Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Overview of 5010 and ICD-10: Definitions, Planning and Readiness Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Welcome! Introductions Review of this afternoon’s sessions: • Overview of 5010 and ICD-10 • 5010 Working Session • ICD-10 Working Session Agenda for Overview Session 5010 ICD-10 Implementation Resources Questions EDI 5010 Overview 5010 Questions What is 5010 and why do we have to do this? When does 5010 happen? Who uses 5010? Where is 5010 used? EDI 5010 Overview What is 5010? • Started with requirement that the Secretary of the Department of Health and Human Services (HHS) adopt standards for covered entities to use when they electronically conduct certain health care administrative transactions. • The Transactions and Code Sets final rule published on Aug. 17, 2000, adopted standards for the statutorily identified transactions, some of which were modified in a subsequent final rule published on Feb. 20, 2003. • On January 16, 2009, HHS announced a final rule that replaces the current Version 4010/4010A and NCPDP Version 5.1 with Version 5010 and Version D.0, respectively. EDI 5010 Overview What is 5010? • Improvements in structural, front matter, technical, and data content. • More specific in requiring the data that is needed, collected, and transmitted in a transaction. • Significant improvements for the reporting of clinical data, enabling the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS procedure codes, and distinguishes between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes. EDI 5010 Overview Why do we have to do this? Because of the Final Rule published by the US Department of Health and Human Services on 1/16/2009: http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf EDI 5010 Overview When does 5010 happen? December, 2010 Complete internal testing – able to send & receive compliant transactions January, 2011 Begin external testing with trading partners January 1, 2012 All covered entities must be in production EDI 5010 Overview Who uses 5010 Covered Entities: • PROVIDERS (doctors, clinics, hospitals, psychologists, dentists, chiropractors, nursing homes, pharmacies – submitting information electronically for HHS standard transactions) • HEALTH PLANS (health insurance companies, HMOs, company health plans, gov’t health plans such as Medicare, Medicaid, etc.) • HEALTH CARE CLEARINGHOUSES (entities that process non-standard health information from another entity into a standard or vice versa) EDI 5010 Overview Where is 5010 used? Covered transactions include: • 837 P, I, and D claims (including COB) • 835 health care payment and remittance advice • 270/271 eligibility request/response • 276/277 claim status request/response • 278 referral certification and authorization • 834 health plan enrollment/disenrollment • 820 health plan premium payment • NCPDP D.0, 5.1, and 3.0 EDI ICD-10 Overview ICD-10 Questions What is ICD? Who uses ICD-10? When does ICD-10 happen? How is ICD used? Why are we moving to ICD-10 How does ICD-10 differ from ICD-9 EDI ICD-10 Overview ICD-10 Code Structure The patient is in the office for the first visit because of a closed greenstick fracture of the right radial shaft. 813.21 Fracture of shaft; radius alone S52.311A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture EDI ICD-10 Overview Diagnosis Code Structure S52.311A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture Root Root Root Site Severity Etiology Extension S 5 2 3 1 1 A Injuries to the elbow and forearm Fracture of Forearm Radial Shaft Greenstick Injury, poisoning and certain other consequences of external causes Right Initial Encounter EDI ICD-10 Overview Procedure Code Structure OTF4ZZZ Lithotripsy Section Body System Root Procedure Treatment Site Approach Device Qualifier O T F 4 Z Z Z No Device Noted No Qualifier Noted Medical Urinary Fragmentation Left Renal No Pelvis Approach Noted EDI ICD-10 Overview Mapping of 813.21 There are 90 ICD-CM code possibilities for mapping of 813.21 S52.3Ø1A Unspecified fracture of shaft of right radius, initial encounter for closed fracture S52.3Ø1G Unspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed healing S52.321A Displaced transverse fracture of shaft of right radius, initial encounter for closed fracture S52.325A Non displaced transverse fracture of shaft of left radius, initial encounter for closed fracture S52.325G Non displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with delayed healing S52.341A Displaced spiral fracture of shaft of radius, right arm, initial encounter for closed fracture S52.364A Non displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fracture S52.381A Bent bone of right radius, initial encounter for closed fracture EDI 5010 and ICD-10 Implementation Implementation Tasks Phase 1 Awareness and Communication Begin impact assessments Create the structure/governance EDI 5010 and ICD-10 Implementation Implementation Tasks Phase 2: Complete Impact Assessment Complete Budget Planning Determine business and technical strategies Define Functional Requirements EDI 5010 and ICD-10 Implementation Implementation Tasks Phase 3: Complete System Development/ Get Vendor Updates Review contracts, reports, … EDI 5010 and ICD-10 Implementation Implementation Tasks Phase 4: TEST – TEST - TEST EDI 5010 and ICD-10 Implementation Implementation Tasks Phase 5: Communicate changes Analyze potential cash flow implications Go-live Resources HIPAA COW: www.hipaacow.com WEDI: www.wedi.com CMS: www.cms.gov Resources CMS Transactions & Codesets: http://www.cms.hhs.gov/TransactionCodeSetsStands/02 _TransactionsandCodeSetsRegulations.asp ICD 10 Final Rule: http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf 5010 Final Rule: http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf Resources CMS HIPAA Standards Page (gap information links): http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_50 10D0.asp CMS ICD 10 Fact Sheet: http://cms.hhs.gov/MLNProducts/downloads/ICD10factsheet2009.pdf X12 Presentation to NCVHS on 5010 changes: http://www.ncvhs.hhs.gov/070730p4.pdf Questions? THANK YOU! Contact Information: Kit Cairns [email protected] 608.294.6492 Karen Navarro [email protected] 608.662.0817 Claudia Yoakum-Watson [email protected] 608-661-6726 Or [email protected] 608-289-4974 Notes Notes Notes