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Chiropractic Software includes all ICD-10 codes

 In Chiropractic Billing Software, Chiropractic Dream Practice

Are you and your Chiropractic Practice ready for ICD-10 and all of the new billing codes that you’ll need to know? Learn more about how your billing and collections will be impacted and learn how to avoid denied claims and underpayments.

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Read the transcript:

Jess: All right. Good afternoon everyone and thank you for attending our webinar on ICD-10. Today’s presenters are Kathleen Casbarro and Mellisa Levine. Kathleen is the head of our SWAT department and she is a certified coder. She has been in this industry for 30 years and we have Mellisa Levine who is the head of our support department here at Vericle and she is responsible for over a hundred professionals, that’s been 500 practices and post 14 million in monthly payments. So welcome Kathleen and Mellisa.

Kathleen: Thanks, Jess. Appreciate that. Just wanna welcome everybody today to our ICD-10 webinar. The webinar today will be 30 minutes. The reason why we do this in half-an-hour because its a lot to take in and if we can deliver our message in 30 minutes to you, of course, if you want additional information from us after the webinar please feel free to reach out. Jess, at the end, will give you our contact information. So I wanna welcome all of you and I hope most of you on this phone have not had to dig out of 12 inch of this snow, but hopefully, we can make your lunch half-hour at least entertaining.

Our focus for today is really understanding the complexity of ICD-10, that is our learning objective. We all know that ICD-10 is coming and it’s gonna hit us on October 1st, 2014. For a lot of us who are in the health care industry, were actually looking for ICD-10 to hit us on October 1st, 2013, but they gave us a year reprieve. In saying that though people actually wonder why, you know, why are we having conversations so early in the game? Why are we talking about ICD-10 in January?

Well, a lot of us have actually been talking about ICD-10 for years and talking about it early is really the best way to start. We do know that it is coming in 9 months, but in this particular case if any of you on the phone are familiar with 50-10 that was a struggle, this is gonna be even more difficult because it’s gonna involve a lot more people within your practice. So we really wanna talk about ICD-10, why it’s a problem and how we have to work together to fix it. So really what is the problem? Why is ICD-10 such a big issue? And you know you’re seeing this guy in a car kind of on the edge of a cliff feeling like he’s gonna fall over it because everybody’s so worried about it. And there is a good reason to worry because it’s gonna impact you. It’s gonna impact your practice. Is it going to take away time from your patients? Really, that’s what we want to avoid. Everybody is out there to help their patients. You wanna help them get better and stay better. What we don’t want this to do is really impact your patient care.

The purpose for ICD-10 is to improve patient care. The reduction on cash flow, that’s something we always have to worry about. Not only reduction on cash flow, the cost of implementing a major change like this into your practice and everybody always worries about office workflow change, you know, do I have to hire more people? Do I need different computers? How do I have to upgrade my system? Should I upgrade now? How about testing and superbills. We do have…people are out there still using paper superbills. Think about it, right now, you’re looking maybe at a one-page superbill in front of you with ICD-9 codes. We’ve seen these translations turn from a 1-page superbill into a 10-page superbill. The last thing we want our docs to do is you know, walk around the office with a ream of paper. The new office superbill really should be something that’s an electronic format to avoid all of that paper and you know, you’re gonna have a difficult time trying to find your codes on 10 pieces of paper. So those are the things…that’s why this problem is so hard to solve because there’s so many things that we have to focus on. And one of the other things that we have to focus on and we all, you know, shrug at this is really the payer readiness and Jess introduced Mellisa in the beginning, I’m actually turning this over to her and Mellisa’s really gonna talk to us a little but about monitor paying readiness.

Mellisa: Thanks, Kathy. So payer readiness is one of the other things that makes this just really complicated and a transition that’s very hard to handle because not all the payers are gonna be ready at the same time. So the official deadline is October 1st, 2014. Some payers are gonna be ready early so you may have one of your payers that’s ready in, let’s say July, another one in August, another one in September and there’s gonna be some payers like we saw the transition to 50-10 though that also had a hard deadline. Some payers weren’t ready for months or even years afterwards. One of the things that makes this real complicated is knowing which codes go to which payers.

Kathleen: You know, I agree with you there Mellisa and I have to say, you and I have been attending numerous webinars with clearing houses, I mean how many have we attended honestly?

