icd-10: a payer update with aetna & united health group

900-3571-0213

Open Line Friday: ICD-10 Edition

ICD-10: A Payer Update with

Aetna & United Health Group

Nov. 21, 2014

9:30 a.m. – 10:30 a.m. EST

Dial Toll-Free: (800) 882-3610 or (412) 380-2000

Conference Passcode: 6829655#

900-518-1104

Open Line Friday: ICD-10

Panelists*

Deborah Stewart, MD Medical Director

Florida Blue

Gale Scott EDI Regulatory Compliance

Administrator Tampa General Hospital

Laurie Darst Revenue Cycle Regulatory Advisor

Mayo Clinic (MN)

Matthew Ketterman Director, Business Solutions

Availity®1

Jackie Griffin VP, U.S. Operations

Secure EDI

Lee Ratliff Clinical Business Technology Consultant

Baptist Health South Florida

Mary Rita Hyland RN, BS, MBA, CHP

Healthcare Industry Consultant Diana Brijbag

CMM, CPC, CCP, CMSCS, HITCM-PP Office Manager

The Springs Family Medical Center

George Vancore Senior Manager, Delivery Systems

Mandates and Compliance Florida Blue

*Panelists are subject to availability.

1 Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit www.availity.com

2

Joseph Nichols, MD Principal,

Health Data Consulting

Special Guests for Nov. 21, 2014:

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Note: Practitioner guests are subject to unforeseen clinical or other emergencies. Should our guest(s) lack availability at the time of our program, Florida Blue will attempt to reschedule guest(s) for a future session.

Brian Parkany

Senior Director

Strategic Initiatives

Shirley Reynolds

Senior Product Manger



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ICD-10: A Payer Update with Aetna & United Health Group

Agenda for Nov. 21, 2014

1. Objectives

2. Healthcare Industry Regulatory Update

3. Brian Parkany, Aetna

4. Shirley Reynolds, United Health Group

5. Next Steps

Follow us on Twitter @FLBlue

Objectives

1. Promote collaboration, communication and coordination between providers, payers

and electronic trading partners.

2. Expand your understanding of the current state of ICD-10, recent regulatory

decisions and industry perspectives.

3. Raise your awareness and understanding of the unique opportunities and challenges

that ICD-10 brings to the entire health care industry including providers, payers and

electronic trading partners.

4. Provide you with tools, techniques, best practices and helpful hints from your peers

that can be used as you continue (or begin) your ICD-10 journey.

**** Please remember that during the call all attendees will be placed on “mute”

except for any guest speakers and all panelists. If you have a question, please

email it to [email protected].

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mailto:[email protected]


Health Care Industry & Regulatory Update

• Medicare announced two rounds of ICD-10 testing with physicians/provider: • Functional Acknowledgement Testing: this is where you test the “chain of trust” partners from the

provider to the payer (Medicare) using an ICD-10 coded claim; Medicare will edit and compliance check the

claim and return a response to the sender; there is no claim adjudication or ERA is being generated during this

round of testing; test claims can be sent to Medicare anytime up to the October 1, 2015 implementation date;

• Special Functional Acknowledgement Testing Weeks: Medicare submitters will have access to

real-time help desk support during the weeks of November 17th through the 21st, 2014; March 2nd through the

6th, 2015 and June 1st through the 5th, 2015.

• End-to-end testing: this is where ICD-10 coded claims are sent to the Medicare (the payer), adjudicated

and an ERA is generated back to the provide; participation in Medicare’s end-to-end testing requires enrollment

and selection by your MAC; on a national basis, Medicare is limiting the number of testing providers to 2550.

• For additional details, please see the following:

• http://medicare.fcso.com/ICD-10/267332.pdf

• www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/SE1409.pdf

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/MM8858.pdf

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http://medicare.fcso.com/ICD-10/267332.pdf



http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1409.pdf











http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8858.pdf













Health Care Industry & Regulatory Update (cont’d)

• NUCC changed the CMS 1500 professional paper claim form to accommodate ICD-10

(see www.nucc.org); the transition to this new form began in January 2014 and continues

across the health care industry.

• Partial code freeze continues until one year after the implementation of ICD-10: • Only codes for new diagnosis or new technologies will be considered for exception inclusion.

• Last regular updates to ICD-9-CM and ICD-10 occurred on October 1, 2011.

• Regular ICD-10 updates will begin on October 1, 2016.

• Miscellaneous health care industry and regulatory updates will be provided from our

panelists when applicable and when time permits.

