Your ICD-10 Preparedness Plan

August 17th , 2015

Speakers

Diana Dipierro, Vice President Customer Support, HME

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What is ICD-10 and what is the scale of Medicare’s requirement for compliance

How much work will converting to ICD-10 require

The elements of an effective ICD-10 compliance plan

Where technology can and cannot help providers make this transition

Brightree’s ICD-10 Product Plans

Agenda

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Avoid Cash Flow Crunch!

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Preparing for ICD-10

“… a common estimate put forth by WEDI (Workgroup for Data Interchange) and others is that about 35 percent of the ICD-10 work will be handled by technology department workers…”

Why Y2K was no ICD-10October 23, 2013 | Tom Sullivan, Editor

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ICD-10 Basics

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ICD-10 Basics

International Classification of Disease (ICD), 10th Rev

Effective Date: October 1, 2015 A new standard for diagnosis codes

More Laterality, Specificity and Severity details

Required for claims with date-of-service (DOS), or From Date, on or after 10/1/2015 Recurring orders Documentation requirements Not all covered entities required to move to ICD-

10 http://www.cms.gov/ICD10

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ICD-10 Basics

Source: CMS https://implementicd10.noblis.org/understand_comparison/?guide=

Clinical Modification (CM) Codes

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ICD-10 Basics

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ICD-10 Impact Estimates for Code Changes

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~30%

~70%

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ICD-10 BasicsICD-9-CM ICD-10-CM

Field Length 3 – 5 characters 3 – 7 characters

Code Composition[A = Alpha][N = Numeric]

_ _ _ _ _N N N N N

A

_ _ _ _ _ _ _A N A A A A A

N N N N N

HME327.23 – Obstructive sleep apnea G47.33 – Obstructive sleep apnea (adult)

(pediatric)

HME496 – Chronic airway obstruction, not elsewhere classified

J44.9 – Chronic obstructive pulmonary disease, unspecified

HME

250.80 – Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled

E11.618E11.620E11.621 – Type 2 diabetes mellitus w/ foot ulcerE11.622E11.628E11.630E11.638E11.649E11.65E11.69

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Workload Calculator

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General HME Provider– Work Effort Example

$10M Revenue/Allowable @ $125 average invoice

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6,667 Total patients/orders that need to be updated

2,000 Have a 1 : 1 exact match (~ 30%)

4,667 Requires review (~ 70%)

30% orders require recoding

Estimate 3 minutes /per order

2,000 * 3 minutes =

100 Hours

70% orders will require research and recoding

Estimate 10 minutes for research + 3 minutes /

per order4,667 * 13 minutes =

1,011 Hours

1 Full Time Person

~ 6.4 Months

1,111 Total Hours

Planning Guide For Providers

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Multiple Areas of Impact

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Planning Guide

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OCTOBER 1, 2015

RISK AVERSION

• Develop “Plan B” Contingency

• Identify when to implement

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Choose a team and assign a project leader

Include a budget for training and cash flow during

transition

Schedule regular meetings for progress updates

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Look at your workflow and business process, internally and externally

Identify impact to documentation

Identify impact to forms

Custom forms | Claim forms

Other impact - Business rules

Identify Recurring Rentals affected

Identify Recurring Supplies affected

Conduct Analysis

Use Excel to create Pivot Tables

Determine how many unique ICD-9 codes you have

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Identify top ICD-9 codes used

Use General Equivalence Mappings (GEM’s) to identify correlating ICD-10 Codes

Calculate work effort required based upon data analysis

Develop detailed project plan for dedicating resources

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Monitor timing of updates from your software provider

Have staff get familiar with new ICD-10 functionality

Understand if there are any ICD-10 tools from your

software provider

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Communicate plan to all internal staff impacted by

changes

Communicate to external parties

Communicate with your doctors, referral sources and

payers

How do they want to provide ICD-10 requests? What if they have 1,000 patients (or more)? Are your payers following CMS guidelines?

Keep informed of what others are doing

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Seek out and get role-specific training for all impacted staff

Plan timing of training for maximum retention

Start training staff to collect and input ICD-10 Codes on new orders

Send out paperwork to request both ICD-9 and ICD-10 codes

Start migrating patients when as you receive updated Codes

Start reviewing the LCDs for coverage requirements

Review current charting processes Are you capturing everything you need?

