Presentation is loading. Please wait.

Presentation is loading. Please wait.

Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Overview of 5010 and ICD-10:

Published byPiers Shields Modified over 9 years ago

Similar presentations

Presentation on theme: "Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Overview of 5010 and ICD-10:"— Presentation transcript:

1 Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Overview of 5010 and ICD-10: Definitions, Planning and Readiness

2 Introductions Review of this afternoon’s sessions: Overview of 5010 and ICD-10 5010 Working Session ICD-10 Working Session Welcome!

3 Agenda for Overview Session 5010ICD-10ImplementationResourcesQuestions

4 5010 Questions What is 5010 and why do we have to do this? Who uses 5010? EDI 5010 Overview When does 5010 happen? Where is 5010 used?

5 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.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.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.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

6 What is 5010? Improvements in structural, front matter, technical, and data content.Improvements in structural, front matter, technical, and data content. More specific in requiring the data that is needed, collected, and transmitted in a transaction.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.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

7 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 Why do we have to do this? Why do we have to do this?

8 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 When does 5010 happen?

9 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 Who uses 5010

10 EDI 5010 Overview Where is 5010 used? Covered transactions include: 837 P, I, and D claims (including COB) 837 P, I, and D claims (including COB) 835 health care payment and remittance advice 835 health care payment and remittance advice 270/271 eligibility request/response 270/271 eligibility request/response 276/277 claim status request/response 276/277 claim status request/response 278 referral certification and authorization 278 referral certification and authorization 834 health plan enrollment/disenrollment 820 health plan premium payment NCPDP D.0, 5.1, and 3.0

11 ICD-10 Questions What is ICD? How is ICD used? Why are we moving to ICD-10 When does ICD-10 happen? How does ICD-10 differ from ICD-9 Who uses ICD-10? EDI ICD-10 Overview

12 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 ICD-10 Code Structure EDI ICD-10 Overview

13 Diagnosis Code Structure S52.311A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture RootRootRootSiteSeverityEtiologyExtension S52311A Injury, poisoning and certain other consequences of external causes Injuries to the elbow and forearm Fracture of Forearm Radial Shaft GreenstickRight Initial Encounter EDI ICD-10 Overview

14 Procedure Code Structure OTF4ZZZLithotripsy Section Body System Root Procedure Treatment Site ApproachDeviceQualifier OTF4ZZZ MedicalUrinary Fragment- ation Left Renal Pelvis No Approach Noted No Device Noted No Qualifier Noted EDI ICD-10 Overview

15 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 Mapping of 813.21 There are 90 ICD-CM code possibilities for mapping of 813.21 EDI ICD-10 Overview

16 Implementation Tasks Phase 1 Create the structure/governance Begin impact assessments Awareness and Communication EDI 5010 and ICD-10 Implementation

17 Implementation Tasks Phase 2: Determine business and technical strategies Complete Budget Planning Complete Impact Assessment EDI 5010 and ICD-10 Implementation Define Functional Requirements

18 Implementation Tasks Phase 3: Complete System Development/ Get Vendor Updates EDI 5010 and ICD-10 Implementation Review contracts, reports, …

19 Implementation Tasks Phase 4: TEST – TEST - TEST EDI 5010 and ICD-10 Implementation

20 Implementation Tasks Phase 5: Go-live Analyze potential cash flow implications Communicate changes EDI 5010 and ICD-10 Implementation

21 HIPAA COW:www.hipaacow.com www.hipaacow.com WEDI:www.wedi.com www.wedi.com CMS:www.cms.gov www.cms.gov Resources

22 CMS Transactions & Codesets: http://www.cms.hhs.gov/TransactionCodeSetsStands/02 _TransactionsandCodeSetsRegulations.asp http://www.cms.hhs.gov/TransactionCodeSetsStands/02 _TransactionsandCodeSetsRegulations.asp ICD 10 Final Rule: http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf 5010 Final Rule: http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf Resources

23 CMS HIPAA Standards Page (gap information links): http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_50 10D0.asp http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_50 10D0.asp CMS ICD 10 Fact Sheet: http://cms.hhs.gov/MLNProducts/downloads/ICD- 10factsheet2009.pdf http://cms.hhs.gov/MLNProducts/downloads/ICD- 10factsheet2009.pdf http://cms.hhs.gov/MLNProducts/downloads/ICD- 10factsheet2009.pdf X12 Presentation to NCVHS on 5010 changes: http://www.ncvhs.hhs.gov/070730p4.pdf Resources

24 Questions?

25 THANK YOU!

26 Contact Information: Kit Cairns catherine.cairns@deancare.com 608.294.6492 Karen Navarro KNavarro@uwhealth.org 608.662.0817 Claudia Yoakum-Watson CYoakumw@weatrust.com 608-661-6726Or ccrsconsulting@tds.net 608-289-4974

27 Notes

28

29

Download ppt "Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Overview of 5010 and ICD-10:"

Similar presentations

Centers for Medicare and Medicaid Services Administrative Simplification Compliance Act (ASCA) and CMS Readiness Karen Trudel.

