ICD-10 Compliance Project Status 20111101.ppt - inprovider.indianamedicaid.com/media/67183/icd-10 compliance project... · November Update ICD-10 Compliance Project Status Statement

November Update

ICD-10 Compliance Project Status

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Presented by Hewlett-Packard Enterprise Services 1 November 2011

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TopicsTopics

Estimated timeline Answers to your questions ICD-10 date processing logic HP ICD-10 surveys in general HP ICD-10 Vendor Readiness Survey HP ICD-10 IHCP Provider Readiness Survey HP ICD-10 IHCP Provider Readiness Survey Advice to HP vendors and IHCP providers Where is HP in ICD-10 readiness?

M ti ? More questions? Points of Contact Questions and Answers


Assessment Phase

Estimated timeline

(Gap Analysis/Impact Report) . . . . . . . . . . . . . . . . . . . . . . . . . . Completed Implementation Options, Recommendations,

and Strategy Report to FSSA . . . . . . . . . . . . . . . . . . . . . . . . . . Completed Steering Committee review and approval . . . . . . . . . . . . . . . . . Completed Master Design, Development, and

Implementation (DDI) Work Plan . . . . . . . . . . . . . . . . . . . . In developmentI t t d DDI M t P j t S h d l D b 31 2013 Integrated DDI Master Project Schedule . . . . . . . . . . . December 31, 2013

Implementation Phase complete . . . . . . . . . . . . . . . . . December 31, 2012 Testing activities . . . . . . . . . . . . . . . . . . . January 2013 – September 2013

V d t ti J 2013 S t b 2013 Vendor testing . . . . . . . . . . . . . . . . . . . . . January 2013 – September 2013 Operational Readiness Review . . . . . . . . . . . . . . . . . . . . . . . August 2013 Go Live . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . October 1, 2013

I l t ti Ph l t D b 31 2013


Implementation Phase complete . . . . . . . . . . . . . . . . . December 31, 2013

Answers to your questionsAnswers to your questions

Wh di b f th fi li d i f d t dWhy are we proceeding before the finalized versions of updated claim forms are available and when will that be?

We are keeping tabs on the development of updated paper claim forms and will notify our providers when they become available.

At this time, planning is the key. Identifying what will be impacted and what changes will need to occur is part of the assessment you shouldwhat changes will need to occur is part of the assessment you should be conducting at this time.



H i i th ICD 10 d t i t h l t l h lthHow is using the ICD-10 code sets going to help control healthcare costs and improve patient care?

An accounting of the cost control and improvements to patient care and claims processing is outlined in the news release from the U.S. Health and Human Services office titled, HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules.

Available from the HHS website at http://www.hhs.gov/news/press/2009pres/01/20090115f.html.

C


Continued on next slide


F th CMS ICD 10 R i l Offi T i i W k h T i iFrom the CMS ICD-10 Regional Office Training Workshop: Training segments to assist State Medicaid Agencies with ICD-10 Implementation, April 2011:

“State Medicaid agencies can pay more accurately based on the greater specificity and granularity of ICD-10 codes… Fine tuning case management and disease management [from] the increased granularity of codes results in substantially more parameters of diagnosis codes that provide much greater insights into characteristics of patients’ health state.”

Available from the CMS website at https://www.cms.gov/MedicaidInfoTechArch/downloads/ICD-

10_Training_Segments.zip.



H d b i lid t d l i b i i i ICD 10?How are codes being validated on claim submissions in ICD-10?

The code specificity validation check is not changing. There will be no up front validity check for the letters “O” and “I”up-front validity check for the letters O and I .



Wh t b t l i th t th O t b 1 2013 i l t tiWhat about claims that span the October 1, 2013 implementation date?

Mixing of ICD versions will not be allowed. Any claims that are submitted with mixed ICD versions will be rejected.

Information about span dates on claims follows.


ICD 10 date processing logic:

Use FROM or

ICD-10 date processing logic:Institutional provider claims

Facility Type/Services Claims Processing RequirementTHROUGH Date Effective 10/1/2013

Inpatient Hospital Medicare: THROUGH(Hospital, PPS hospital, LTCH, CAH)

HP:Claim Type I (Inpatient) and A

If the hospital claim has a discharge and/or THROUGH date on or after 10/1/2013, then the entire claim is billed using ICD-10

IHCP:• Currently, IHCP requires the use of Occurrence Code 51 to

(Inpatient Crossover) indicate discharge. Occurrence Code 51 shall continue to be required for this purpose, but will not be used to validate the ICD-10 code.

• Currently, IHCP uses the FROM date of service for Inpatient (I) and ( A) claim types; however, this will change to use of the THROUGH date with ICD 10 implementation.

• Providers are not allowed to mix ICD-9 and ICD-10 codes on the same claim.



Use FROM or


Facility Type/Services Claims Processing Requirement THROUGH Date Effective 10/1/2013

Outpatient Medicare:Split Claims Requires providers split the claim so all ICD-9

FROM

HP:Claim Type C (Outpatient Crossover) and O (Outpatient)

Split Claims – Requires providers split the claim so all ICD-9 codes remain on one claim and all ICD-10 codes remain on the other claim

IHCP:• HP recommends for services that span the compliance date• HP recommends, for services that span the compliance date

of 10/1/2013, providers separate claims submission so that ICD-9 codes remain on one claim (services prior to 10/1/2013) and all ICD-10 codes remain on the other claim (services on or after 10/1/2013).

• Currently use the FROM date; HP recommends continued

Federally Qualified Health Clinic (FQHC) (eff. 4/4/2010)

• Currently, use the FROM date; HP recommends continued use of the FROM date.

