Hi, everyone, and welcome to today's webinar, How to Make a Smooth Transition to ICD-10. We're so glad you could be here today to learn critical planning strategies specifically designed to prepare for using ICD-10-CM beginning in October. Your moderators for today are myself, Suzanne Hill, Professional Development Supervisor, and Carrie Peterson, Member Services Supervisor. Our expert presenter today is Amy Hayes. Amy is the owner of The Office Assistant LLC in Cheyenne, Wyoming. She's developed a healthcare service business offering an array of support and consulting services to include coding and billing, education, and auditing services to facilities, practices, and professionals. We're very excited to have Amy as our presenter today, but before we get started, we have just a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on demand through the IHS website in the near future. This webinar is available for one continuing education credit through the International Hearing Society. You can find out more about receiving continuing education credit at our website, ihsinfo.org. You can click on the webinar banner on the homepage or choose webinars from the Professional Development menu on the left side of the page. There you'll find the IHS CE quiz. Also on the webinar page, you'll find the slides from today's presentation to help you gather the information you'll need for the CE quiz. If you haven't already downloaded the PDF, feel free to do so now. Tomorrow you will receive an email with a link to a survey on this webinar. It is brief and your feedback will help us create valuable content for you moving forward. Today we'll be covering the following topics, a high-level overview of ICD-10-CM code structure, ICD-10-CM specifics for hearing professionals, super bill and charge slip updates, and key steps in ICD-10-CM preparation. At the end of the presentation, we'll move on to a Q&A session. You can send us a question for Amy at any time by entering your question in the question box on your webinar dashboard, which is usually located to the right of your webinar screen. We'll take as many questions as we can in the time we have available. Now I'm going to turn it over to Amy, who will guide you through today's presentation. Take it away, Amy. Thank you for that kind introduction. I'm very excited to be able to spend time with all of you, even if it's remotely today. We have quite a bit to cover in the time that we have, but before we begin, I want to make sure and let everyone know that this presentation is solely based around the United States federal, state, and local requirements for the implementation of ICD-10. If you're in other areas, please feel free to stay on the line and perhaps gather some other tips and tricks that may help you in your own organization, but the content that we've developed for use today is very specific to the United States, and some of it may not be applicable in other areas. The first thing I want to do as we get started in our time today is give you a little bit of ICD-10-CM overview. I don't know each of you individually, and I don't know where you're at in your organization, but since ICD-10 legislation was drafted and then it's been delayed a few times, it's kind of hard to know where everyone is at with their knowledge, and so if this is a repeat of things you already know, please stay on the line, because there will be things that you'll get to take away as tips and tricks to move forward into the ICD-10 arena. So for all U.S. healthcare entities, we must implement ICD-10-CM on October 1, 2015. So what that means is any service that you render on or after October 1, 2015, you'll need to use the coding structure of ICD-10 rather than the current ICD-9 that we use today. And so when ICD-10 came about, it was part of the HIPAA Transaction Standards, and it's applicable to entities that submit electronic claims, but they also, as a covered entity, meet certain other requirements. So if you're not submitting electronic claims and you're not considered a covered entity under HIPAA, you're not required to follow the ICD-10 mandate. You could potentially be able to continue using ICD-9. By way of example, workers' compensation is not considered a HIPAA-covered entity, and therefore, some workers' compensation programs may not adopt ICD-10, and it's within their realm to say, no, I want all submissions to be in ICD-9 for diagnosis coding. So something to consider, depending on your individual organization, if you have any circumstances in which you treat hearing loss for workers' compensation beneficiaries. So to put things in perspective, October 1st may sound like it's a ways away, and we're barely into spring and summer, and October's not until winter and all those things, but if we put it in perspective, it really is only about five months' worth of time. But counting today, if we look at it from a working day perspective, with the holidays and weekends and whatnot, there are only about 90 working days to become prepared and do the things that you need to do to be compliant for October 1st. For those numbers folks like I am, that means we only have 720 working hours, and if anyone's on vacation or you're understaffed or you're on vacation as the owner, that limits your working hours in which to work on all the things that we'll talk about today to get prepared for ICD-10. So just some