Your ICD-10 Preparedness Plan August 17 th, 2015

Speakers Diana Dipierro, Vice President Customer Support, HME

© 2015 Brightree 3  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

© 2015 Brightree

Avoid Cash Flow Crunch! 5

© 2015 Brightree 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-10 October 23, 2013 | Tom Sullivan, Editor 6

ICD-10 Basics

© 2015 Brightree ICD-10 Basics International Classification of Disease (ICD), 10 th 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

© 2015 Brightree ICD-10 Basics Source: CMS 9 Clinical Modification (CM) Codes

© 2015 Brightree ICD-10 Basics 10

© 2015 Brightree ICD-10 Impact Estimates for Code Changes 11 ~30% ~70%

© 2015 Brightree ICD-10 Basics 12 ICD-9-CMICD-10-CM Field Length 3 – 5 characters3 – 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 HME – Obstructive sleep apnea G47.33 – Obstructive sleep apnea (adult) (pediatric) HME 496 – Chronic airway obstruction, not elsewhere classified J44.9 – Chronic obstructive pulmonary disease, unspecified HME – Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled E E E – Type 2 diabetes mellitus w/ foot ulcer E E E E E E11.65 E11.69

© 2015 Brightree 13 Workload Calculator

© 2015 Brightree General HME Provider– Work Effort Example $10M $125 average invoice 14 6,667 Total patients/orders that need to be updated 2,000 Have a 1 : 1 exact match (~ 30%) 4,667Requires 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 order 4,667 * 13 minutes = 1,011 Hours 1 Full Time Person ~ 6.4 Months 1,111 Total Hours

Planning Guide For Providers

© 2015 Brightree Multiple Areas of Impact 16

© 2015 Brightree Planning Guide 17 OCTOBER 1, 2015 RISK AVERSION Develop “Plan B” Contingency Identify when to implement

© 2015 Brightree 18  Choose a team and assign a project leader  Include a budget for training and cash flow during transition  Schedule regular meetings for progress updates

© 2015 Brightree 19  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

© 2015 Brightree 20  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

© 2015 Brightree 21  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

© 2015 Brightree 22  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

© 2015 Brightree 23  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

© 2015 Brightree 24  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

© 2015 Brightree 25  Develop “Plan B” Contingency  Identify when to implement  Identify what you can live without RISK AVERSION

© 2015 Brightree Planning Guide 26 OCTOBER 1, 2015

Five Key Questions to Ask Your Software Vendor

© 2015 Brightree 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? 28 1

© 2015 Brightree Five Key Questions to Ask Your Vendor Will the new release support dual coding - both ICD-9 and ICD-10? 29 2

© 2015 Brightree Five Key Questions to Ask Your Vendor How many resources should I need to address the changes needed in my data? 30 3

© 2015 Brightree Five Key Questions to Ask Your Vendor Are you automatically updating my 1: approximate codes? 31 4

© 2015 Brightree Five Key Questions to Ask Your Vendor What additional tools and services will be available to assist me in this transition? 32 5

© 2015 Brightree 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? 33 Bonus ?

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

© 2015 Brightree 35 ICD-10 – A Major Move

© 2015 Brightree 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 36 Countdown to ICD Days

Brightree Product Plans and Services

© 2015 Brightree 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 38

© 2015 Brightree 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 39 Countdown to ICD Days

© 2015 Brightree 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 40

© 2015 Brightree 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 41

© 2015 Brightree Brightree Services for HME - Prototype 42

© 2015 Brightree Brightree Revenue Cycle Management A/R clean-up - Improve cash reserves 43

© 2015 Brightree LLC Securing Cash Reserves  Provides clarity on the collectability of 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

© 2015 Brightree LLC Follow-ups and denials Analyze existing A/R 190 – 150 days Project Conclusion Continuous follow-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

© 2015 Brightree LLC 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 of aged A/R - In time for ICD-10 Increased knowledge of your team to more efficiently manage A/R moving forward Avoid potential loss of revenue due to timely filing

Suggested Resources

© 2015 Brightree Suggested Resources  ICD-10 Website   Implementation Guides   General Equivalence Mappings (GEMs)  GEMs.html GEMs.html  Reimbursement Mappings  ment_Mapping_dx_2015.zip ment_Mapping_dx_2015.zip 48

© 2015 Brightree Questions? 49

© 2015 Brightree 50 For more information: call 844.GET.BRTE ( ) Thank You