Mellisa: I can’t even count at this point. Here’s the question though? Did we get a clear message from any of our clearing houses as to when any of these payers or themselves will be ready?

Kathleen: Clearing houses are starting to have some idea, but based on their contact with the payer cause most of our clearing houses have direct contact with key payers, they’re getting the message of, “We’ll be ready when we’re ready and we”ll let you know.” I like that message for a 50-10 and it sounds like were getting that same message for ICD-10 as well and let me just preface that to which we just also had a change in HICFA on January 1st, where we went to the old HICFA form and now we’re on the O212 version and we still have three months to test it before they implement it on April 1st. Again, because we have payers that aren’t ready to accept the new form, that’s going to hold 12 diagnoses codes and it’s gonna support ICD-10. So I mean, that in itself is an example of…we’re in January 1st and we’re still allowed three months to try to accommodate all the payers that aren’t ready. So yeah, I appreciate that monitoring the payers is not gonna be an easy task for anybody.

Mellisa: Certainly not.

Kathleen: So we really talk about why it’s important. So any change to your practice in terms of workflow is always an important problem because you don’t wanna change your workflow. You wanna be able to continue on your day, implement something new and kind of keep going. But in this particular case, implementation costs are going to be…are gonna be large depending really on your practice size, smaller for others. But either way, you’re gonna have these implementation costs because you have to talk about training, you have to talk about superbills, upgrading your system possibly. There’s the need for the steep learning curve, it’s going to happen because not only are we implementing a new set of codes, ICD-10 codes along with that comes with new documentation rules. That’s where our steep learning curve comes in, where we have to learn not only a new set of codes, but we also have to learn how to document as well. And turning into that is the increased audit. We’re seeing audits all the time, audits are coming through from Medicare, pre-submission audits, you know, post-payment audits, pre-paying audits were seeing. We’re seeing audits on specific CPT codes. If we don’t think that the payers are gonna increase the audits when ICD-10 comes, we’re definitely amiss to what’s going to happen here.

The reason for the ICD-10 is because we are…we do have specificity and we do have laterality and the payers are going to be looking for that in the documentation and want to assure that those documentation and the ICD-10 codes match. So a risk of audits is inevitable, it’s going to happen. Is there also going to be a higher risk for errors? Absolutely. That’s also going to happen and we’re gonna give you examples where some codes have underlined codes so you have to make sure you send 2 ICD-10 codes or the 1 ICD-10 code that you send doesn’t matter. Are we gonna get denials? Absolutely. Because as Mellisa mentioned, the payers aren’t ready and unfortunately, that’s gonna financially impact us. And again, I’m gonna turn it over to Mellisa about the billing process disruptions that you’re also going to have to face.

Mellisa: So thanks, Kath and you’re certainly gonna see some disruptions at the time of billing as well as afterwards tying into those denials and errors. Going back to what I was talking about earlier with the payers being ready at different times, every time you go to bill you’re gonna have to think about which set of codes need to be sent to the payer for the specific patient you’re working with. Does this payer take ICD-10 yet? Are they requiring it yet? Are they only handling ICD-9 still? This is gonna be something you’re gonna have to think about each you go to bill because if you send that wrong set of codes and that payer maybe can’t handle ICD-10 yet and you send the wrong ones, that’s gonna be an automatic denial. They’re not even gonna know what those codes are and the same thing in the other direction, if you send an ICD-9 code and they’re already implementing ICD-10 only you’re gonna get those denials and it’s gonna slow down your payments.

Kathleen: I think in all of these together as a whole really are going to have a financial impact on practices without question. We have to talk about then…we know what the problem is, we know why it’s important because there’s a financial impact. There’s not being able to treat as many patients as you’re trying to implement this new code setting and documentation. But the question then is why is it so difficult to solve, right? We solved problems in the medical industry in the past, we have advanced technologies, so why can’t we just solve this one? And that’s because of the complexity because were moving from 14,000 codes to 68,000 codes, it’s a lot. Now, am I gonna say that everybody out there uses every code in the ICD-9 book, that would be incorrect because it’s not true. We’ve become so accustomed to ICD-9 codes that we know where certain sections are, we know that, you know, codes that start with eight are injuries, codes that start with four are cardiac. I mean, we can kind of shuffle our way around a book pretty easily. But now, we have to train our brains to look at 68,000 codes and now understand a whole new set of rules. But along with that difficult problem to solve in terms of complexity, I mean, in here yes, we show a funny picture of [inaudible 00:10:49] by a title or were you struck by title. Does it make sense? In ICD-9 we do have a lot of these codes, they’re e-codes that you would see in your ICD-9 book, but now, it becomes…they want a clear picture and were gonna get to that. What I’m also gonna do right now is actually turn you over to Mellisa again about that unfair payer advantage which you know what, it irks me every time we talk about it.