perspective, summer's a busy time for vacations and people to take time off, and so if you've appointed a staff member or you yourself are in charge of preparing for ICD-10, with time off and those kind of things, the time will run through very quickly and there's a lot to accomplish. So when we talk about the ICD-10 code structure and the need to have a designated person or persons in your organization to take charge of this, we're talking about it from many different perspectives. With the code structure increase, we're talking about laterality, we're talking about being able to still use some level of unspecified codes, we have some focused categories for hearing professionals, but what I don't want to happen is it to be misconstrued as overwhelming because I think it's very doable for all healthcare entities. We currently use about 14,000 diagnosis codes through ICD-9. The design of ICD-10 is to bring in more specificity and allow payers, providers, clinics, practices, federal and state agencies to collect more specific information. And so we have an additional roughly 54,000 codes, which makes roughly 70,000 codes in ICD-10 to select from. Putting that into perspective though is I don't want the code increase volume to scare anyone away because 70% of that increase was because we added laterality specific codes for paired extremities, paired organs, and when laterality is applicable. And so many people are talking in the industry that it's insurmountable, there's so many more codes, but the reality is we didn't create through ICD-10 54,000 more health conditions. What we did was added necessary specificity so that we could really use the data for data mining and other benefits when we can't get that in I-9 because I-9 is so antiquated and the code set is full. We can't add codes without disrupting the full code structure. So the increase should not scare anyone. If you live in a certain realm of coding conditions for I-9, it will be very similar to that in ICD-10. So by way of example and visual representation, this is what the ICD-10 code structure is going to look like. We still have our decimal point immediately following the third character. What's different in I-10 is that we have an alphanumeric code structure. And so our category will be represented in the first three characters. The fourth through sixth will be etiology, anatomic site, and severity. And then what we have is what we call a code extender. And that won't typically apply to hearing professionals. But in some circumstances, if there's an injury, you may get to where you will see that or need to code that depending on the information that you have at hand. So for the first character, it's always going to be alpha. For the second character, it will always be numeric. And then characters three through seven can be alpha or numeric. And so if you think about this from a manual process or a written process in your organization, most of your billers, coders, people who enter into your system are accustomed to using a 10-key because we're currently between CPT and ICD-9, we use numeric values so it's very easy to 10-key. But in the ICD-10 code structure, you're now going to be entering or writing alpha and numeric. And so we have to watch for zeros and O's being confused. It may slow down some productivity if you're used to keying 10-key and now you have to use both the alpha and numeric values. And so just something to think about as you're pondering how ICD-10 will impact your practice, both from a written standpoint but also from a data entry standpoint in making sure that you have thought through the representation of characters, your handwriting, who's keying for you and those kinds of things. To give you an example of what you'll see or what may fit in your realm as a hearing professional, I've given a couple of examples. So the first one we have is bilateral abnormal auditory perception. Our category obviously is H93 because that's represented in the first three characters before our decimal. The 293 represents our etiology, our severity, and our anatomic site. The same holds true for the second example I've given you, which are the disorders of bilateral acoustic nerve. What I want to bring to your attention or call to your attention is the 3 in the sixth position for both of these codes represents a bilateral condition. So as you will see going through the I-10 code structure, whenever there's a laterality specific code, left, right will always be representative of the same character. So 1 being left, 2 being right, 3 being bilateral. And so it will be very consistent as you work through your coding process. But I will caution you or give you something to consider. I have been teaching ICD-10 for about four to four and a half years now. And I have so many codes memorized in ICD-9 that sometimes I don't even have to pick up my book. What has happened with I-10, since they're alphanumeric, it's very, very difficult to memorize unless you have a photographic memory, which certainly I don't. So things to think about is how speedy you are because you've memorized certain diagnosis codes in I-9 and perhaps how much less speed and acuity you may have until you become very familiar with the I-10 codes. And perhaps you can memorize up to a certain point or a certain number of characters, but then you will have to use your resources to make sure that you're