july/august 2013 preparing for icd-10 working with availity · it’s important that you begin...
TRANSCRIPT
ICD-1010.1.14
ARE YOUREADY?
JULY/AUGUST 2013
PREPARING FOR ICD-10Working with Availity
ALSO NEWS | EVENTS | TRAINING
FEEDBACK? EMAIL US AT [email protected]
A NEWS MAGAZINE FOR USERS OF THE AVAILITY WEB PORTAL
SPECIAL EDITION: PREPARING FOR
ICD-10
PREPARING FOR ICD-10 Working with AvailityOur goal is to help you process claims without disruption, so you can maintain a healthy, thriving organization.
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JULY/AUGUST 2013
01
PULSE
A NOTE FROM OUR CEO
QUESTIONS AND ANSWERS
ICD-10 INFORMATION FROM YOUR HEALTH PLANS
WHAT’S NEW
EVENTS
03
04
05
09
10
HEADLINES 07
SPOTLIGHT 1 1
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 1
With all the demands on your busy office, the last thing you want to worry about is your clearinghouse or practice management system’s readiness for ICD-10. Because the readiness of your business partners can affect your practice’s revenue stream—and many providers still need to update or replace software to achieve compliance—it’s important to know where Availity stands.
We are well-preparedAvaility is prepared to meet the Oct. 1, 2014 compliance deadline for ICD-10. Our goal is to help you process claims without disruption, so you can maintain a healthy, thriving organization.
We have completed all the necessary system upgrades, and we’re advocating for you when interacting with our vendor partners and health plans. But we won’t stop there. We’ve formed a dedicated ICD-10 leadership team to ensure a smooth and coordinated transition for you. We’re also participating in industry workgroups and initiatives so we can pass
that expertise on to you as well. And through the Availity Learning Center, you can get best-in-class ICD-10 training and education from industry leaders.
We will help you prepare, tooIt’s important that you begin preparing for ICD-10, if you haven’t already. While the Oct. 1, 2014 mandate deadline may seem far off today, several of the changes will take a lot of time to implement. Consider how much effort is required to establish a transition plan, develop
PREPARING FOR ICD-10Working with Availity
We have completed all the necessary system upgrades, and we’re advocating for you when interacting with our vendor partners and health plans.
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 2
an implementation budget and schedule, conduct transaction testing and train your staff in coding and documentation changes, among other things.
Contacting your practice management system is one task Availity recommends you do now, if you haven’t already. Your practice management system vendor can tell you whether its software supports ICD-10 claims, or when an update will be available that will allow you to submit ICD-10 claims.
Help is availableYou can expect that we will keep you informed of important industry updates, testing availability and guidelines, educational opportunities and more through our availity.com website. We’ll be adding a section for ICD-10 to our website in the coming weeks, and we’ll update it often. In addition, we’ll provide you with important information through Announcements in our Web Portal, email, newsletters and more.
Our ICD-10 Webinar Series is available to you and your peers through the Availity Learning Center, and many sessions are free. Recorded presentations of past sessions are available on-demand and live webinars are being added regularly. Be sure to check out our upcoming webinar “Five Things to Jump Start Your ICD-10 Transition.” This webinar is free, and is being offered on your choice of two dates: July 25 and Aug. 6 at noon (ET). Additional dates are being added, so be sure to check the Availity Learning Center for a current schedule of webinars.
— George Tellman, ICD-10 Program Manager, Availity
While the Oct. 1, 2014 mandate deadline may seem far off, several of the changes will take a lot of time to implement.
We’ve got you covered. Check out our FREE upcoming session, “Five Things to Jump Start your ICD-10 Transition” on July 25 or August 6.
Visit the Availity Learning Center for these and other on-demand and live webinars.
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 3
“Change Management” might not be the first thing that comes to mind when you think of Availity; however, it’s part of our commitment to help our customers maintain healthy businesses. And that means we have a role in helping you navigate changes in the health care system that can affect your business’ performance.
ICD-10 is one of those changes, and the Oct. 1, 2014 mandate deadline is approaching more quickly than it may seem.
