1. Your ICD-10 Preparedness Plan August 17 th, 2015

2. Speakers Diana Dipierro, Vice President Customer Support, HME

3. © 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

4. © 2015 Brightree

5. Avoid Cash Flow Crunch! 5

6. © 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

7. ICD-10 Basics

8. © 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-10 8 http://www.cms.gov/ICD10

9. © 2015 Brightree ICD-10 Basics Source: CMS https://implementicd10.noblis.org/understand_comparison/?guide=https://implementicd10.noblis.org/understand_comparison/?guide= 9 Clinical Modification (CM) Codes

10. © 2015 Brightree ICD-10 Basics 10

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

12. © 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 327.23 – 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 250.80 – Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled E11.618 E11.620 E11.621 – Type 2 diabetes mellitus w/ foot ulcer E11.622 E11.628 E11.630 E11.638 E11.649 E11.65 E11.69

13. © 2015 Brightree 13 Workload Calculator

14. © 2015 Brightree General HME Provider– Work Effort Example $10M Revenue/Allowable @ $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

15. Planning Guide For Providers

16. © 2015 Brightree Multiple Areas of Impact 16

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

18. © 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

19. © 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

20. © 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

21. © 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

22. © 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

23. © 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

24. © 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

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

26. © 2015 Brightree Planning Guide 26 OCTOBER 1, 2015

27. Five Key Questions to Ask Your Software Vendor

28. © 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

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

30. © 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

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

32. © 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

33. © 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 ?

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

35. © 2015 Brightree 35 ICD-10 – A Major Move

36. © 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-10 44 Days

37. Brightree Product Plans and Services

38. © 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

39. © 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-10 44 Days

40. © 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

41. © 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

42. © 2015 Brightree Brightree Services for HME - Prototype 42

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

44. © 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

45. © 2015 Brightree LLC 45 3060 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

46. © 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

47. Suggested Resources

48. © 2015 Brightree Suggested Resources  ICD-10 Website  http://www.cms.gov/ICD10 http://www.cms.gov/ICD10  Implementation Guides  https://implementicd10.noblis.org https://implementicd10.noblis.org  General Equivalence Mappings (GEMs)  http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and- GEMs.html http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and- GEMs.html  Reimbursement Mappings  http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Reimburse ment_Mapping_dx_2015.zip http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Reimburse ment_Mapping_dx_2015.zip 48

49. © 2015 Brightree Questions? 49

50. © 2015 Brightree 50 For more information: call 844.GET.BRTE (844.438.2783) email ICD10@brightree.com Thank You