Mellisa: It irks me as well because they make it so hard. They have so much control over what they will take when and we just have to follow along. And that makes it so difficult for our practices to really have a good handle on what’s going on and keep them running smoothly. Because they get to say, “All right, I think we’re ready now. Oh, you didn’t know we were ready? Why not?” And because that readiness date is gonna change for each of these payers, it just becomes so complicated to try and solve and keep track of everything and for a practice to stay on top of all that, it’s just…there’s just so much to juggle at one time.

Katleen: Yeah, and I love the hard deadline for us. I mean, we have to be ready by October 1st, but you know the mass part of the industry can be ready when they’re ready and, you know, it’s okay and they have leeway, but we don’t. We have to be able to teach ourselves which one has 9 and which one has 10 simultaneously while trying to treat a patient, while trying to do our documentation, right? I mean, that’s clearly an unfair advantage. Yes, and we have to able to juggle back and forth between the codes, but each payer can just say, “Okay, we’re taking this one now and were done with the other.” We don’t get that flexibility.

Mellisa: Yeah, you’re right. I love that part. So when we talk about how many codes, I did just say we can juggle ICD-9, we’ve had it for tens of years, we’ve got it, we know these codes, we know where they are in the book. We can say, “I’m in the 7th section, I’m in the 8th section, I know what it is.” I mean, and you can look at the correlation here on the screen. ICD-9? Yes. We can. One clinician would be able to figure that out, but now you’re looking at ICD-10, it is such a big burden because not only are we talking about the length of the code, but we’re talking about, you know, we go from three to five, to three to seven characters in length. And we’re really trying to represent here the big burden of ICD-10 on one clinician. It’s a lot to bear.

So we’re gonna show you and work with you to give you what our approach and our solutions are to this. As we talk and we get to those solutions, we see ICD-9 versus ICD-10 and I mentioned before because of the advancement with medical technology and the advancement in medicine, ICD-9 can’t expand any further. We’ve outgrown ICD-9 and so ICD-10 as you can see here in the photo, there’s a difference. ICD-9 lacks the specificity of detail and it lacks laterality. And ICD-10 provides us with a clear picture of the patient’s treatment and what the payers are looking for which is outcome. Now, is ICD-10 new? It’s not. The ICD-10 is used around the world, it’s pretty much just new to the U.S. If you were to go to, travel to Europe, you’re gonna see ICD-10. They’ve been using it for years. So it’s just something that’s new to us.

But in order to bring that specificity and that laterality to both the patients’ diagnoses coding and documentation, what they’re looking for is better outcomes.That’s really the key here is outcome assessment. We’re gonna take a code and were actually gonna break it down for you. So, you know, ICD-9 like I mentioned, first digits may be alpha or numeric like I mentioned e-codes and b-codes here, ICD-10 fist digit is always alpha, and then we break it down. So where in ICD-9 you’re first code really told you what category it was in, now your first three characters are going to tell you what category that you’re in. Then break down the ideology and then we use our extensions and most of all we have these lovely Xes as placeholders. You’ll see most of your placeholders that’re in the medication section right now, that’s where most of the placeholders are.

We find our category, we do our comparison. So we’re gonna gonna look at a structure here. For example, we have an anterior dislocation of the elbow which in ICD-9 is 832.01, in ICD-10 we translate that to where the S53 is actually the category, that this entry belongs to which injury to elbow and forearm, 0 shows for the anterior dislocation, a 14 is for the right because were doing laterality right radio head. And then we have our 7th code which lets us know if this is an initial encounter, a subsequent encounter, or sequelia. That’s how we can go out to 7 digits. Again, were breaking down by category, we can build an ICD-10 code, but were going from 14,000 codes to 68,000 codes. So we have to keep that in mind. So we can have also coding issues when we come across this and some of those coding issues can be that if a particular code has an underlying code where you have to send two ICD-10 codes wherein ICD-9 you’d only have to send one.

