What s Up Wednesday. Together Let s Get ICD-10 Ready. Date: May 20, 2015 Time: 2 3 p.m. Phone Number: Pass code:

Transcription

1 What s Up Wednesday Together Let s Get ICD-10 Ready Date: May 20, 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 Department of Human Services Stacey Zambito, ICD-10 Project Manager CMS End-to-end Testing Pat Washington and Stacey Horne, Pinnacle Health PA Blues Plans update on Pre-Auth and Referrals Independence Blue Cross Tim Wadsworth, Director Provider Communications Highmark Deb Cotter, Director, Strategic Programs Blue Cross of Northeastern Pennsylvania Pam Ross, RN Manager, Reporting and Coding Applications Capital BlueCross Lisa McNaughton, ICD-10 Project Manager

4 4 dhs.state.pa.us Pennsylvania Department of Human Services ICD-10 Overview Stacey Zambito, CPC ICD-10 Project Manager

5 5 dhs.state.pa.us DHS ICD-10 CM/PCS Project Phases Awareness and Assessment April 2011 March 2013 Remediation and Testing April 2013 August 2015 Requirements Gathering, Analysis and High Level Design January 2012 March 2013 Transition May 1, 2015 December 31, 2015

6 6 dhs.state.pa.us Awareness and Assessment Phase Primary focus to educate DHS staff on ICD-10 Distributed information to key stakeholders Identified operational areas of potential impact Created a governance structure Drafted Communication and Training Plans Assessment interviews conducted Phase completed March 2013

7 7 dhs.state.pa.us Requirements Gathering, Analysis and High Level Design Concentrated on two areas: Medicaid Operations Enterprise Medicaid Management Information System (PROMISe ) Operational Impact Analysis Consisted of inventory of all areas with ICD-10 impact PROMISe Impact analysis completed

8 8 dhs.state.pa.us Remediation and Testing Remediation Plan addresses: ICD-10 Code Mapping with PROMISe and supporting systems Revision and update of Policy, Process and Regulations Develop Business/System Requirements and Change Requests for PROMISe and Supporting Systems Design and Develop System Changes Creation of Test Data and Test Scenarios

9 9 dhs.state.pa.us Remediation and Testing Testing Unit Testing Systems Testing Regression Testing Non-Functional Testing Internal End-to-End Testing Testing of Portals, Transaction Specifications and Certifications

10 10 dhs.state.pa.us External End-to-End Testing Group of randomly selected providers Claim types Professional Institutional inpatient and outpatient Dental Testing will demonstrate Ability to accept claims containing ICD-10 codes Adjudicating the claim appropriately Returning Electronic Remittance Advices

11 11 dhs.state.pa.us Transition Finalize business and policy preparations System changes will be in effect on October 1, 2015 Post Implementation Activities

12 12 dhs.state.pa.us Critical Success Factors Accept electronic claims with ICD-9 and ICD-10 coding based on the dates of service/discharge using Version 5010 transactions on or after October 1, 2015 Adjudicate diagnosis dependent claims based on dates of service/discharge Pay providers/entities for claims with ICD-9 and ICD-10 codes based on the dates of service/discharge and Pay managed care organizations using ICD-9/ICD-10 Complete coordination of benefit processes Create and send T-MSIS reports for ICD-10 claims

13 13 dhs.state.pa.us ICD-10 Resources Dedicated website containing ICD-10 information: ation/index.htm ICD-10 Mailbox: ICD-10 Listserv

14 Pinnacle Health ICD 10 Testing: Medicare End-to-End Testing: Round 1 Professional Round 2 Professional and Hospital Round 3 Professional and Hospital recommended we include other types of Medicare coverage Medicare Railroad pending approval Payer testing Internal system testing

15 Medicare End-to-End Testing: Reviewed specific ICD-10 codes or scenarios Created test accounts using production data and Medicare required data Manipulated dates to comply with Medicare requirements Round 1 and 2 claims submitted, processed and many remits returned.

