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Page 1: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

WELCOME

Confidential & Proprietary

Affinity ICD-10 Testing

to

Page 2: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

Affinity ICD-10 Testing

Confidential & Proprietary

Revenue Cycle Team

October 30, 2014

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Agenda Impact of ICD-10 Delay Affinity ICD-10 Revenue Cycle Overview Release Timelines Regulatory Discussion

Page 4: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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But First……. John in 2009

Where to

start?

Page 5: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Foundational “Truths”

•After 10/1/15 – 100% of coding is ICD-10 •Payer’s lack of compliance is a billing problem - not a coding problem

•Payer is not ready: Reimbursement Mapping Table(s) used

Affinity ICD-10

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Impact of ICD-10 Delay

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2015-2016 – Impact of ICD-10 Delay

Legislative Mandate

336 Days…240 weekdays

The clock is ticking…

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2015-2016 – Impact of ICD-10 Delay

Estimated 1 BILLION Dollars……

to

$6.6B

Page 9: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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2015-2016 – Impact of ICD-10 Delay

$

Page 10: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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2015-2016 – Impact of ICD-10 Delay User Group User Ballot Client Communication

Page 11: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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2015-2016 – Impact of ICD-10 Delay WEDI Survey • Top ICD-10 Provider concerns:

1. Accurate claims and adjudication process 2. Increase in denied claims and appeals 3. Increased operational costs (training/proper use of

ICD-10 codes) 4. Impact of DRG reimbursement

• Payer & Provider Preparedness As of August, over 50% of payers and ≈ 33% of

providers have started external testing

http://www.hfma.org/
Page 12: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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QuadraMed Business Intelligence

Page 13: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Affinity ICD-10

Page 14: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Affinity ICD-10

Page 15: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Med Learn Matters 8858 – 8/22/14 Transmittal R1423OTN

• Defines testing weeks – acknowledgement testing only 11/17/14 – 11/21/14 3/2/15 – 3/6/15 6/1/15 – 6/5/15

Med Learn Matters SE1409 – 7/31/14 • Mentions End-to-End testing (test 835s) Limited group of Providers Additional details about the end-to-end testing process will

be disseminated at a later date in a separate MLN Matters article.

Affinity ICD-10

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System wide updates to support ICD-10 – M12 • Registration • MRA/DRG • Patient Accounting/EDI

Facility Editable Implementation Date Support billing with both code sets

• Support via Reimbursement Mapping Table ICD-10 Codes “translated” to ICD-9 Codes

• Control at the Payer level • New “versioned” ICD file supporting both code sets

Affinity ICD-10

Page 17: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Affinity ICD-10

ICD-10 ICD-9

Full ICD-10

Description

Page 18: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Encoder updates • Nuance integration update • 3M interface update

Testing capabilities – testing in “Live” • Test MRA ICD-9 Live/ICD-10 Test

• v5010/ICD-10 test claims Interface specific configuration • Outbound….ICD-9, ICD-10 or both

Query migration services

Affinity ICD-10

Page 19: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Each client is responsible for reviewing your custom queries/reports to determine if changes need to be made for M12 ICD-10 changes How many queries have you written/modified at your site that use the ICD Diagnosis or Procedure code fields? How do you identify queries that need to be reviewed? • Services Identify queries needing review Assess queries needing changes QuadraMed engagement to make changes

ICD-10 Query Impact Overview

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M12SP1 Product

M12SP1 ICD-10 Train/Test ICD-10 Effective Date:

1/1/14

M12SP1 Support ICD-10 Effective Date:

10/1/15

M12SP1 Live ICD-10 Effective Date:

10/1/15

ICD-10 Primary Code Set

ICD-9 Primary Code Set

Affinity ICD-10

Please keep current on releases

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Support ICD-10 Pilot DRG grouper (Update 2) • Used with testing utilities in “Live” only • Grouping done in “encoder” – 3M/Nuance • Pricing done in Affinity Ongoing updates to the ICD-9/ICD-10 and Reimbursement Mapping Tables Use of ICD-9 Grouper post ICD-10 date (Update 3) • Support DRG grouping using mapped ICD-9s post date

ICD-10 Updates

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Page 23: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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ICD-10 testing success stories? • What went well…. • What didn’t go so well….

Testing with Clearinghouses? • Ability to connect to multiple Payers? • Guidance

Anyone sign up for end-to-end testing?