Centers for Medicare and Medicaid Services Administrative Simplification Compliance Act (ASCA) and CMS Readiness Karen Trudel.
Overview of ICD-10 Transition

Overview of ICD-10 Transition
X12N Task Group 3/Work Group 2 July2000 Health Care Transactions ANSI ASC X12N Insurance Sub-Committee Task Group 3 Business Transaction Coordination and.

X12N Task Group 3/Work Group 2 July2000 Health Care Transactions ANSI ASC X12N Insurance Sub-Committee Task Group 3 Business Transaction Coordination and.
1 Health Insurance Portability and Accountability Act of 1996 IS&C Expo October 16 & 17, 2002 John Wagner Governor’s Office of Technology.

1 Health Insurance Portability and Accountability Act of 1996 IS&C Expo October 16 & 17, 2002 John Wagner Governor’s Office of Technology.
Introduction ICD-10-CM Overview Presented By Erline Franks CCS-P.

Introduction ICD-10-CM Overview Presented By Erline Franks CCS-P.
ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012.

ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012.
Lessons Learned from the 5010 Conversion to take into ICD-10

Lessons Learned from the 5010 Conversion to take into ICD-10
HIPAA Privacy Rule Training

HIPAA Privacy Rule Training
© 2009 The McGraw-Hill Companies, Inc. All rights reserved. 1 McGraw-Hill Chapter 1 The Goal of HIPAA: Administrative Simplification HIPAA for Allied Health.

© 2009 The McGraw-Hill Companies, Inc. All rights reserved. 1 McGraw-Hill Chapter 1 The Goal of HIPAA: Administrative Simplification HIPAA for Allied Health.
 5010 Purpose and Requirements  County Testing  Implementation & Schedule Constraints.

 5010 Purpose and Requirements  County Testing  Implementation & Schedule Constraints.
HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson

HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson
ICD-10 Planning and Assessment

ICD-10 Planning and Assessment
1 5010 Project Status January 2012. 2 HIPAA 5010 CMS Updates CMS recently released a communication which outlined a “contigency” window for 5010 compliance.

Project Status January HIPAA 5010 CMS Updates CMS recently released a communication which outlined a “contigency” window for 5010 compliance.
CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 The Use of Health Information Technology in Physician Practices.

CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 The Use of Health Information Technology in Physician Practices.
HIPAA Privacy Rule Compliance Training for YSU April 9, 2014.

HIPAA Privacy Rule Compliance Training for YSU April 9, 2014.
 The Health Insurance Portability and Accountability Act of 1996.  Federal Law designed to protect sensitive information.  HIPAA violations are enforced.

 The Health Insurance Portability and Accountability Act of  Federal Law designed to protect sensitive information.  HIPAA violations are enforced.
1 Operating Rules Status NCVHS Subcommittee on Standards December 3, 2010 Updated on enhancements to Operating Rules for Eligibility and Claim Status.

1 Operating Rules Status NCVHS Subcommittee on Standards December 3, 2010 Updated on enhancements to Operating Rules for Eligibility and Claim Status.
1 ICD-10 Working Session Building Awareness and Tools/Resources Karen Navarro Claudia Yoakum-Watson April 16, 2010.

1 ICD-10 Working Session Building Awareness and Tools/Resources Karen Navarro Claudia Yoakum-Watson April 16, 2010.
2 The Use of Health Information Technology in Physician Practices.

2 The Use of Health Information Technology in Physician Practices.
HIPAA TRANSACTIONS HIPAA Summit IV 2002 UPDATE. HHS Office of General Counsel l Donna Eden l Office of the General Counsel l Department of Health and.

HIPAA TRANSACTIONS HIPAA Summit IV 2002 UPDATE. HHS Office of General Counsel l Donna Eden l Office of the General Counsel l Department of Health and.

Similar presentations

Ads by Google