getting to the correct fourth, fifth, or sixth character as the case may be in I-10. So the good news for the hearing professionals is that most of the codes in Chapter 8 are only five characters. So when ICD-10 was introduced, they separated out into its own chapter, if you will, diseases of the ear and mastoid process, which we don't have that specific chapter in I-9. But what we found throughout Chapter 8 are there are no official guidelines for coding. There may be some coding notes. And most all of the codes are only five characters. The example I gave you before represents the six-character codes, but there are very, very few throughout the chapter. One of the things that I want you to hear today, and you'll hear me say it repeatedly over the next little bit, is that I want everyone to keep top of mind that there is discussion in the industry that payers may be able to deny or delay claim processing for lack of specificity. I'm not trying to scare anyone or give you false information, but payers have talked about this for years. And because hearing professionals don't always get the level of specificity that they need, it's something we're going to talk about when we get to the section regarding payers and reimbursement and how that might all turn out and potential areas that you can monitor to prevent that from happening. So to wrap up kind of our ICD-10 code structure overview, you know, this isn't coding class and so I don't want to get too detailed into that. I'd like to suffice it to say that think about these things and how it's going to impact your practice. They're going to be alphanumeric code structures. It can be up to seven characters in length for your ICD-10 specific code. Laterality is key for hearing professionals and many other specialties as well. And there may be points throughout using I-10 where you have to use a placeholder. And so there's got to be some level of training at your organization once you determine who's exposed and who uses I-9, then you can go forward and determine how much education and training needs to occur for those specific folks, including yourself and your organization, so that everyone has the information they need, but also that you can build a really solid team to help move you into an ICD-10 arena, which is going to happen very quickly for all of us. So let's talk about ICD-10 specifically for hearing professionals for a few minutes. So as I mentioned earlier, Chapter 8 is a new chapter in ICD-10 that is specific for diseases of the ear and mastoid process. And so most of the diagnosis codes that hearing professionals will use will come from Chapter 8, and there may be a few that are outside of that, but by and large, this is the section of I-9 that you live in, and so it will continue to be the grouped section or focus section, if you will, of I-10. One of the things that I do want to draw to your attention is that many hearing professionals do hearing tests, and so we use a V72.19 currently in ICD-9, and our V codes in I-9 will now translate to Z codes in I-10. So we have our Z01.10, which is an exam without abnormal findings, and then we have our exam code for a failed hearing screening. The important part is in I-10, we have some additional notes, and so we've gotten very specific that if you're providing an exam with abnormal findings, then there's instructional notes in ICD-10 that indicate we have to use an additional code to describe the abnormal findings. And so, this is one of those areas in which you really have to be knowledgeable in I-10 because if you submit a code similar to the Z01.118 for an exam with abnormal findings, but you don't add the additional code that describes the abnormal findings, this is one of those areas where payers will have every reason to deny or delay reimbursement and request additional information or perhaps may even deny for not medically necessary because it's missing that extra component of information that you may need to have. And the only way you'll know that is by becoming familiar with ICD-10 and the new instructional notes and the new rules and that type of thing. We are all aware that the FDA specifically allows for a patient to waive the requirement to see a physician before getting hearing aids. And a lot of times, there's a lack of specificity on the type of hearing loss, but there's good news to go along with that because in ICD-10, we still have a coding category, if you will, for unspecified hearing loss. And so, when we look at Category H91 in ICD-10, it's designed specifically or included in TIE-10 specifically for things like the FDA allowing that waiver and patients coming in on their own accord without a definitive diagnosis. And so, you'll be able to use these unspecified codes. Unspecified still requires that laterality component, though. So, again, I don't intend to beat up on payers. I just want practices to be aware and be informed that if you have a face-to-face encounter with an individual and you use an H91.90 as a hearing professional, which is unspecified ear, again, this is one of those areas where a payer might say, you had a face-to-face encounter with the patient and you can't tell me which ear has hearing loss. And so, they're going to question it. And while they may not deny payment forever, it's very likely that they could deny it for additional information and you would have to appeal their decision