Sometimes experience is the best teacher. Here are a few lessons we learned from our 5010 conversion that can help ensure a smooth and coordinated ICD-10 conversion:
Communication is keyDuring 5010, we saw that where there was confusion, there was a lack of communication. Early and regular communication with your staff, vendors and health plans is essential to developing a strategic plan for implementation.
If you’re not already talking with your system vendors about testing, we recommend you do so now. Find out if and when software updates will be available for your practice management system and when your health plans will be ready to test ICD-10 transactions with you. Then, check back at regular intervals to keep your implementation plan current.
Know your resourcesClearinghouses were many providers’ first-line support during 5010—identifying issues behind claim rejections and providing guidance on correcting claims—but clearinghouses won’t be able to provide that same level of guidance through ICD-10. While they can help, they can’t tell you which ICD-10 codes to use based on your clinical documentation.
In addition to working closely with your health plans and vendors, you may want to familiarize yourself with ICD-10 information available through the U.S. Centers for Medicare and Medicaid Services, professional associations and industry workgroups, such as the Workgroup for Electronic Data Interchange. And don’t forget free training options for you and
Managing change, from 5010 to ICD-10 and beyond
A NOTE FROM OUR CEO
your staff, such as the ICD-10 Webinar Series available through the Availity Learning Center.
What’s the point? It’s important to remember that there are substantial business improvement opportunities available to providers as a result of ICD-10, including more accurate claims and fewer denials/underpayments as the billing and reimbursement process becomes more efficient. Bringing it all togetherAdapting to change can be challenging, particularly when you are already facing accelerated regulatory requirements and financial burdens that detract from patient care. But whether its 5010, ICD-10, new Operating Rules or otherwise, the health care industry is taking important steps to advance the quality, efficiency and transparency of health care, and these changes benefit all health care stakeholders.
And as always, Availity is here as your trusted partner to help you succeed.
Thank you.
Russ Thomas
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 4
When is the ICD-10 compliance deadline?
The ICD-10 deadline is October 1, 2014.
Why is the switch to ICD-10 happening?
ICD-9 codes provide limited data about
patients’ medical conditions and hospital
inpatient procedures. ICD-9 is 30 years old, it has
outdated and obsolete terms, and is inconsistent with
current medical practices. Also, the structure of ICD-9
limits the number of new codes that can be created, and
many ICD-9 categories are full.
ICD-10 codes allow for greater specificity and exactness
in describing a patient’s diagnosis and in classifying
inpatient procedures. ICD-10 will accommodate newly
developed diagnoses and procedures, innovations in
technology and treatment, performance-based payment
systems and more accurate billing. The new codes will also
make the billing process more streamlined and efficient,
allowing for enhanced fraud detection.
What does ICD-10 compliance mean? ICD-10
compliance means that a HIPAA-covered entity
uses ICD-10 codes for health care services
provided on or after Oct. 1, 2014. ICD-9 diagnosis and
inpatient procedure codes cannot be used for services
provided on or after this date. All HIPAA-covered entities
must be compliant starting on Oct. 1, 2014.
Who is affected by the transition to ICD-10?
Everyone covered by HIPAA must use ICD-10
starting October 1, 2014. This includes health
care providers and payers who do not deal with Medicare
claims. Organizations that are not covered by HIPAA, but
use ICD-9 codes, should be aware that their coding may
become obsolete if they do not transition to ICD-10.
Will ICD-10 replace Current Procedural
Terminology (CPT) coding? No. The transition
to ICD-10 does not affect CPT coding for
outpatient procedures and physician services. Like ICD-
9 procedure codes, ICD-10-PCS codes are for hospital
inpatient procedures only.
What happens if I don’t switch to ICD-10?
Claims for all health care services and hospital
inpatient procedures performed on or after
Oct. 1, 2014 must use ICD-10 diagnosis and inpatient
procedure codes. Claims that do not use ICD-10 diagnosis
and inpatient procedure codes after the mandate deadline
cannot be processed. For services provided before Oct. 1,
2014, use ICD-9 codes.
