© 2015 TriZetto Corporation ICD-10: Ready, Set, Go! August 27, 2015

© 2015 TriZetto Corporation Learning Objectives 3 Review types of activities that should have happened or should be happening in your organization now to prepare for ICD-10. Understand how your clearinghouse and other industry organizations can help. Identify key metrics to monitor before and after Oct. 1.

© 2015 TriZetto Corporation 4 Get Ready

© 2015 TriZetto Corporation Are you ready for the new coding standard? You must use ICD-10 codes for all services provided on or after Oct.1, You must use ICD-9 codes for all services provided before Oct. 1, ICD-10 Compliance Deadline Is Coming 5

© 2015 TriZetto Corporation Make A Plan 6 Obtain access to ICD-10 codes Train your staff Identify your top codes Update your processes Talk to your vendors and health plans Test your system and processes

© 2015 TriZetto Corporation Obtain Access To ICD-10 Codes 7 The codes are available from many sources and in many formats: Code books CD/DVD and other digital media Online – download from cms.gov/ICD10 Practice management systems Electronic health record (EHR) products Smartphone apps

© 2015 TriZetto Corporation Understand The Role Of Your Clearinghouse 8 Clearinghouses can help by: Identifying problems that lead to claims being rejected. Providing guidance about how to fix rejected claims (e.g., more or different data needed to be included). Clearinghouses cannot: Code unless they offer a billing service. Call payers regarding denials on your behalf.

© 2015 TriZetto Corporation Train Your Staff 9 Determine who needs training? What level of training is needed? When should training should take place? Train on ICD-10 fundamentals. What ICD-9 diagnosis codes does your practice see most often? Start with the top 25. Practice coding in ICD-10 using current clinical documentation. Flag any cases where more documentation is needed. Talk about ICD-10 at regular staff meetings so the issue is always in focus.

© 2015 TriZetto Corporation Update Your Processes 10 Review your current systems and work processes that use ICD-9 codes. Update hardcopy and electronic forms. Resolve documentation gaps identified while coding top diagnoses in ICD-10. Make sure clinical documentation captures new coding concepts. Examples include: Laterality—or left versus right Initial or subsequent encounter for injuries Trimester of pregnancy Types of fractures

© 2015 TriZetto Corporation Talk to Your Vendors and Payers 11 Call your vendors to confirm the ICD-10 readiness of your practice management system. Review your contract to determine if regulatory updates are included in your maintenance. If your existing system is unable to accommodate the ICD-10 codes, or your vendor is not upgrading the system for ICD-10, you will likely need to purchase a new system. Confirm that the health plans, clearinghouses and third- party billing services you work with are ICD-10 ready. Document who to call should there be any ICD-10 related issues.

© 2015 TriZetto Corporation Test Your System 12 Verify that you can use your ICD-10-ready systems to: Generate a claim Perform pre-authorization, eligibility and benefits verification Schedule an office visit Schedule an outpatient procedure Prepare to submit quality data Update a patients history and problems Code a patient encounter

© 2015 TriZetto Corporation Test With Your Trading Partners 13 Have you submitted test claims to your clearinghouses and payers? What about the vendors, labs and hospitals you work with? Focus on the partners you regularly work with. Explore alternate ways to submit claims to payers if you think your systems might not be ready for ICD-10 by Oct. 1. Ask other payers you work with about different options.

© 2015 TriZetto Corporation 14 Get Set

© 2015 TriZetto Corporation Key Metrics 15 Baseline and monitor key performance indicators (KPIs) to measure the success of your transition to ICD-10: Top Used ICD-9 Codes Claim Volume – Total Claims and Rejection Claims Top Rejections Days to File by Payer Denial Rate / Denial Impact Top Denials by Payer Average A/R Days Trending Billed vs. Paid Trending

© 2015 TriZetto Corporation Managing Denials 16 How do you identify appeal and track claims that were incorrectly denied? Claim rejections and denials are expected to increase in the immediate aftermath of ICD-10. Now is the time to strengthen denial management processes.

© 2015 TriZetto Corporation Track Your Denials 17 Don’t wait until ICD-10 hits to address the increase in denials. Understand what types of denials your practice currently receives. Get these under control before ICD-10. Track the amount of reimbursements denied, the reason for denial and your appeal status. Create a plan of action now for denials coming on or after Oct. 1, 2015 due to ICD-10 coding issues.

© 2015 TriZetto Corporation Identify Denial Trends 18 Why are your claims getting denied today? Find details of your denials on your remits or explanation of benefits. Stop denials before they start by adding alerts to the system. Address the management of denials to prevent denials all together!

© 2015 TriZetto Corporation 19 Go!

© 2015 TriZetto Corporation Last 30 Days 20 Confirm everything is ready to go: Planning completed. Go live tasks and associated actions have been identified and are in place. Response team in place to address potential issues. KPIs in place.

© 2015 TriZetto Corporation Oct. 1 st and Beyond 21 You made it! Now what? Ensure claim reimbursement continues at the ICD-9 rate. Watch the impact on workflow and productivity. Continue to train staff beyond Oct. 1. Lessen the impact to your revenue by monitoring KPIs to quickly identify any issues.

© 2015 TriZetto Corporation Industry ICD-10 Resources American Academy of Professional Coders (AAPC) ICD-10 Information and Resource Page American Health Information Management Association (AHIMA) ICD-10 Information and Resource Page American Medical Association (AMA) ICD-10 Information and Resource Page Centers for Disease Control and Prevention (CDC) International Classification of Diseases, Tenth Revision (ICD-10) Centers for Medicare and Medicaid Services (CMS) ICD-10 Information and Resource Page Road to 10 Health Information Management Systems Society (HIMSS) HIMSS ICD-10 Playbook Workgroup for Electronic Data Interchange ICD-10 Workgroup 22

© 2015 TriZetto Corporation There’s A Code For That F43.0 Acute stress reaction

© 2015 TriZetto Corporation Contact Information 24 Laura Pazera

© 2015 TriZetto Corporation Thank you 25