icd-10 open line friday 9/18/2014 - payer update
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900-3571-0213
Open Line Friday: ICD-10 Edition
Navigating to ICD-10:
A Payer Update with
Humana & Florida Blue
September 19, 2014
9:30 a.m. – 10:30 a.m. EST
Dial Toll-Free: (800) 882-3610 or (412) 380-2000
Conference Passcode: 6829655#
900-4699-0914
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
Joseph Gonzalez VP of Business Development
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
1 Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit www.availity.com
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Open Line Friday: ICD-10
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Navigating to ICD-10: A Payer Update With
Humana & Florida Blue
Agenda
Sept. 19, 2014
1. Objectives
2. Healthcare Industry Updates
3. Humana & Florida Blue Updates
4. Next Steps
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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Open Line Friday: ICD-10
Open Line Friday: ICD-10
Health Care Industry & Regulatory Update
• Medicare recently 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; there will be ONLY three opportunities to
do this type of testing with Medicare (Nov 17 through 21, 2014; Mar 2 through 6, 2015 and June
1 through 5, 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 provider.
• 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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Open Line Friday: ICD-10
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 and 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.
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Open Line Friday: ICD-10
Please refer to our guest speaker’s program material if available which can be accessed at
www.floridablue.com/ICD-10 under Open-Line Friday located in right margin.
Navigating to ICD-10:
A Florida Blue Update
The Current State of ICD-10: A Florida Blue Update
George Vancore
Florida Blue
ICD-10 Open-Line Friday
September 19, 2014
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Session Objectives
1. Increase your awareness and understanding of the current state
of ICD-10 from an internal and external perspective.
2. To provide an update on Florida Blue’s ICD-10 strategies and going-forward approach given the one-year delay.
The Current State of ICD-10 A Florida Blue Update
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Background
• On April 1, 2014, Congress passed and the President signed into law H.R. 4302.
Section 212 of this bill states as follows:
“Sec. 212. DELAY IN TRANSITION FROM ICD-9 TO ICD-10 CODE SETS.
The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10
code sets as the standard for code sets under section 1173(c) of the Social Security Act (42
U.S.C. 1320d-2(c)) and section 162.1002 of title 45, Code of Federal Regulations”.
• A few days after the enactment of H.R. 4302, CMS issued the following statement:
“On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93)
was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015.
Accordingly, the U.S. Department of Health and Human Services expects to release an
interim final rule in the near future that will include a new compliance date that would
require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA
covered entities to continue to use ICD-9-CM through September 30, 2015.
The Current State of ICD-10 A Florida Blue Update
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Current State of ICD-10: the Health Care Industry
• Health care industry reaction to the delay ranged from shock to anger to relief with
most constituents eventually landing on acceptance.
• The implications of changing (again) the ICD-10 implementation date through the
“legislative process” varied across the health care industry; some of these are: • High levels of frustration centered on the fact that this is the 4th time that the ICD-10 implementation
date has changed.
• Measurable loss of stakeholder momentum across the industry (I.e. Medicare end-to-end testing; code
set freeze).
• A serious loss of federal regulatory credibility going forward.
• This delay required covered entities, electronic trading partners and others to re-assess and re-plan
their ICD-10 efforts including the re-prioritization of compliance related initiatives, re-allocation of
resources and 2014/2015 initiative funding.
• Several going forward ICD-10 implementation strategies have surfaced throughout
the health care industry; some of these are: • Transition to ICD-10 when it “impacts physician and provider reimbursement”.
• Postpone engagement until “sometime in 2015”.
• Continue limited engagement with reduced funding, re-prioritization and re-deployment of resources.
• Continue on plan with a focus on testing and collaboration.
The Current State of ICD-10 A Florida Blue Update
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Current State of ICD-10: Florida Blue
• As a result of the delay, Florida Blue re-assessed and re-planned its ICD-10
implementation strategies and tactics and has declared the following: • Migrate ICD-10 enabled and dual-use (to handle claims run-out) capable internal business system
capabilities to a production and maintenance status.
• Continue testing with external 3rd parties, vendors, delegated entities and business associates; attain
ICD-10 attestations when and where applicable.
• Continue with Florida Blue’s physician and provider outreach and engagement initiatives:
• ICD-10 Open-Line Friday monthly teleconferences
• presentations and panel discussions at medical associations and societies
• author and publish ICD-10 “articles of interest” to industry trade journals and to medical
associations and societies newsletters
• utilize social media as a communication and outreach channel
• Continue with our three-phased physician and provider end-to-end testing initiative.
• Continue with the development of physician and provider “business continuity” and “business
disruption” mitigation strategies, tactics and plans.
• Continue claims modeling and financial risk assessments.
• Operational Readiness and training of front-line staff have been postponed until 2nd quarter of 2015.
The Current State of ICD-10 A Florida Blue Update
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Open Line Friday: ICD-10
Please refer to our guest speaker’s program material if available which can be accessed at
www.floridablue.com/ICD-10 under Open-Line Friday located in right margin.
Navigating to ICD-10:
A Humana Update
http://www.bcbsfl.com/DocumentLibrary/Providers/Content/SidHerbertPres.pdf
.
Send ICD-10 questions, comments or feedback to
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Open Line Friday: ICD-10
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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
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.
Open Line Friday: ICD-10
Follow us on Twitter @FLBlue 16
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 Survey on Industry ICD-10 progress:
http://www.wedi.org/docs/comment-letters/2013-wedi-icd-10-survey-results-letter.pdf?sfvrsn=0
FREE CMS and WEDI ICD-10 End-to-End Testing Webinars available for download:
http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=220AC00000156
HIMSS/WEDI National ICD-10 Pilot Program Update:
http://www.himss.org/library/icd-10/national-pilot-program?navItemNumber=13477
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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Open Line Friday: ICD-10