What s Up Wednesday. Together Let s Get ICD-10 Ready. Date: July 15, 2015 Time: 2 3 p.m. Phone Number: Pass code:

Transcription

1 What s Up Wednesday Together Let s Get ICD-10 Ready Date: July 15, 2015 Time: 2 3 p.m. Phone Number: Pass code: Presented by the Pennsylvania Blues Plans

2 2 What s Up Wednesday and ICD-10 Increase Collaboration, communication, education and coordination between hospitals, physicians, payers and vendors Expand Understanding of the current state of ICD-10, recent regulatory decisions and industry perspectives Raise Awareness and understanding of the unique challenges that ICD-10 brings to the entire health care industry Provide Tools, techniques, best practices, and helpful hints that can be used to support ICD-10 implementation Please remember that during the call all attendees are on mute except for any guest speakers and panelists. Please any questions you would like addressed during or after the call to ICD10ProviderCommunication@capbluecross.com.

3 3 Today s ICD-10 Agenda CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 Todd Askew, AMA, Director, Congressional Affairs Pennsylvania Blue s Plans Testing Update Deb Cotter, Highmark Kevin Quaglia, Blue Cross of Northeastern PA Janessa Smith, Independence Blue Cross Lisa McNaughton, Capital BlueCross

4 ICD-10 Highmark Internal Testing October of 2010 to the present: Iterative Functional Testing in execution mode October of 2013 to the present: Neutrality Testing with a focus on payment, benefit, medical policy, clinical, and operational impact External Testing Clinical Coding Testing: Comparison of ICD-9 to ICD-10 code sets End-to-End Testing: Actual Path validation and ICD-10 code set behavior review Provider and Clearinghouse work stream

5 Highmark Clinical Coding Testing: Available to all Network Providers through December of 2015 Web based tool that contains 2,700 medical scenarios Allows coders to practice ICD-10 coding scenarios, identify potential training needs, and to benchmark against national vendor supplied scenarios. Clinical Coding Participants represent a variety of professional providers and facilities in DE, PA, and WV Trends thus far (more to be shared via the Provider Resource Center) Close attention should be paid to the following areas when coding diagnoses in ICD-10: Laterality Cardiology Maternity fetus selection

6 Highmark End-to-End Testing Validates the Process Providers submit 837 X12 claim to process through adjudication Providers receive following transactions: 999 Acknowledgement, 277ca Acknowledgement and 835 Payment Remittance and Advice. Compares claims submitted in ICD-9 and ICD-10 to determine any outcome variances. Participation is limited and includes representation from a multitude of health care settings. Multi-Specialty Hospitals,, Children s Hospitals, Physicians/Clinics, Durable Medical Supplies, Clearinghouses Trends thus far (more to be shared via the Provider Resource Center) Validation is successful. Positive results obtained.

7 Highmark Blue Cross Blue Shield Testing Update Internal Benefit Neutrality testing for First Priority Health (FPH) was completed in the 2 nd Quarter of Approximately 8,000 claims were converted to ICD-10, processed through the test region and results were compared to the production ICD-9 claims. ICD-10 claims processed at an accuracy rate of 99.5%. End-to-End testing for First Priority Health (FPH) began in the 2 nd Quarter of P (Professional) testing is ongoing with positive results to date. 837I (Institutional) testing is targeted to begin late July 2015.

8 Independence Blue Cross Testing Update Our primary objectives To minimize and eliminate potential business disruptions so our providers experience a successful transition to ICD-10 To align medical policies so there is no change in current ICD-9 policy based outcomes after the transition to ICD-10 Additionally, to ensure services that are currently covered under ICD-9 will be covered under ICD-10 Testing experience Internal Testing: Completed successfully - Independence is confident with our readiness in compliance, systems, claims processing, and support External Testing: Status: Ongoing, we are currently half-way through external end-2-end testing with test partners

