900-3571-0213

Open Line Friday: ICD-10 Edition

The Current State of ICD-10 WEDI Survey Results & Small

Practice/Physician UpdateFeaturing Nachimson Advisors LLC & AthenaHealth

Oct. 17, 20149:30 a.m. – 10:30 a.m. EST

Dial Toll-Free: (800) 882-3610 or (412) 380-2000 Conference Passcode: 6829655#

900-4749-1014

Open Line Friday: ICD-10

Panelists*

Deborah Stewart, MDMedical Director

Florida Blue

Gale ScottEDI Regulatory Compliance

AdministratorTampa General Hospital

Laurie DarstRevenue Cycle Regulatory Advisor

Mayo Clinic (MN)

Matthew KettermanDirector, Business Solutions

Availity®1

Jackie GriffinVP, U.S. Operations

Secure EDI

Lee RatliffClinical Business Technology Consultant

Baptist Health South Florida

Mary Rita HylandRN, BS, MBA, CHP

Healthcare Industry Consultant

Diana BrijbagCMM, CPC, CCP, CMSCS, HITCM-PP

Office Manager Springs Family Physicians, LLC

George VancoreSenior Manager, Delivery Systems

Mandates and ComplianceFlorida 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, MDPrincipal,

Health Data Consulting

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Open Line Friday: ICD-10Oct. 17, 2014

Special Guests

Michael Palatoni

Senior Product Innovation Manger

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.

Nachimson Advisors, LLCMaking Health Care Information Technology Work for YOU!

Stanley NachimsonPrincipal

Open Line Friday: ICD-10

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Oct. 17, 2014

Agenda

1. Objectives

2. Healthcare Industry Regulatory Updates

3. Stanley Nachimson: WEDI Survey Results

4. Michael Palantoni: AthenaHealth small practice &

physician update

5. Next Steps

Objectives1. 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 FloridaBlueOpenLineFriday@FloridaBlue.com.

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Open Line Friday: ICD-10Oct. 17, 2014

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Open Line Friday: ICD-10

at www.floridablue.com/icd-10

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 ICD-10Testing@floridablue.com.

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)

ICD-10 Testing Phase

Start Date(s)

Instructions for Test Phase

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)

ICD-10 Testing Phase

Start Date(s)

Instructions for Test Phase

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)

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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Health Care Industry & Regulatory Update (Cont’d)

• 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.

Open Line Friday: ICD-10

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Health Care Industry & Regulatory Update (Cont’d)• 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 4 th 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.

Open Line Friday: ICD-10

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Health Care Industry & Regulatory Update (Cont’d)

• 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.

Open Line Friday: ICD-10

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Open Line Friday: ICD-10

Oct. 17, 2014

WEDI’s Latest Survey Resultswith Stanley Nachimson

Nachimson Advisors, LLCMaking Health Care Information Technology Work for YOU!

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Open Line Friday: ICD-10

Oct. 17, 2014

AthenaHealth’sSmall Practice & Physician Update

Michael Palantoni

.

Send ICD-10 questions, comments or feedback to

floridablueopenlinefriday@floridablue.com.

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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

floridablueopenlinefriday@floridablue.com

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 ICD-10Testing@floridablue.com

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 @FLBlue16

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