• FQHC crossovers from Medicare are processed as outpatient crossover claims. However, when an FQHC claim is for a member with no Medicare the claim is submitted on


is for a member with no Medicare, the claim is submitted on a CMS-1500.


Use FROM or



Skilled Nursing Medicare:If the LTC claim has a discharge and/or THROUGH date on or

THROUGH

HP:Claim Type L (Long Term Care) and A (Inpatient Crossover)

If the LTC claim has a discharge and/or THROUGH date on or after 10/1/2013, then the entire claim is billed using ICD-10.

IHCP:HP recommends following this requirement.

Home Health

HP:Claim Type H (Home Health)

Medicare:Split Claims – Requires providers split the claim so all ICD-9 codes remain on one claim and all ICD-10 codes remain on the other.

FROM

IHCP:HP recommends, for services that span the compliance date of 10/1/2013, providers separate claims submission so ICD-9 codes remain on one claim (services prior to 10/1/ 2013) and all ICD-10 codes remain on the other claim (services on or after


ICD-10 codes remain on the other claim (services on or after 10/1/2013).


Use FROM or

ICD-10 date processing logic:Professional claims


All anesthesia claims Medicare:Anesthesia procedures that begin on 9/30/2013 but end on

FROM

All specialties billed on Professional Claims

HP:Claim Type M (Medical) and B

Anesthesia procedures that begin on 9/30/2013, but end on 10/1/2013, are to be billed with ICD-9 diagnosis codes and use 9/30/2013, as both the FROM and THROUGH date.

IHCP:HP recommends using the FROM dateClaim Type M (Medical) and B

(Medical Crossover)HP recommends using the FROM date.



Use FROM or

ICD-10 date processing logic:Supplier claims


DMEClaim Type M (Medical) and B

Medicare:Billing for certain items or supplies (such as capped rentals or

FROMClaim Type M (Medical) and B (Medical Crossover)

Billing for certain items or supplies (such as capped rentals or monthly supplies) may span the ICD-10 compliance date of 10/1/2013, (such as the FROM date of service occurs prior to 10/1/2013, and the THROUGH date of service occurs after 10/1/2013).

IHCP:HP recommends using this logic for all span dates.*

*Our intent is to follow Medicare to the extent possible and seek further clarification from CMS regarding the use of ICD-10 codes and the claim format to be used to report these claims.


HP ICD 10 surveys in generalHP ICD-10 surveys in general

HP and FSSA have committed to surveying contracted vendors and IHCP providers every 90 days through August 2013.

The purpose of continuously surveying contracted vendors and The purpose of continuously surveying contracted vendors and IHCP providers is to understand where they are in preparation for the change to ICD-10 and to track progress.

Survey results will help us help you Survey results will help us help you.

Survey results will be shared in the monthly ICD-10 Assessment and Implementation Status presentations.

Information about these surveys is available in the IHCP Newsletters.


HP ICD 10 Vendor Readiness SurveyHP ICD-10 Vendor Readiness Survey

HP ICD-10 Vendor Readiness Survey II released on November 7, concluding on November 18.

E-mail invitations regarding survey participation sent to FSSA and E mail invitations regarding survey participation sent to FSSA and HP contract vendors.


HP ICD 10 IHCP Provider ReadinessHP ICD-10 IHCP Provider Readiness Survey

HP ICD-10 IHCP Provider Readiness Survey I released on November 8, concluding on November 21.

A link to the survey posted on the Indiana Medicaid websiteA link to the survey posted on the Indiana Medicaid website, Provider page in the News and Announcements section at indianamedicaid.com.

Surveys should be completed by the individual that is instrumental Surveys should be completed by the individual that is instrumental in planning, implementing, and/or managing the transition to ICD-10 in the provider’s business.


Advice to HP vendors and IHCP providers

W iti til th fi t t f 2012 ft i l t ti f 5010 i

Advice to HP vendors and IHCP providers

Waiting until the first quarter of 2012, after implementation of 5010, is not the best plan.

Now is the time to begin the ICD-10 planning process if you haven’t already.

We would like to see your plans for gap analysis, testing, and implementation It is also important to keep us updated on changesimplementation. It is also important to keep us updated on changes to these plans.

If you have not been contacted by your software vendor and/or clearinghouse about ICD 10 readiness be proactive and contactclearinghouse about ICD-10 readiness, be proactive and contact them.


Where is HP in ICD 10 readiness?Where is HP in ICD-10 readiness?

Requirements will be finalized in November 2011

Master Design, Development, and Implementation (DDI) Work Plan i i d l tis in development.

Some business design work has started; primarily around the proprietary file changes.

HP continues to be on track for implementation October 1, 2013!


More questions?More questions?

You are encouraged to submit your questions to FSSA and HP throughout this project. Submit HP ICD 10 related questions to your Provider Relations Submit HP ICD-10-related questions to your Provider Relations

Representative or to [email protected].

Feel free to direct inquiries to the “Points of Contact” designated for th j tthe project.


Points of Contact

J li Sl S t Di t (HP) P i t f t t f

Points of Contact

Julie Sloma, Systems Director (HP) – Point of contact for vendors for processes which are impacted by ICD-10 and directly relate to the HP environment.

Hong Gao, Systems/IT Manager (FSSA) – Point of contact for systems/IT inquiries from vendors and providers that are impacted by the transition to ICD-10 and directly relate to theimpacted by the transition to ICD 10 and directly relate to the HP environment.

Nick Taylor, PM (FSSA) – Point of contact for systems/IT y , ( ) yinquiries from vendors and providers that are impacted by the transition to ICD-10.


Questions and Answers


Documents

ICD-10 Compliance Project Status 20111101.ppt - inprovider.indianamedicaid.com/media/67183/icd-10 compliance project... · November Update ICD-10 Compliance Project Status Statement