or send additional documentation to support either using a different diagnosis code, meaning identifying right, left, or bilateral, or you're going to have to send them your notes. And if your documentation isn't specific to right, left, or bilateral, the reality is they very well may deny that service as not medically necessary or lacking specificity that's required for adjudication. When you have a referral from a physician, we typically get more information. We get specificity, we identify the type of loss, the laterality, perhaps there are other medical diagnoses that go along with the hearing loss. And so, if you're not getting that information from your referral sources, you really want to reach out to them because they have to follow the same ICD-10 rules and instructions and notes that you all have to follow. And so, you want to reach out to them in the event that you're not currently getting that information and start that partnership in working with them to get more information on the referrals so that you're able to code and use that information to the highest specificity to prevent any delay in reimbursement for your services. I've mentioned reimbursement and payers a lot already, but the thing to remember for all intents and purposes is that your professional services will still be reimbursed based on your CPT and HCPCS codes. The importance of ICD-10 is to capture our diagnoses to the highest level of specificity, but it isn't going to be the driver of your fee structure. You'll continue to build your fee structure based on your CPT and HCPCS code. There will be times that I expect hearing professionals to use unspecified, but going forward with that, I really want you to think about when and where you could acquire more specific information, particularly from your referral sources, to prevent using those unspecifieds as impossible. Because I think as we move into the ICD-10 arena, it's going to take a period of time for the payers and the adjudication systems to catch up and really determine if unspecified should be denied or processed as submitted. So when we talk about submitting and gathering information for the services that you're rendering, I want to talk a little bit briefly about how to update your super bills or things to think about as you update your super bills or your charge slips, whatever you may call them in your organization. Most hearing professionals and the ones that we work with certainly still use the charge slips and the circling of the diagnoses or the X-boxes or whatever that process is. It's still somewhat manual and in paper format to capture all those professional services. And so think about some things that are going on or take a look at your current super bill or charge slip and how you might need to change that. Because in I-10, we're talking about longer characters or more characters in your code structure. We're transitioning from it being a unilateral condition to identifying right, left, or bilateral. Many of our CPT and HCPCS codes are required to have a right and left modifier because we've never had the specificity in I-9. But moving into I-10, it may not be required to use those CPT and HCPCS modifiers identifying right and left because that information will be captured in your diagnosis code in many circumstances. So one of the things you're going to want to watch for as you start working through this is if payers are issuing bulletins or guidance or information with regard to the need for the right and left modifiers on your professional service codes when it's already representative in your I-10 code. The other thing that you can do that will make this transition a more smooth process is you may want to run a list of your top 25 diagnoses. These are the ones that you use over and over. Maybe it's not 25, maybe it's your top 10, maybe it's your top 15, whatever that number is. And then use that as your guide to look up, validate, and verify your ICD-10 codes so that you know how or what to update your super bills or charge slips with. And so by way of visual example, I'm a very visual learner if you haven't figured that out by now. I've kind of given you a little stop and go information on the slide that should be in front of you. And it's just a brief super bill example. But what I really want to bring to your attention is looking through Category H90 or a brief synopsis of it. We have our bilateral conductive hearing loss, which is an H90.0. And I've labeled that green because green means you have a valid ICD-10 code. If you look right below that at H90.1, you see my red in the descriptor that says not valid, you need to get to a fifth digit. And so below that, you have your green again, which means go because we've gotten them to a level that is specific and valid for conductive hearing loss. And so we have our right as one being in the fifth character position. We have our left is a number two in the fifth position. And so we only have to get to four characters for unspecified or bilateral. However, it's going to be the same or a similar process as we move on to sensioneural hearing loss. We have our stop, which is red. You really probably don't need to put that on your Super Bill. Where it's green, those are the descriptors or information that you're going to want to build in. One of the things I would encourage you to do is make sure that when you're developing