So we’re using it here, patient has triactica [sp] in ICD-10, but we have…two patient has lumbago if there’s any other underlying reasons for the triatica, [sp] we have to mention that as well. So those are potential coding issues where you know, in the ICD-10 book it’s clearly gonna say to you there’s a primary ICD-10 code that need to be coupled with this code. And you know, those rules are things that we need to pay attention to very closely and this is one of those potential coding issues. So really what we talk about then as we’ve been going over this is really what’s our approach and solution. For the last 19 minutes, we’ve been scaring you with financial impact, going over documentation, trying to be just as ready as the payers and be one step ahead of them. We have numerous payers out there and they’re not really willing to tell us when they’re gonna be ready. And we also mentioned about changing your workflow, but we wanna give you an approach and a solution that helps solve some of those problems for you. And I’m gonna turn this back over to Mellisa because she does such an awesome job explaining it.

Mellisa: Thanks, Kathy. Way to set the bar. So we’re doing several things in our software to help practices through this change. Because it is such a large changes. We wanna try to make it so that you’re not gonna have to change the workflow that you’re comfortable with and you’re used to already as much as possible. So far we have all the new codes loaded into our systems, we also have loaded the crosswalk tables that are provided by CMS of Gems that is right built into the system to help you convert from the codes that you are used to in ICD-9 over to their equivalent mappings in ICD-10. You’ll get a chance to kind of learn and see that translation right within the workflow you’re already using.

We’re also going to be keeping track…as I mentioned before, one of the things that makes this all so difficult is payers changing at varying times. Our system is gonna be keeping track of that though communications with our clearing houses and with our payers so that as they make themselves ready for ICD-10, the systems going to be updated with that information. So right when you’re at the point of billing, its gonna tell you based on the payer that’s configured for you’re patient. Which coding system you need to be selecting from, or in some cases both coding systems. In addition to that as Kathy mentioned you’re gonna have your customised superbill built under ICD-9 maybe 1 page on paper and under ICD-10 can go up to 5, 10 or 15 pages. We’re gonna have the ability for you to put that into electronic format in our system and have that customized with both versions readily available at the point of billing.

Kathleen: Think that’s everything that’s on there. So, I have a question for you Mellisa, if I have a patient that walks through the door and they have Medicare primary ETNA secondary and Medicare is ready for ICD-10 and ETNA’s not, were gonna be telling our practices on both the primary and secondary.

Mellisa: We are, were going to prompt them to select in some cases both code sets. It also gonna depends if maybe Medicare is ready, but not requiring it. They’ll have the option to just take ICD-9 but they’ll know that ICD-10 can be fore-acted. We’re really trying to give you some good direction on what coding sets to pick based on your payers.

Kathleen: Right, and in terms of that customized superbill like you said, as they crosswalk, as we build up to…we use that one ICD-10 code example for the fracture they will be able to choose the category, the ideology and then be able to, you know, pick their code whether or not it was an initial encounter, a subsequent encounter or sequelia. Now, once they pick that code, that code will then be stored on their new ICD-10 superbill, so they won’t need to crosswalk that again.

Mellisa: Right, so they may need to…it’s a different variation of same ICD main code, they will have the option to do that. But they will also be able to pick it directly from their ICD superbill

Kathleen: Right. So once they populate that ICD-10 code on their superbill, the patient comes in for a follow-up visit, do they need to go search for that code again? Or is it just gonna populate?

Mellisa: It will populate automatically actually if they already picked their ICD-10’s on their previous visit, those are gonna come up automatically on the next visit and all they would need to do is change it to something about the patient’s condition changed.

Kathleen: Okay, yeah. I love that. So you know the question is now to yourself, we’ve given you our approach, we’ve instilled some fear which I don’t like to instill fear, but you know what? I am a certified coder and I have been working with ICD-10 for a while now and it’s not getting any easier actually. So you have to say to yourselves, “What do we need to do?” Going out there ourselves, working with our clearing houses, you know they’re giving us a nine-step process of what you need to do. Learn the code, figure out which codes you need to use, contact your vendors, contact your payers, you know, do your upgrades and do you internal testing, get all your intakes forms and your superbills taken care of. Now, do external testing, train your employees and then wait.