Will I need to use both ICD-9 and ICD-
10 codes during the transition? Practice
management systems must be able to
accommodate both ICD-9 and ICD-10 codes until all
claims and other transactions for services before Oct.
1, 2014 have been processed and completed. Promptly
processing ICD-9 transactions as the transition date nears
will help limit disruptions and will limit the timeframe
when dual code sets need to be used.
If I transition early to ICD-10, will CMS be
able to process my claims? CMS and other
payers will not be able to process claims using
ICD-10 until the Oct. 1, 2014 compliance date. However,
organizations will need to work with their internal team and
with business trading partners to test their software systems.
This involves testing claims, eligibility verification, quality
reporting and other transactions and processes using ICD-10
to make sure the new code set can be processed correctly.
What steps can I take to ensure my practice
has a smooth transition to ICD-10? Have
a transition plan in place and make sure
it documents the steps being followed and the dates
that milestones will be achieved to comply with ICD-
10 requirements. Include vendor tasks in your plan and
timeline, and make sure to communicate with your
practice management system and/or electronic medical
record vendors regularly about ICD-10. Also, establish an
emergency fund to cover unexpected costs and possible
reimbursement delays.
01
QUESTIONS AND ANSWERSICD-10 transition information from the Centers for Medicare and Medicaid Services
Visit the CMS website for complete
FAQs on your ICD-10 transition
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 5
Recent industry surveys on provider ICD-10 planning
have indicated that many providers have not yet begun
preparations for ICD-10, possibly expecting another
delay in the compliance deadline. The Centers for
Medicare and Medicaid Services (CMS) continue to
affirm the Oct. 1, 2014 compliance deadline, and there
are no signs that it will be delayed.
Florida Blue recommends reaching out to your payers
now to discuss or schedule ICD-10 testing. Even if
your practice is not yet ready to begin testing ICD-10
transactions, letting your payers know you are interested
in testing can improve coordination and communication,
which are essential components of this transition.
CMS has more tips on testing with payers in its ICD-10
Handbook for Small and Medium Medical Practices:
• Identifycommunicationprocessestorecognizeand
correct issues early with your payers
• Developtestscenarioswithpayerstoconductend-
to-end testing, including payment results
• Communicatecodingpracticesandscenariosto
payers throughout the testing and transition process
• Usehigh-dollar,high-volume,high-riskscenariosas
test claims
Test with Florida Blue If you would like to test ICD-10 codes with Florida Blue,
send an email with contact information for your ICD-10
testing coordinator and a list of your system vendors to
ICD-10 INFORMATION FROM YOUR HEALTH PLANS
GETTING READY TO TEST WITH PAYERSA message from Florida Blue
To learn more about testing and
other important ICD-10 information,
join Florida Blue for complimentary
provider ICD-10 teleconferences,
“ICD-10 Open Line Friday.” Hosted
by a panel of providers, ICD-10
stakeholders and guests, these
teleconferences cover ICD-10 industry
news, ideas for addressing ICD-10
challenges, lessons learned, and other
related topics. This free event is held
every third Friday of the month from
9:30 to 10:30 a.m. (ET).
Join the conversation
Whether you’re in Florida or not,
you can access Florida Blue’s ICD-10
provider toolkit for more information
on preparing for ICD-10. Just go to
www.floridablue.com/ICD-10.
Get prepared
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 6
TIPS FOR IMPLEMENTING ICD-10 A message from Humana
Implementing ICD-10 will take planning, coordination,
communication and a variety of resources. You can
help ensure a smooth implementation by planning
for these things now. CMS recommends the following
steps to facilitate a successful transition:
• SeekresourcesforICD-10transition.TheCenters
for Medicare & Medicaid Services (CMS) and
professional and membership organizations
have information to guide you through ICD-10
implementation.
• EstablishanICD-10projectteam.Thisteam
will be responsible for overseeing the ICD-10
transition, and will vary based on the size of your
organization. Larger practices should have a team
with representatives from different departments
(e.g., executive leadership, physicians and
information technology). Smaller practices may
only have one or two individuals responsible for
helping the practice transition.