your Super Bill, remodeling it, recreating it, make sure that there is a way to call out the specificity of right or left or bilateral. Because since we're somewhat manual with Super Bills or fully manual, I would say, we have a tendency to circle or X or whatever that is with our ink. And so if you are circling or you're in a rush and you don't know your codes as well as you know your I-9 codes, we really want to make sure that we're circling right or left or bilateral as appropriate based on our documentation. And so if there is a way to update your charge slip or Super Bill using bold for that level of specificity or a color that really makes the right, left, laterality-specific terminology jump out, I think it will go a long way to helping in the process of keeping it clean and very accurate. So some other recommendations that might fit in with your Super Bill or charge slip is to only put on the ones that you use frequently. So reduce the clutter, I guess, is what I'm trying to encourage. Because ICD-10 is so much more specific, the codes are longer, the descriptors are longer, you really want to just put on your frequently used codes and then leave some space to write in the things that you see less frequently or conditions, signs and symptoms, additional other diagnostic information that may be relevant but not something that you would typically circle or choose on a routine basis. And then again, I'm going to mention to use only the valid code descriptors. I wouldn't encourage putting a great big header and then your right, left, and bilaterals below it because there can be some confusion and that may cause additional interruptions or running back to the provider asking, is this right or left because you circled an unspecified. And so any way that we can mitigate errors is always a good thing to do. And that's one of the things I have found with the paper Super Bill or charge slip is that when we get in a hurry, we think we're circling the right things sometimes and we end up with an unspecified. And to prevent that, I think you can use some bold or some color and only put on the descriptors that you really need on a day-to-day basis. So that's a lot of paper discussion. So what I want to talk about now are some ICD-10 preparations, but then also we'll move into a discussion about payer and reimbursement because that's always a hot topic of discussion when we have changes in the healthcare industry. So some ICD-10 preparations is really designed or the thought process is around keeping your revenue stream coming in. And so remembering that you're going to continue to be reimbursed based on your CPT and HCPCS, I don't think the concern should be that you're not going to get paid. It needs to be from the perspective of are the payers going to be able to process the claims with the new code set and are you ready to submit claims in the new code set? And so it really is driven around our technology and how we're using it in preparation as well as having the education and knowledge of ICD-10 and what it's going to mean for our individual organizations. When we talk about payers, it is still unknown if payers will all be required to test prior to implementation of I-10. And so right now the mandate is that they're able to accept and process I-10, but there's no mandate that says the payers have to test their systems prior to implementation of October 1, 2015. And so when we think about that from a revenue perspective, if they aren't ready, what's going to happen to our organization? And so even though the revenue may not stop because you have some payers that are ready and are testing, but you have others that aren't, what will happen in your organization from a business sense if your revenue is sporadic or delayed? And so the recommendation I have for all of you is to think about that. If you're submitting claims to payers, take time to identify your top five to ten payers and find out if they're testing. Nearly all payers of the larger venue have ICD-10 sections or segments on their website. And so you should be able to go to the payer website and access their ICD-10 readiness or their ICD-10 planning, their timelines and things like that for the larger payers. If you have some smaller payers in your area, it might have to be a phone call if they don't have a website where you can look at their links and find out what they're doing in preparation for the transition to ICD-10. So we've talked about revenue quite a bit, and I keep bringing up the evil R word, but the reality is most of us can't survive if we don't have our revenue coming in. And so the industry recommendation is that we, as organizations, have a cash reserve because ICD-10 may slow down or delay payment. And so for small to mid-size practices, a delay in revenue can cause a serious hardship. I'm in Wyoming, we're a very rural state, and many of the organizations, we couldn't survive with a delay in our revenue for 30 to, you know, 90 to 120 days. And so the industry has come out with various recommendations. Headscape is one that I've read an article recently about how much cash reserve they're recommending for practices to have at the time ICD-10 is implemented, and perhaps for up to 120 days until the payers get processing the claims in a timely fashion and you get a feel for what's going on. Some other things to think about throughout your organization