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8d - AHCCCS ICD10 Overview Presentation

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Our first care is your health careArizona Health Care Cost Containment System
Arizona Health Care Cost Containment System (AHCCCS)ICD-10 Overview – January 2014

Our first care is your health careArizona Health Care Cost Containment System
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What is ICD-10?
ICD-10 is the updated version of the sets of codes used for claims coding of:Diagnosis; for all types of providers (ICD-10 CM)Inpatient hospital procedures (ICD-10 PCS)Effective - for outpatient and professional dates of service, and inpatient dates of discharge 10/1/2014 and after. The law mandates that ICD-9 procedures and diagnosis codes be replaced with ICD-10 procedure and diagnosis codes
Our first care is your health careArizona Health Care Cost Containment System
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Why is ICD-10 a major change from ICD-9?
Not just the usual annual update of codesICD-10 is very different from ICD-9 both structurally and conceptuallyRequires changes to most clinical and administrative systems and processesImpacts reimbursement and coverageImpacts key reporting functions
Our first care is your health careArizona Health Care Cost Containment System
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Challenges with moving from ICD-9 to ICD-10
No clear mapping from ICD-9 to ICD-10May be 1 ICD-9 to many ICD-10’s; Many to many; no good equivalent, etc…Information in ICD-9 is not as specific so crosswalks are difficultAHCCCS approach to understand concepts and intent behind policies, processes, etc… to ensure appropriate and timely decision making from ICD-9 to ICD-10
AHCCCS Approach
In order to move to ICD-10 we must do the following:Determine which ICD-10 diagnosis codes should be considered under each applicable policyOperational staff who must make these determinations must first be trained on the new ICD-10 coding structures, etc….Once determinations are made, identify all related system impactsMake identified system changes to include the ICD-10 codes to be considered
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AHCCCS Approach, cont.
Make identified system changes, to ensure the accommodation of appropriate ICD-10 valuesUpdate Reference tables with ICD-10 valuesMake any changes to related reportingReview and update all related documentation including Provider Billing Manuals; Claims processing policies; Rule; etc…Ensure all updated materials are posted to the AHCCCS Website
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AHCCCS Approach, cont.
Ensure that the AHCCCS Contracted Health Plans are informed of all necessary changes, and track to ensure that like changes are made in their systems, documentation and processesEnsure that all impacted and/or interested staff receive training regarding changesEnsure that all impacted providers/trading partners receive communications related to and training regarding the changes
Our first care is your health careArizona Health Care Cost Containment System
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ICD-10 Impacts to Consider
Provider Documentation –Codes must be supported by medical documentation and since ICD-10 codes are more specific, more documentation may be necessaryRevenues may be impacted by specificityCoverage and Payment –New coding may result in new coverage policies, new medical review edits and new reimbursement schedules overtime. For example AHCCCS will be moving to APR-DRG reimbursement or Inpatient Hospitals
Our first care is your health careArizona Health Care Cost Containment System
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ICD-10 Impacts to Consider, cont.
Billing Related Transactions –Updates to include/support ICD-10 where appropriateExpect increase in rejects, denials and pends during transition and initial implementation periodsLaboratory and Pharmacy orders will need to be supportedQuality Measures/Pay for Performance –Updates to measuresNew measuresWill be difficult to measure impacts of change from ICD9 to ICD10 and during overlap reporting periods
Our first care is your health careArizona Health Care Cost Containment System
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Impacted Areas
Important to recognize that this is not just an IT project (60% Operational and 40% Systems)ICD10 impacts a wide range of Business areasBenefits/CoveragePayment policiesProvider relationsClaims/Encounters processingStatistical trendingFraud and AbuseBudgetingQuality Measures and Quality ManagementEtc…
Our first care is your health careArizona Health Care Cost Containment System
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Must Do’s
Complete an assessment of business and system impacts first and revisit as neededInvolve the entire agencyRealize that this is a business and a technical projectInvolve and train experts early onEnsure strong project management/tracking toolsSpread-out the resources and budget commitments appropriatelyPlan for and execute testing of business processes as well as systems
Our first care is your health careArizona Health Care Cost Containment System
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AHCCCS Timelines and Status
The AHCCCS ICD10 Project remains on scheduleAHCCCS ICD10 Project MilestonesRequirements and Design Reference System -CompletedCoding Reference Systems -CompletedRequirements and Design All other Systems –CompletedInternal Testing Reference System -CompletedCoding All other System Areas –In progressSystem Implementation Reference System –CompletedInitial Reference Table Loads –Completed (final qc and validation of key policy impacts in progress)
Our first care is your health careArizona Health Care Cost Containment System
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AHCCCS Timelines and Status, cont.
Internal Testing All other Systems –In ProgressExternal Testing Begins - January 2014837 Submissions (Claims/Encounters) - January 15th2014Claims/Encounters Editing and Results Reporting – March 15th2014Reports – June 1st2014ICD10/DRG Integrated End to End – June 1st2014System Implementation All other Systems - September 2014
Our first care is your health careArizona Health Care Cost Containment System
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Available Resources
Webpage -http://azahcccs.gov/commercial/EDIresources/ICD10.aspx
Our first care is your health careArizona Health Care Cost Containment System
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8d - AHCCCS ICD10 Overview Presentation