january 2015 icd-10 open line friday
TRANSCRIPT
900-3571-0213
Open Line Friday: ICD-10 Edition
The Cost of ICD-10 Implementation:
Testimonials
Jan. 16, 20159:30 a.m. – 10:30 a.m. EST
Dial Toll-Free: (800) 882-3610 or (412) 380-2000
Conference Passcode: 6829655#
900-733-0115
Open Line Friday
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 ConsultantDiana Brijbag
CMM, CPC, CCP, CMSCS, HITCM-PP Office Manager
The Springs Family Medical Center
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
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Joseph Nichols, MDPrincipal,
Health Data Consulting
Speakers
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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.
Open Line Friday
Stanley NachimsonPrincipal
Nachimson Advisors, LLC
Lori FergusonBilling Manager
Harbor Oaks Eye Associates
Open Line Friday Panelists
Lori Ann Martell, LPN, CMP, Practice Administrator
Advance Medical of Naples, LLC
Open Line Friday
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Agenda
1. Objectives
2. Healthcare Industry Regulatory Update
3. The Cost of ICD-10 Implementation: Testimonials
4. 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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Open Line Friday
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.pdf6
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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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)
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
A Florida Blue Update
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Send ICD-10 questions, comments or feedback to
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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.
Follow us on Twitter @FLBlue11
Open Line Friday: ICD-10
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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Open Line Friday: ICD-10