is that you may have to increase some staff on the short-term or maybe even long-term to manage the request for additional information. And so if some of your payers aren't ready for I-10 and your claims are getting rejected or not processing, you may need someone on the inside to be working those accounts receivable sooner rather than later. And anything that's hitting that 30 or 45 day mark that's unpaid would require a lot of follow-up in determining why those things aren't processing through the system. You may need someone to review claims for additional accuracy, verifying your I-10 codes are correct and those kind of things. And then also keep in mind that there will be a period of time, unless you do not submit or code and you have a cash-only type practice, where you're working claims in both ICD-9 and ICD-10. And so whoever codes for your office, even if you do it yourself, you'll have to be knowledgeable and be very focused on the detail based on the date of service as to whether you're using I-9 or I-10, if it's a worker's comp, does that worker's compensation plan accept I-10 or do you have to code it in I-9, even if the date of service is beyond the ICD-10 implementation. And so just some things you really need to think through from a business perspective in how that's going to interrupt or possibly have an impact on your cash flow. So, key considerations regarding the payers. We've talked about will the payers be ready. There's no crystal ball that I'm aware of that will tell you if everyone's going to test. It's going to require some additional time and legwork to make that determination. Medicare fiscal intermediaries are currently testing. And so whichever region you're in, you're going to want to get with that fiscal intermediary and make some contacts, check with your state Medicaid agencies to determine if they're testing. Again, not all payers are required to test, so it's unknown without some work on your behalf to determine how quickly you can get to testing. And this isn't the only webinar that I've presented at. And imagine the rush for people to be preparing for ICD-10 if you haven't started already And the volume of phone calls or emails or support tickets that are going to be going in between now and implementation. And so my recommendation is the sooner you start, the sooner you get into the line so that you're testing sooner and you're acknowledging those payers and they're acknowledging that you are on top of this and want to make a smooth transition. For those of you who have organizations and practices that are cash only and where you don't bill insurance companies, that's okay. I think that's a beautiful thing if it works, but please consider that if you give the patient a super bill or a claim form to submit to their insurance company, it still has to be coded in I-10 or the patients won't get reimbursed. It'll get sent back to them. And so I completely understand the process of not submitting or not participating with insurance companies and leaving that responsibility to the beneficiaries. But remember, we have to be able to give them the information they need so that they can get reimbursed and do the legwork of working with their insurance companies. So in order to develop the best possible outcome, my recommendation is you should already be testing your ICD-10 claims. I know that UnitedHealthcare is testing, Aetna is testing, your Medicare's are testing, many of your Blue Cross, your Blue Shields are testing, Cigna, Great West, they've scheduled their testing and on their website they have a timeline and you can request to be a submitter of a test file. So things to be considering, but at this point with only five months to go, really everyone should already be in the queue, if you will, to be able to test for ICD-10. And so for those of you who are a little geeky like I am, I kind of dig the statistics. And so an article came out in Health Data Management about January 15th, January 18th. And it said, according to CMS, they have accepted an acceptance rate, they've accepted 81% of claims that were sent during a week-long ICD-10 end-to-end testing period. And so this happened in about mid-January and they disclosed that they had, excuse me, about 661 participants and there were approximately 15,000 claims submitted for this end-to-end testing phase. And so throughout this, they talk about how proud and pleased they are that they had an 81% pass rate on these claims. So essentially what that means is that there were about 2,800 claims rejected. About 13% of that 2,800 were not ICD-10-related rejections. But from perspective as a business owner, as a healthcare professional, as a healthcare entity, 19% rejection rate is still very significant. And so when you think about that from your organization's standpoint, I really want you to think about it from the perspective of, can I live without 20% of my revenue for an unknown period of time? That doesn't mean that it's going to be all of your claims, but if you have a significant payer in your area that's not prepared for ICD-10, that could be your 20% revenue delay. And it's unknown how long it will take them to work through their systems and develop ways or fixes if they're having problems accepting ICD-10 claims and processing them through the system. So 81%, yeah, okay, that sounds pretty good. But with only five months to go and CMS