American Osteopathic College of Occupational and Preventive Medicine - - PDF document

American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington B-1

What to Do Now Thru Oct 1, 2015 (and even beyond!) Stanley Nachimson AOA Presentation Oct 25, 2014

 Last year, I presented on ICD-10 to this very

conference

 I indicated that on Oct 1, 2014 the industry

would be moving to ICD-10 and that

• steopathic practices needed to get moving

 Question – who has done any ICD-10

preparation?

 Question - who has looked at the CMS

“Road to 10” web site?

 “If I had been here before I would certainly know

just what to do – don’t you?” CSN&Y

 Frankly, I could give the same presentation again –

Why?

 Last April, a law was passed and signed which, among

• ther things, prevented the Secretary of HHS from

adopting ICD-10 any earlier than Oct 1, 2015

 Passage of the law surprised many entities (including

CMS)

 Brought a halt to many ICD-10 activities

 Health plan testing (Medicareet al)  Vendor development and installation  Provider training and planning

 Some folks lost faith that ICD-10 would ever be

implemented

 Final Rule for ICD-10 Implementation Published

Monday Aug 4, 2015

 Sets Oct 1, 2015 as the ICD-10 compliance date (use

ICD-10 codes for all services on and after Oct 1, 2015)

 Requires that ICD-9 coding continue to be the

standard thru Sept 30, 2014

 No one can implement early (in production)  No one can do dual coding (in production)  Testing can take place at any time  Opposition by some provider groups  Indications that the industry may not have been ready

(survey results from WEDI, MGMA, and others)

 Late deliveries from vendors  Lack of robust end to end testing  Lack of health plan information on new edits, policies,

etc.

 Few providers enthusiastic  Medicare not doing end to end testing until late July

American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington B-2

 New Date - Oct 2015  Other than that, not very much has changed  What can provider groups do to drive themselves and

the industry forward?

 What we were doing before was not working  Need to change messaging to providers  Need to provide clearer path to implementation  Determine the status of your implementation –

 What have you done?  What needs to be done – training, system upgrades,

process review, etc.

 Build new project timeline  Leave time for testing  Restart the efforts  Collaboratewith peers

 That’s the same message for any project  That’s the message that wasn’t working  Need to get started  What should we change!  Question – what do you think is the first step?  I looked at my presentation last year – and I see the

problem

 The one item osteopathic practices should be working

• n is CDI

 There will be benefits whether or not we move to ICD-

10

 Patient history and treatment  Better information exchange  Better coding (and maybe better reimbursement)  Audit protections

American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington B-3

Step 1 – Identify high priority diagnosis groups for your practice (not individual codes)

 Highest revenue  Highest volume  Most complex  Health plan denials or requests for information  Use past year’s records, information from health plans or

clearinghouses, or other sources of compiled data.

 Don’t rely on guessing – use the data

 Step 2 – Collect samples of your documentation for

these cases

 Step 3 – Look up the ICD-10 codes for these types of

problems

 Step 4 – Understand the documentation and

descriptions for these codes

 Step 5 – Compare your current documentation to the

documentation requirements and descriptions for the ICD-10 codes

 Step 6 – Determine what you may need to do to get

your documentation to support the ICD-10 codes

 Note that you will need to document if this is Type 1,

Type 2, drug or chemical induced, or due to underlying condition

 Note you will have to document with or without coma  Note you will have to document the manifestation of

the disease (e.g. ketoacidosis, opthalmic)

 Note use of insulin

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 Once you have identified opportunities for CDI, take

the necessary steps to implement them.

 Changes in forms or EHRs  Staff training  Questions for patients

 Plan for upgrades  Get information on timing, cost, support  Sooner is better!  Question – Who has gotten information from your

vendors on ICD-10?

American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington B-4

 Providers have long depended on vendors for meeting

the HIPAA EDI mandates

 Vendors are often blamed for lack of provider

readiness.

 Providers need assistance in judging vendor

capabilities

 EHNAC and WEDI are developing the PMSAP  Voluntary accreditation program for practice

management systems

 Criteria will include HIPAA EDI and ICD-10

capabilities, privacy and security, revenue cycle management, customer support, readiness.

 Will give providers assurance that their PMS meets

basic requirements

 Following the EHNAC process for program

development

 In beta testing now  Expectation to be ready 1st quarter 2015  What are they doing for ICD-10?  What resources are available?  When can I test?  Question – who has gotten information from your

health plans on ICD-10?

 Time  Resources  Collaboration  No doubt some providers may not be ready, or have

some hiccups in implementation

 May be some issues with some health plans  Develop and share contingency plans appropriately

 Not a substitute for being ready  Should be time limited  May involve some cost  Emphasize the Oct 1, 2015 date for being ready

 ICD-10 will never happen  There are too many codes  It doesn’t impact me because I get paid via contract or

CPT code

 My vendor or clearinghouse will take care of this  I don’t have to do it

American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington B-5

Do The CDI – it will pay off

 Stanley Nachimson  Nachimson Advisors LLC  Nachimson_advisors@verizon.net