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http://www.nucc.org/

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Visit www.floridablue.com/icd-10 and select the Test ICD-10 Icon:

ICD-10 Provider Testing

Testing ICD-10 is one of the more critical success factors in achieving ICD-10 compliance and managing your revenue interruption risk. Florida Blue is recommending ICD-10 provider testing in the three phases below. Links to testing instructions and other important details are available below for initiating testing with us. Questions? Email us at [email protected].

Testing Results may be accessed following Phase III Instructions below.

ICD-10 Testing Phase

Start Date(s)

Instructions for Test Phase

Phase I

“Code Validation”

Now

Phase I testing (click here for overview) involves coding a selection of clinical diagnosis scenarios developed by Florida Blue Nurse Coders. You can print out the scenarios for your staff to code in both ICD-9 and ICD-10 for you to compare. This is a manual process and is

available for you on a self-service basis. Clinical Scenarios are

available in the instructions below.

Phase I Instructions: (click here)


Start Date(s)


Phase II

“Internal End-to-End”

Now

Phase II testing (click here for overview) consists of electronic receipt and internal processing of ICD-10 coded claims transactions that were previously processed by Florida Blue with ICD-9 codes. The instructions contain contact information for a Florida Blue ICD-10 testing coordinator in order to initiate Phase II testing

Phase II Instructions: Providers (click here)

Vendors (click here)


Start Date(s)


Phase III

“Round-Trip”

Now

Phase III testing (click here for overview) pertains to the “Round-trip” processing of ICD-10 coded electronic claim and remittance advice transactions. Phase II testing is a prerequisite.

(click here)

Phase III Instructions:

Providers (click here)

Vendors (click here)


A Florida Blue Update

http://www.floridablue.com/icd-10 and select Test ICD-10



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ICD-10: A Payer Update with Aetna

Brian Parkany

Senior Director, Strategic Initiatives


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ICD-10: A Payer Update with United Health Group

Shirley Reynolds

Senior Project Manager


.

Send ICD-10 questions, comments or feedback to

[email protected].

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ICD-10

The most effective

way to do it,

is to do it! – Amelia Earhart

Next Steps Next Steps

Build your ICD-10 action plan now with the CMS “Road to 10” tool. Visit www.roadto10.org

Access our Open Line Friday podcasts at www.floridablue.com/icd-10

ICD-10 Open Line Friday email list: send us your email by contacting us at

[email protected]

Test ICD-10 with us. Visit www.floridablue.com/icd-10 and select our “Test ICD-10 icon”

for details. Testing questions? Email us at [email protected]

Access Florida Blue’s ICD-10 Provider Toolkit and more at www.floridablue.com/ICD-10

Visit the Availity Learning Center (www.availity.com/learningcenter) to access live and webinars

including information about Ready10 - a popular ICD-10 project management tool (see “There’s

Ready and There’s Ready10”).

Add, update or delete your email and contact information at any time using Availity's secure website. Log

on to Availity at www.availity.com, select Payer Resources, Florida Blue and Update My Email

Information with Florida Blue then follow the prompts.

Follow us on Twitter @FLBlue 13


http://www.roadto10.org/

http://www.floridablue.com/icd-10











http://www.floridablue.com/ICD-10



http://www.availity.com/learningcenter

http://www.availity.com/

Addendum

ICD-10 Helpful Resources and Reference Material

• www.cms.gov/ICD10

• www.wedi.org

• www.ama-assn.org

• www.ahima.org/icd10

• www.availity.com

• www.fha.org

• www.hbma.com

• www.mgma.com

• www.floridablue.com/ICD-10

• www.fmaonline.org/HomePage.aspx

• www.cdc.gov/nchs/icd/icd10.htm

• www.AAPC.com

For regular CMS ICD-10 email updates, subscribe at:

https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608

WEDI's 2014 Survey on Industry ICD-10 Readiness:

http://www.wedi.org/news/press-releases/2014/08/04/WEDI-Releases-ICD10-Readiness-Survey

Though not inclusive, the following list includes several public websites that can help increase general awareness

and understanding of the ICD-10 mandate and its impact to the health care industry:

The links below were referenced during this presentation. The actual URLs below are provided for your convenience:

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http://www.cms.gov/ICD10

http://www.wedi.org/

http://www.ama-assn.org/



http://www.ahima.org/icd10

http://www.availity.com/

http://www.fha.org/

http://www.hbma.com/

http://www.mgma.com/




http://www.fmaonline.org/HomePage.aspx

http://www.cdc.gov/nchs/icd/icd10.htm

http://www.aapc.org/

https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608