being the official push for ICD-10, 20% fail rate is pretty significant. On this slide, I want this to just be something that is a resource for all of you. This is the CMS Frequently Asked Questions and Talking Points for ICD-10. Even though it's been developed by CMS, it's hugely valuable in talking with your software vendors. It's very valuable in making sure that you've reviewed the steps and all of those components related to submitting electronic claims, updating your software system, testing, and those kind of things. So it's a really good resource to go to, whether you're small or large. It's really an important piece. The one piece, if you don't look at anything else, these references, please take a look at the role of a clearinghouse in ICD-10. One of the things that you may have already experienced or what you'll experience going forward is that you'll get people pointing the finger back and forth at one another saying, well, it's not me, it's your software vendor, it's not your software vendor, it's your clearinghouse. And you may have experienced this in some other fashion, but it's going to happen, unfortunately, if we're not prepared. And so please know that the role of your clearinghouse is just to be the mailman. And what I mean by that is the clearinghouse just accepts what you send it. It makes no modifications to your data. It makes no modifications to any of it. It's just a place that parses the information out to the right people. And so if you consider a letter that you've sealed and you've put in your mailbox, your mailman picks it up and delivers it to the next spot. He doesn't open it and refold it and reseal it. He's just the mailman. He picks it up and makes it go from one place to the next. And that's exactly what your clearinghouse does. And so when you start talking with your vendors and they say, well, the clearinghouse, this, that, or whatever, make sure you don't let that back and forth finger pointing go on and on. Because typically your relationship is with your software vendor and not with the clearinghouse. And the contractual relationship is typically between the vendor and the clearinghouse that they have elected to use. That's a big one when you get to the software piece and you start talking to your vendors about when they'll be ready to allow you the ICD-10 codes or being able to submit them. So work with your vendor. If you're using software, any type of electronics, any type of technology, you want to make sure that they're giving you formal documentation that either testing has occurred or they're ready to test. Put on their timeline so that they're able to create your test files and have your ICD-10 work plan in place so that you know you've tested, the claims have passed or failed, and you can start making any fixes. Or you can hop around the office and do the happy dance because you had no fails and all of your testing is completed and you're ready to go. Which would be a blessing and a wonderful thing for everyone. So we've covered a lot of information today. I want to do a quick recap before we close and we open it for ICD-10 questions or anything related to our presentation. So for a recap, remember that ICD-10 codes are required for all U.S. healthcare entities to be used by October 1, 2015. All of our codes are going to be alphanumeric in structure and have a much higher level of specificity. For hearing professionals, it's very particular to our laterality. Practices, staff, everyone's going to need some level of knowledge about ICD-10. And it's highly recommended that you're testing your ICD-10 claims before the implementation date so that you're not running the risk of a delay or a loss of revenue. Some other recommendations that I have for you is to look at all of your internal forms, documents, contracts, reports. Remember that if you give courtesy claims to your patients for insurance submittal, they'll have to be coded in ICD-10. And so it's really not going to go away, if you will. It's going to be very relevant. It's going to come up very quickly. And so the sooner you look at your internal processes and the things that need to change, the more you'll have a leg up, if you will, on making sure that things go very smoothly as we move into this new code structure. And then last but certainly not least, I want to encourage everyone to set your benchmarks. If you don't benchmark now, I'd encourage you to start working on some benchmarks, whether it's your days in accounts receivable, whether it's denial benchmarks, whether it's claims processing turnaround time. You need to measure now, because if you don't know where you're at now, you won't be able to know what changes have occurred after ICD-10 is implemented. And it'll be pretty difficult to backtrack if you don't know your current statistics to know if once October has passed and you've started submitting claims, if you're getting paid as timely and if your denial rates are the same. Excuse me. And so with that, what I'd like to do is turn it back to Suzanne and see if there are any questions I can answer for you regarding our presentation today. Thank you, Amy. We're so excited. We had over 300 attendees join us today on this webinar. One of the questions we have comes from Cheryl, and it says, where can we get a list of all of the ICD-10 codes? Cheryl, there are various publishers that issue ICD-10-CM books. They're