• DevelopanICD-10communicationandawareness
plan. This plan will map out how your organization
will communicate with internal staff and external
partners about ICD-10 throughout the transition.
• Revisitandreviseyour
implementation timeline. Your
timeline for ICD-10 implementation
activities should be updated on a
regular basis.
• Shareyourimplementationplans
and timelines. Discuss the ICD-10
compliance deadline and share your
implementation plans and timelines
with internal staff and external
partners to coordinate transition
activities.
Refer to the CMS ICD-10 planning
checklist for more information or visit
Humana’s Provider Portal.
Discuss the ICD-10 compliance deadline and share your implementation plans and timelines with internal staff and external partners to coordinate transition activities.
ICD-10 INFORMATION FROM YOUR HEALTH PLANS
SPECIAL EDITION: PREPARING FOR
ICD-10
Availity Pulse July/August 7
HEADLINES
VALUE-BASED PAYMENT MODELS EXPECTED TO REACH TIPPING POINTImplementing real-time information exchange with providers will be key
A majority of health plans—nearly 60 percent—project that more than half of their business will be supported by value-based payment models in the next five years, according to a new research study from Availity.
The study, “Health Plan Readiness to Operationalize New Payment Models,” assesses commercial health plans and their progress as they expand from fee-for-service to value-based models of physician compensation.
The findings indicate health plans are taking emerging payment models seriously—models such as accountable care organizations and pay-for-performance. In fact, 82 percent of respondents said they consider payment reform a “major priority” at their respective organizations and are adapting their businesses accordingly.
But health plans also realize they can’t go it alone. Importantly, the study highlights the consensus among plans that information sharing with physicians must be automated—primarily in real-time—for these models to achieve success. And that means significant changes in how and what information is exchanged need to occur quickly.
Transitioning to payment models that base compensation on outcomes will require physicians and health plans to exchange new kinds of information—different than what is required under today’s largely fee-for-service arrangements. Although less than
half of the health plans have real-time capabilities, 85 percent say the highest value will come from real-time exchange.
“The physician revenue cycle is changing and the data collected in this study gives us guidance on how quickly that may happen,” said Russ Thomas, CEO of Availity. “We’re seeing the shift begin; we’re excited about the future and the contributions we are making to ensure the health of our customers’ businesses.”
The study further details the lines of business targeted for new payment models, payment model maturity, and expectations for growth over the next 18 months. To download a copy of the study, click here.
— Brian Kagel, Director of Research, Availity
82 percent of respondents said they consider payment reform a “major priority” at their respective organizations and are adapting their businesses accordingly
Download the study
Availity Pulse July/August 8
HEADLINES
Availity has named Paul B. Kusserow as the next chairman of Availity’s Board of Managers. Kusserow, the senior vice president, chief strategy, innovation and corporate development officer for Humana Inc., succeeds Joe Grantham, who has been Availity’s Chairman since 2004.
“I’m delighted to take on this role working alongside a great group of incredibly talented people, on the Board and on Availity’s management team, who are all committed to Availity’s continued great success,” Kusserow said.
KUSSEROW NAMED AVAILITY BOARD CHAIR
GET THE VITAL SIGNS OF A HEALTHY BUSINESS
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As senior vice president, chief strategy, innovation and corporate development officer, Kusserow has responsibility for Humana’s strategic planning, corporate development, merger and acquisition, innovation, and venture-capital activities. He reports directly to the president and CEO and is a member of the executive team, which sets the strategic direction for the company.
Availity Pulse July/August 9
WHAT’S NEW
New and helpful changes to the Availity Web Portal
• We’veaddedanewcheckboxfornon-specific procedure code description on Humana claims.
• WhenaddingaproviderusingtheManage Providers feature, the Manage Providers page now displays a Billing Address Same As Physical Address check box.
• We’veaddedanExpress Entry—Address field to forms on the Web Portal.
• AnewlookfortheWebPortal—checkitout!