Everybody wants to sit back and wait, but I don’t think that’s gonna be the case, you know what we wanna tell you is that we’re taking away some of those steps. Learn the codes, that has to happen. Its critical that everybody in your practice understands, you know, how these codes work and how they’re going to work with your documentation. It’s key to understand that. Update your internal processes. Yes, you have to think about your workflow, yes you have to think about your intern forms. Conduct training, that’s mandatory. Are physicians, any of our clinicians are gonna need to understand the new mandates for documentation for ICD-10 that are gonna come down the path. And then really wait for October 1st. In that particular case in terms of waiting, you know, its become a beta tester. Try to send your claims out when the payers say, “Listen were ready to test on the front end.” You know, “Do you have some claims that you wanna send over to us?” I’ll let everybody know right now that CMS has put out a notification that they’re gonna be ready to do front-end testing in March. So as early as March, we can send some, you know, front end tasks to Medicare to see if they’re front end edits work well with the new changes, with the ICD-10. And along with the new form, the new HICPA that we have to put out there.

So, you know, we talk about what it is we need to do, we definitely need to prepare. The next thing we wanna talk about is really what are your next steps? Always crosswalk your top 50 ICD-10 codes and just as letting me know, just so we can come off mute for a second, H and F for NC uses are putting together the top 50 codes.

Mellisa: That’s nice to hear.

Kathleen: Looks like H and F is working with their clients in North Carolina, I appreciate that. I’m from North Carolina. So really what we wanna do, we wanna assess our top 50 ICD-9 codes and start crosswalking them to ICD-10. So you say to me,”Well, how do I do that? I don’t know anything about ICD-10.” The best tool that you can use you can go to CMS Gems, G-E-M-S, and we will be providing links on our blog along with this webinar for you to go out there and use the Gems system. And you can also go to they have a neat little crosswalking tool on their website as well and were gonna provide that link for you too.

Again, determine the cause of implementation and you have to say to yourself, “Am I on paper? I mean, do I wanna carry around a stack of papers or do I wanna be electronic and be able to have it in front of me, and be able to be forewarned when I know a payer’s ICD-9 or 10 ready?” And, you know, that’s part of the implementation and reviewing internal billing process. What’s your flow now? What do you think needs to change? Will you need additional staff? You have to think about that. Auditing your sample record, we should all be doing that now anyway, making sure that our documentation matches both the CPC, H6 and ICD-9 are sending to our payers. But you really wanna learn how to crosswalk your documentation to ICD-10 coding. Is laterally or specificity missing from that documentation then you have to go back to your clinician and go,” You tell me the [inaudible 00:24:55], is it the right or left?” Those are things you have to work about so learning these new mandates, your physicians and the staff should learn them so you’re ready when ICD-10 hits.

And then implementing and testing with payers for any of your billing software that you have, you know, reach out and say, “Listen, are you beta testing? Can I get on the list? Can I be someone who can send their claims to you in ICD-9 and ICD-10?” Get feedback from the payers so we know whats right and whats wrong and start preparing. So really you wanna talk to your software company like I mentioned, your top 50 ICD-9 codes I can’t say it enough, start working now because ICD-9 to 10 is not a one-to-one relation. Not all the time. You even have ICD-9 and ICD-10 codes that don’t even crosswalk to each other, there are some of those out there. So, you know, it’s better to find out now what they are and start to get used to using them. Like I said, become a beta tester, get of ETNA or Signa, when they say that they’re ready, raise your hand and go, “Listen, I wanna test.”

The other thing that we really want you to do is watch out for our future webinars, we are gonna be focusing on ICD-10, it’s definitely a passion of mine, I love talking about it, I love teaching about it. The next one that we’re gonna have in March is really ICD-10 documentation talking about that laterality and that specificity. So we really want you to, kind of, get on board, start preparing for ICD-10 and get yourselves ready for October 1st. So with that being said Jess, I think it’s my time to turn to turn it over to you now.

Jess: Thank you, Kathy. All right, anyway fill out the survey, its two questions and once you fill out that survey we will send you the certificate that you can then go onto the [inaudible 00:26:47] website and get your credit for attending this webinar. Information for you, if you are a member of our service we have extended hours, we are working until 9 p.m. Eastern. Here at the training desk and our coaching services are available up to 10 p.m. Eastern by appointment. That’s all and thank you so much for attending, and we hope to see you in March for our ICD-10 documentation webinar.

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