still in draft format. And so you can get an ICD-10 book from most any publisher. Make sure that it's the CM, not the PCS. The PCS is the code structure for the inpatient hospital. You can purchase it in draft format. The final version of ICD-10-CM won't come out until October 1st, and it will be dated for 2016. But you'll use it from the go-live date for ICD-10 until the following October. Thank you, Amy. We have another question from Catherine, and it's asking, if an MD refers to an audiologist, not knowing which ear is affected nor the type of hearing loss, how can the MD code to help? Oh, great question. This is the age-old debate back and forth. Your MD should be able to give you a right or left at the very least. If you have to use an unspecified hearing loss code, I think that that's going to work itself through the system just fine. But I would query the referring doctor and ask for a laterality-specific referral. Thank you. We have another question from Cynthia, who's asking, is the number 3 used for bilaterally designation Y00 and H9 0.0 for conductive hearing loss bilateral? Because some codes don't require that we get out to that fifth and sixth character. We've tried to make it very consistent, and so there aren't right or left in that specific category. And unfortunately, I don't have my I-10 book open right in front of me. I would have to look at the book for more descriptors or definition on that. It's just that that's the only code for that particular category section. Thank you, Amy. We're getting some questions about what other resources or training are available for ICD-10. Oh, gosh. You know, I would encourage you all to look at your state medical societies, your state or local associations. Partner with IHS, of course, for additional training opportunities. For hearing professionals, you know, I wouldn't encourage you to have to sit through a three or a five-day boot camp for ICD-10, because you really use the same range, and it's a very small range of codes. So I would look for resources within your state or local areas, and then also perhaps reach out to IHS and see if they have some offerings that are specific for training just to kind of focus on the code set that hearing professionals would need. Thank you, Amy. I have another question from Kristen who asks, how do I perform testing repairs? Are you using electronic claims and do you submit direct or do you have your own software? She didn't specify. We did have a question from someone who does paper claims and was asking how this is going to affect them. I would tell you that, let me answer that twofold. If you're using your own software to submit claims, you need to get a hold of your software vendor to create test files once you know which payers you want to submit to. And so that's the first step. If you're submitting online and you're manually just keying in your claims directly to the payer, then you'll want to get on their testing timeline and schedule a time to test with those individual payers. If you're still submitting paper claims, I would tell you that there are many states currently, Wyoming included, that are moving to taking the position that Medicare has taken where they will not accept any paper claims once ICD-10 is in a go-live mode. And so if you're still submitting paper claims and the payers are accepting them, make sure you're using the updated CMS 1500 form and keep doing what you're doing, just making sure that your ICD-10 codes are on the new forms correctly. Thank you, Amy. I think we're going to take one final question, and just so everyone is aware, on the final slide, we are going to post Amy's email address if you have any questions that we can't get to during this presentation. And actually, she's showing us this slide now. The final question comes from Jessica, and that is, will there be new CPT and HCPCS codes? No. CPT and HCPCS are going to continue to update in January of every year. That part hasn't changed, and so if there are updates, it will be on the same schedule that we have now. Please note that CPT and HCPCS updates in January on an annual basis. ICD-9 and ICD-10 update October 1st annually. And so those parameters should not be changing, and there's no discussion that those would change at this point in time. Great. Well, thank you for answering all these questions, and thank you, Amy, for an excellent presentation. And thank you to everyone for joining us today on our webinar, How to Make a Smooth Transition to ICD-10. As shown on the slide, if you'd like to get in contact with Amy, you can email her at ahays.oabilling.com. For more information about receiving continuing education credit for this webinar, visit the IHS website at ihsinfo.org. Click on the webinar banner or find more information on the webinar tab under Professional Development. IHS members receive a substantial discount on IHS CE credit, so if you're not already an IHS member, you will find out more info at ihsinfo.org. Please keep an eye out for the feedback survey you'll receive tomorrow via email. We ask that you take a moment to answer a few brief questions about the quality of today's presentation. Thank you again for being with us today, and we will see you at the next IHS webinar.

webinar

ICD-10 transition

preparation

ICD-10 codes

laterality specificity

super bills

charge slips

testing ICD-10 claims

revenue impact