• AvailityResources has moved to Knowledge Base, and retired the former Resources page.
For more information, review the What’s New and Changed help menu topic.
May Release Notes
June Release Notes
Empire BlueCross BlueShield now available The Web Portal now offers Empire BlueCross BlueShield providers real-time, single sign-on access to the following functionality:
• Eligibilityandbenefits—submitrealtime requests and receive instant responses
• Webclaimsubmissions—instantlysubmit real-time or batch claims
• Claimstatusinquiries—checkclaim status details and payment information
Not all functionality is applicable to all areas of New York. Check with Empire to determine what’s available in your area.
Availity Pulse July/August 10
EVENTS
July 24 Breezy Point, Minn.
Aug. 7 Indianapolis, Ind.
Aug. 22 Washington, D.C.
Aug. 23Nashville, Tenn.
Aug. 28Myrtle Beach, S.C.
Sept. 5 Austin, Texas
Sept. 8Asheville, N.C.
Sept. 10Carmel, Ind.
Sept. 11Coeur d’Alene, Ida.
Sept. 13Minneapolis, Minn.
Sept. 15Hershey, Penn.
Sept. 18Las Vegas, Nev.
Sept. 18Delray Beach, Fla.
Sept. 20St. Louis, Mo.
Sept. 22Williamsburg, Va.
Sept. 24Lombard, Ill.
Sept. 26Atlanta, Ga.
Sept. 28Linthicum, Md.
Minnesota Medical Group Management Association Summer Conference
Indiana Rural HealthAssociation
Greenway—PrimeLeader User Group Meeting
Code Right and Run Better Business Systems, presented by the American Academy of Orthopaedic Surgeons and Karen Zupko & Associates Inc.
South Carolina Medical Group Management Association’s Annual Conference
Texas Medical Group Management Association’s Fall Conference
North Carolina Healthcare Information and Communications Alliance Annual Conference & Exhibition
Indiana Medical Group Management Association’s Fall Conference
Idaho Medical Group Management Association’s Annual Conference
Code Right and Run Better Business Systems, presented by the American Academy of Orthopaedic Surgeons and Karen Zupko & Associates Inc.
National Plan Automation Group’s 2013 Conference
Healthcare Billing and Management Association’s Fall Conference
Healthcare Financial Management Association - Florida Chapter’s 2013 Fall Annual Conference
Kathy Mills Chang’s KMC University
Virginia Medical Group Management Association’s Fall Conference
Illinois Hospital Association’s Leadership Summit
Georgia Healthcare Trade Faire and Regional Conference
Maryland Medical Group Management Association State Conference
From workshops to webinars to trade shows, we’re coming to a city near you.
Availity Pulse July/August 11
IN THE SPOTLIGHT
Get up-to-the minute education from industry expertsThrough webinars in the Availity Learning Center, you can get the latest news on the ICD-10 mandate, tips to help you transition, information about working with health plans and vendors, and more. The ICD-10 Webinar Series brings you industry leaders to deliver your essential ICD-10 information at little or no cost.
Be sure to check out our upcoming webinar “Five Things to Jump Start Your ICD-10 Transition.” This webinar is free, and is being offered on July 25 and Aug. 6 at noon (ET). Additional dates for this webinar and new webinars are being added regularly, so be sure to check the Availity Learning Center for a current schedule of webinars.
About “Five Things to Jump Start Your ICD-10 Transition”In this FREE one-hour webinar, we’ll explore the five most critical things you need to do to prepare your organization for ICD-10. From creating an implementation team to conducting an impact assessment, you will learn about tools to help you begin your ICD-10 planning right away.
THE ICD-10 WEBINAR SERIES: NEW ADDITIONS
You’ll learn how to: • Identifynewdocumentationelements• TranslateyourtopICD-9codesto
ICD-10 codes • Performsimplechartreviews• Conductathoroughimpactassessment
Join Denny Flint, President and CEO of Complete Practice Resources, for tips on getting started and receive continuing education units (CEUs) from the American Academy of Professional Coders.