Page 24: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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REVENUE CYCLE OVERVIEW

Page 25: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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GA of Affinity M12 (July 2012) • ICD-10 ready release • Built in testing capabilities • Supports payer billing adoption (or lack of) M12 Service Pack 1 delivered on-time • Therapy Cap solution delivered QuadraMed Business Intelligence (QBI) GA Q412 • 3 sites live QuadraMed Contract Management (QCM) migration to .NET Access Quality Manager (AQM) live at Hunterdon M15 in development/QA

Affinity Accomplishments

QuadraMed

Presenter
Presentation Notes
How man clients using Denial Prevention Tools and AR Mgt Tools….how many are live? Other Applications Released in Past Year Denial Prevention Tools: Address/Demographic Validation at Registration Med Necessity Validation at Registration A/R Management Tools Extended Receivables Management Guarantor Statement processing
Page 26: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Customers Believe It

Industry Leading Solutions

Page 27: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

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Customers Believe It

Industry Leading Solutions

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Industry Leading Solutions

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Release Timeline

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Release Timeline ICD-10 10/1/15: Roll Out Strategy CMS ICD-10 Industry Adoption 10/1/15

Affinity Release M12 (GA July 2012) – Cache 2011 M12SP1 (GA April 2013)

Update Releases scheduled as needed Affinity Release M15 (projected GA Q115)–HealthShare

Major releases (M12/M15) locked down thru ICD-10 migration

Update Releases scheduled as needed ICD-10 implementation 10/1/15 Affinity Release M16 (projected GA Q416)

Return to predictable yearly cycle

Subject to Change

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2014 Q2 Q3

2015 Q1

GA

Q4

Major Activities: ICD-10: Preparation & testing Prepare for “Go Live” Update releases as necessary

GA

ICD-10 Update Special Release

ICD-10 Update Special Release

M12SP1U1

ICD-10 Update Special Release

M12SP1U3

GA

Release Timeline Affinity 2014 Projected Schedule

Subject to Change

GA

QCM 14.0

GA

QCM 14.1

GA

QBI 1.2

Please keep current on releases

M15 to Beta

Beta

M12SP1U2

Page 32: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

32 | Confidential & Proprietary 32 | Confidential & Proprietary

2015 Q2 Q3

2016 Q1 Q4

M15 GA

EDI / ICD-10 Updates RCM/ERM/ACW Updates Rapid OP Admit Denials Workflow APC Batch Automation Delete/Hide Payer User Ballot Enhancements …..

GA

GA

QBI 2.0

ICD-10 Update Special Release

GA

If necessary

GA

QCM 15.1

QCM 15.0

Subject to Change

10/1/15 ICD-10 Implementation

ICD-10 Update Special Release

GA

If necessary

Major Activities: ICD-10: Preparation & testing Prepare for “Go Live” Update releases as necessary

Please keep current on releases

Release Timeline Affinity 2015 Projected Schedule

Page 33: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

33 | Confidential & Proprietary

Key Milestones • EDI Transaction sets v5010 – required for ICD-10 1/1/12 Addenda pending

• Therapy Caps – Released Q413 • National Health Plan Identifier (HPID) - 11/7/16?? • Operating Rules for EDI (CARC/RARC) – 2013 - ongoing • Medicaid movement to APR-DRG - ongoing • Migration to ICD-10 10/1/15 • Bundled Inpatient billing post discharge – 2013 • 275 Additional Information to Support a Health Care Claim

or Encounter (NPRM – Sept 2005) - Now post ICD-10 1/1/17??

HIPAA Watch

Subject to Change

http://cms.gov/default.asp
Page 34: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

34 | Confidential & Proprietary 34 | Confidential & Proprietary

Propensity to Pay Tools • Credit Score used in collections • Charity Assessment enhancements • Patient Liability Estimation

Appeals Management GUI Uplift User Ballots Business Intelligence (QBI) – ongoing

• Payer Scorecard • DNFB Reporting

Contract Management (QCM) – ongoing Regulatory Updates - ongoing

On the Horizon – 2016 & 2017

Subject to Change

Page 35: WELCOME [] Rev...ICD -10 Update Special Release If necessary GA QCM 15.1 10/1/15 QCM 15.0 Subject to Change ICD-10 Implementation ICD 10 Update GA If necessary Major Activities: ICD-10:

Questions


Icd 10 cm untuk fisioterapi, ICD 10 Fisioterapi bahasa Indonesia, JKN, BPJS, ICD 10, Fisioterapi

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