16 Medicare Lessons learned/clearinghouse Tips Work with your clearinghouse to make sure they are enrolled with CMS to participate in the ICD-10 End-to-End testing Make sure application for volunteer testing is submitted by the deadline Once selected for testing you will need to notify the clearinghouse and provide NPIs, PTANs, or HIC #s that will be used for testing to CMS. Remember that during testing you can only submit NPIs, PTANs, or HIC #s submitted on your volunteer form or your claims will not be processed Start of Testing we here at Pinnacle used data from our PROD system and changed the ICD-9 to ICD-10 diagnosis for our Test system Once claims process through day-end in our financial system we transferred them into our clearinghouse test package

17 From the test package we manipulated the date of service. We changed our dos to future dates. For example if the patient in our PROD system was seen we changed the date in our TEST package to report From the test package we also manipulated the claim numbers produced to prevent remits from posting back into our PROD system. For example our claims numbers begin with an S we changed them to begin with X in the test package. This will cause the remit file to error out and not post in PROD. Billing to CMS after claims are valid and ready to bill in our test package. We then submit our claims for billing. Our clearinghouse picks up our file and transmits to the payer The payer then provides 2 reports to our clearinghouse. 1 Acknowledgement Report which provides how many claims qualified for testing. 2 The 277 report listing how many claims was received/accepted/rejected.

18 Internal System testing: Conducted monthly testing with different systems EMR HIM Financial systems Ancillary systems Testing included: Scheduling Registration Charge entry Clinical documentation Coding Billing and collections

19 19 Highmark Pre-Authorization and Referral Update When submitting Pre-Authorizations or Referrals, and the submission date is and prior use version: ICD-9. When submitting Pre-Authorizations or Referrals, and the submission date is and after use version: ICD-10.

20 20 Independence Blue Cross Pre-Authorization and Referral Update When submitting Pre-authorizations or referrals, and the submission date is and prior use version: ICD-9. When submitting Pre-authorizations or referrals, and the submission date is and after use version: ICD-10. Professional, Inpatient and Outpatient Date of service Version to submit Pre-auth/Referral date 9/30/2015 and prior ICD9 Now-9/30/2015 9/30/2015 and prior ICD10 10/1/2015 and after 10/1/2015 and after ICD9 Now-9/30/ /1/2015 and after ICD10 10/1/2015 and after

21 21 Blue Cross of Northeastern PA Pre-auth and Referral Update BCNEPA ICD-10 transition for authorizations will be based on date the authorization was submitted. ICD-10 for submissions 10/1/2015 and after. ICD-9 for submissions prior to 10/1/2015. Existing ICD-9 coded authorizations for services spanning the 10/1/2015 transition date do not need to be updated. BCNEPA can process an ICD-10 coded claim against an ICD-9 coded authorizations. We do not use ICD codes to match an authorization to a claim.

22 22 Capital BlueCross Pre-auth and Referral Update On May 1, 2015, Capital BlueCross issued an administrative bulletin to our providers about pre-authorizations and referrals and ICD-10 compliance. Starting on 7/1/2015, Capital BlueCross will be able to begin receiving preauthorizations and referrals with ICD-10 codes that are requesting services on or AFTER 10/1/2015. It is the BEGINNING date of service on a pre-authorization or referral that will determine the ICD version. If a pre-authorization or referral has a beginning service date of 10/1/2015 or later, they need to be sent in with ICD-10 codes. If a pre-authorization or referral has a beginning service date of 9/30/2015 or earlier, they need to be sent in with ICD-9 codes. Capital BlueCross does not use Diagnosis codes in matching a pre-authorization / referral to a claim.

23 Questions 23

24 24 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: icd10@ibx.com o BCNEPA: ICD10Inquiries@bcnepa.com

25 25 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

26 26 Next What s Up Wednesday Call Next What s Up Wednesday Call: June 17, 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

27 THANK YOU 27