9 Independence Blue Cross Testing Update Internal Testing Neutrality Testing Focused on payment, benefits, medical policy, clinical, and operational impact External Testing Parallel Validation Compare the transition from ICD-9 to ICD-10 coding to verify there are no negative impacts to the provider or member Outcome will serve as source data for day-to-day processing and validation of claims path and associated data Current End to End Testing Testing partners: Several large hospital health systems, a large provider group, and clearing houses 50 scenarios tested from simple, core scenarios to complex, custom scenarios

10 Independence Blue Cross Testing Update Lessons learned Internal and external validation has been successful; Independence is confident with the current testing outcomes, and; We continue to urge that providers take the time to train coders and concentrate on clean coding practices Reminder: Independence will not accept any ICD-9 codes for dates of service on or after October 1, If your office submits an ICD-9 code after the compliance date, your referral, authorization, or claim will be denied and sent back to you for proper coding.

11 Capital BlueCross Testing Update Types of Testing Conducted Internal Testing Content Based Testing End to End Provider Testing

12 Capital BlueCross Testing Update Internal Testing at Capital BlueCross Established a dedicated ICD-10 test environment that mirrored our production environment with ICD-10 configured and active. Performed large volume claim testing with our internal ICD-10 configuration Focusing on: DRG Assignment Benefit Assignment Medical Policy Claim and clinical edits Operational impact

13 Capital BlueCross Testing Update Content Based Testing Geared towards Physicians Offers Medical Scenarios based on specialty, which the provider is asked to read over and determine the appropriate ICD-10 coding. Summary of results were posted to Capital s ICD-10 site on CapBlueCross.com 53 providers responded to our content based testing

14 Capital BlueCross Testing Update Testing Objectives Test connection between providers, clearinghouses and Capital BlueCross. Test internal claims processing systems, front-end editing and back-end adjudication systems. Process claims with ICD-10 coding and apply appropriate claim edits, medical policies and pricing. Confirm that Capital BlueCross can accept, correctly process, and finalize a claim containing ICD-10 codes. Confirm that providers can code, send and process a finalized claim containing ICD-10 codes.

15 Capital BlueCross Testing Update How testing was done: Internal testing started on April 6, 2015 and will end on August 28, We asked test providers to create natively ICD-10 coded claims by re-coding previously processed ICD-9 claims from the original medical records. Claims were delivered to us in 837 format electronically either directly or through clearinghouses, which we received through our front-end processes (using existing, established submission mechanisms). Front-end edit Acceptance/Rejection reports were delivered back to the provider the day following submission. The newly recoded ICD-10 claims were adjudicated in our ICD-10 test environment. The results were compared with the original ICD-9 claims for internal review and analysis. Claims were delivered back to the providers in an ANSI 835 one week after initial claims submission (using existing, established submission mechanisms).

16 Capital BlueCross Testing Update Who we tested with: 28 of Providers (total) 16 Large Facilities (also include Professional Provider Groups) 2 Clearinghouses (directly) 2 Professional Provider Groups Clearinghouses we tested with successfully RelayHealth Emdeon AthenaHealth HMS SSI ENS HDX MedAssets NaviCure

17 17 If You Have A Question. If you have a question, please it to ICD10ProviderCommunication@capbluecross.com so we can address it during the call. We would like to hear from you so please send your feedback to: o Capital BlueCross: ICD10PC@capbluecross.com o Highmark: ICD-10Inquiries@highmark.com o Independence BlueCross: provider _communications@ibx.com o BCNEPA: ICD10Inquiries@bcnepa.com

18 18 Helpful Links Pennsylvania Medical Society The Hospital & Healthsystem Association of Pennsylvania CMS (Center for Medicare & Medicaid Services ICD-10 WATCH ZIRMED Innovating Connected Healthcare WEDI ICD-10 HUB

19 19 Next What s Up Wednesday Call Next What s Up Wednesday Call: August 19, 2015 from 2 to 3PM EST Visit a PA Blue s Plan website for more information: Capital BlueCross Blue Cross Northeastern PA Independence Blue Cross Highmark Blue Shield nts/prof-pub/icd10-library.html We would like to hear from you so please send your feedback to ICD10ProviderCommunication@capbluecross.com

20 THANK YOU 20