Update policies and procedures as needed

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Test internal team on process changes

Monitor and adjust processes as needed

Rerun reports to see how you are doing

Compare to ensure you are on track to be compliant by

10/1/2015

Review the GEM Migration Work List

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Develop “Plan B” Contingency

Identify when to implement

Identify what you can live without

RISK AVERSION

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Planning Guide

OCTOBER 1, 2015

Five Key Questions to Ask Your Software Vendor

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Five Key Questions to Ask Your Vendor

How much downtime

will there be during the

move to an ICD-10

compatible release, and

is there a cost?

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1

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Five Key Questions to Ask Your Vendor

Will the new release

support dual coding -

both ICD-9 and ICD-

10?

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2

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Five Key Questions to Ask Your Vendor

How many resources

should I need to

address the changes

needed in my data?

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Five Key Questions to Ask Your Vendor

Are you automatically

updating my 1:

approximate codes?

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4

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Five Key Questions to Ask Your Vendor

What additional tools and

services will be available

to assist me in this

transition?

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Five Key Questions to Ask Your Vendor

How much of my A/R can I expect to

collect to help reinforce my reserves

in preparation?

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Bonus ?

What Technology Can’t Do -But We Can Help!

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ICD-10 – A Major Move

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ICD-10 Is a Major Move

Put your plan into action

Perform an analysis of your data

Start capturing ICD-10 codes on patients

Migrate patients as ICD-10 information becomes available

Run reports to evaluate how you are doing

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Countdown to ICD-1044 Days

Brightree Product Plans andServices

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What Brightree Is Doing

Software:

ICD-10 Ready – Respond quickly to changes as they occur

Support new CMS 1500 (02-12) form

SaaS Platform - No additional charge for upgrade

Support for both ICD-9 & ICD-10 during transition

System and Payer-level Effective Dates to support various levels of payer compliance

Automated update tools to aid in ICD-10 code changes

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Putting It All Together with Brightree

Run the ICD-10 Migration Report Will help physicians with coordination of care

Use the Migration Work List Charts should be reviewed to ensure you are billing with

the highest degree of specificity available in the clinical documentation

Rerun ICD-10 Migration Report as needed

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Countdown to ICD-1044 Days

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Resources Available from Brightree

Training Live Lunch and Learns

Recorded Web Based Training

ICD-10 series of monthly webinars

Regional Classroom Training Available 2 day sessions

Community- Collaborative On-Line Area – ICD-10 Specific

Payer Updates regarding ICD-10 claims

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What Brightree Services Is Doing:

Business Tool/Service Support:

Business Tools/Reports to support efforts with referral sources

Professional Services to support provider efforts Example: Cash flow protection strategies

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Brightree Services for HME - Prototype

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Brightree Revenue Cycle Management

A/R clean-up - Improve cash reserves

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Securing Cash Reserves

Provides clarity on the collectabilityof current A/R for proper short term financial planning during the ICD-10 transition period

Improves long term forecasting of

on-going revenue

Refocuses the attention of your staff to mission critical projects like ICD-10 transition

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30 60

Follow-upsand denials

Analyze existingA/R

1 90 – 150 days

ProjectConclusion

Continuousfollow-up

Day

Based on the size and scope of the A/R cleanup project

A/R Cleanup – Project Timeline

Weekly meetings to review ongoing findings, activity, results and review reports

$$$

Start to see cash from cleanup efforts

Working claims backlog and taking

action

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25-60%

Increase your cash

A/R Cleanup - Benefits

Results in a cleaner, more accurate outstanding A/R making it ‘active’ and ‘refreshed’ with a realistic and expected closing balance

Fast reduction ofaged A/R - In time

for ICD-10

Increased knowledge of your team to more

efficiently manage A/R moving forward

Avoid potential lossof revenue due to

timely filing

Suggested Resources

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Suggested Resources

ICD-10 Website http://www.cms.gov/ICD10

Implementation Guides https://implementicd10.noblis.org

General Equivalence Mappings (GEMs) http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM

-and-GEMs.html

Reimbursement Mappings http://

www.cms.gov/Medicare/Coding/ICD10/Downloads/Reimbursement_Mapping_dx_2015.zip

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Questions?

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For more information:

call 844.GET.BRTE (844.438.2783)

email ICD10@brightree.com

Thank You