICD-10-CM Replaces ICD-9-CM Volume 1 and 2 . ICD-10-CM… ICD-10-CM is built on our current ICD-9-CM coding system, with

ICD-10 FOR PAIN PRACTICES...Reference: CMS ICD-10 Implementation Guide for Small and Medium Practices Structural Differences between ICD-9 and ICD-10 ICD-9 codes have 3-5 digits; 10

QCM d'examen - uliegeTitle QCM d'examen Author Laurent Created Date 10/9/2015 11:06:21 PM