900-3571-0213

Open Line Friday: ICD-10 Edition

AAPC’s ICD-10 Delay Approach

Rhonda Buckholtz Vice President

ICD-10 Education & Training

American Association of Professional Coders

June 20, 2014

9:30 a.m. – 10:30 a.m. EST

Dial Toll-Free: (800) 882-3610 or (412) 380-2000

Conference Passcode: 6829655#

900-4451-0614

Open Line Friday: ICD-10

Panelists

Deborah Stewart, MD Medical Director

Florida Blue

Gale Scott EDI Regulatory Compliance

Administrator Tampa General Hospital

Laurie Darst Revenue Cycle Regulatory Advisor

Mayo Clinic (MN)

Matthew Ketterman Director, Business Solutions

Availity®1

Joseph Gonzalez VP of Business Development

Secure EDI

Lee Ratliff Clinical Business Technology Consultant

Baptist Health South Florida

Mary Rita Hyland VP of the Cooperative Exchange

Diana Brijbag CMM, CPC, CCP, CMSCS, HITCM-PP

Office Manager The Springs Family Medical Center

George Vancore Senior Manager, Delivery Systems

Mandates and Compliance Florida Blue

1 Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit www.availity.com

2

Open Line Friday: ICD-10

June 20, 2014

Special Guest

3

Rhonda Buckholtz CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

Vice President

ICD-10 Education & Training

Note: Practitioner guests are subject to unforeseen clinical or other emergencies. Should guest(s) become unavailable at the time of our program, Florida Blue will attempt to reschedule guest(s) for a future session.

Open Line Friday: ICD-10

AAPC’s ICD-10 Delay Approach

4

Agenda

June 20, 2014

1. Objectives

2. Healthcare Industry Updates

3. Florida Blue Updates

4. AAPC’s ICD-10 Delay Approach

5. Next Steps

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 FloridaBlueOpenLineFriday@FloridaBlue.com.

5

Open Line Friday: ICD-10

Open Line Friday: ICD-10

Health Care Industry & Regulatory Update

• HHS expects to release interim final rule in near future with a new compliance date

requiring the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA

covered entities to continue to use ICD-9-CM through Sept. 30, 2015.

• American Health Information Management Association (AHIMA) is recommending the

industry “keep its momentum going, continuing to prepare by strengthening clinical

documentation improvement programs, working with vendors on transition readiness,

training coders and other stakeholders, and proceeding with dual coding.”

• CMS ICD-10 Acknowledgement Testing: Providers, suppliers, billing companies, and

clearinghouses may submit acknowledgement test claims with CMS anytime up to the

anticipated Oct. 1, 2015 implementation date. Submitters should contact their local

Medicare Administrative Contractor (MAC) for more information about acknowledgment

testing. However, those who submit claims may want to delay acknowledgement testing

until after Oct. 6, 2014, when Medicare updates its systems.

6

Open Line Friday: ICD-10

Health Care Industry & Regulatory Update

• CMS/Medicare ICD-10 Acknowledgement Testing Results from March 2014 were reported

as follows:

• Approximately5% of all submitters (2600) joined in the testing week.

• Over 127k ICD-10 coded claims were sent to the Medicare FFS claims systems

and received a “functional acknowledgement”.

• Nationally CMS accepted 89% of test claims and some regions reported success

rate of 99%; CMS’s normal acceptance rates range from 95% to 98%.

• All claims were required to have:

• A valid NPI and a valid diagnosis code that must match the date of service.

• Claims using ICD-9 or ICD-10 codes had to have a corresponding ICD-10

code qualifier.

• CMS has announced that they will be conducting end-to-end testing in 2015 with details

and schedules to be released “soon”.

• Several organizations are continuing their ICD-10 testing efforts. Are you?

7

Open Line Friday: ICD-10

Health Care Industry & Regulatory Update (continued)

• NUCC changes to the CMS 1500 professional paper claim form to accommodate ICD-10

(www.nucc.org); the following recommended transition timeline has applied:

• January 6, 2014: Payers begin receiving and processing paper claims submitted on the

revised 1500 Claim Form (version 02/12).

• January 6 through March 31, 2014: Dual use period during which payers continue to receive

and process paper claims submitted on the old 1500 Claim Form (version 08/05).

• April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500

Claim Form (version 02/12).

• Partial code freeze continues until one year after the implementation of ICD-10:

• Only codes for new diagnosis and 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 pending the approval of the October 1,

2015 ICD-10 implementation date.

8

Florida Blue Update:

• Florida Blue is deploying a full remediation strategy to implement ICD-10.

• Florida Blue’s ICD-10 initiative is proceeding on plan. We are in the process of

completing our internal Compliance Level 1 testing and are fully engaged in

Compliance Level 2 testing with physicians, providers and external entities.

• Open Line Friday ICD-10 Edition teleconferences will continue every 3rd Friday

of each month. Audio podcast recordings are available through the Podcast link

located at www.floridablue.com/icd-10.

• ICD-10 Testing with Providers: we are continuing to engage providers in Phase I

and Phase II Testing. Phase III is in beta-test mode and will be generally available

in the late May timeframe; details of our provider testing, including a self-service

option, are available at www.floridablue.com/icd-10.

• Florida Blue’s ICD-10 Provider Toolkit will be maintained going forward and is

accessible from www.floridablue.com/icd-10.

• Attention Small to Medium sized providers: “Build your action plan and start

your transition to ICD-10 now with the CMS “Road to 10” tool. It’s simple. Visit the

www.roadto10.org”

Open Line Friday: ICD-10

9

10

Rhonda Buckholtz CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

Vice President

ICD-10 Education & Training

American Association of Professional Coders

Open Line Friday: ICD-10

AAPC’s ICD-10 Delay Approach

Please refer to our guest speaker’s program material if available which can be accessed at

www.floridablue.com/ICD-10 under Open-Line Friday located in right margin.

.

Send ICD-10 questions, comments or feedback to

floridablueopenlinefriday@floridablue.com.

11

Open Line Friday: ICD-10

AAPC’s ICD-10 Delay Approach

12

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

floridablueopenlinefriday@floridablue.com

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 ICD-10Testing@floridablue.com

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.

Open Line Friday: ICD-10

Follow us on Twitter @FLBlue 13

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

For regular CMS ICD-10 email updates, subscribe at:

https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608

WEDI's Survey on Industry ICD-10 progress:

http://www.wedi.org/docs/comment-letters/2013-wedi-icd-10-survey-results-letter.pdf?sfvrsn=0

FREE CMS and WEDI ICD-10 End-to-End Testing Webinars available for download:

http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=220AC00000156

HIMSS/WEDI National ICD-10 Pilot Program Update:

http://www.himss.org/library/icd-10/national-pilot-program?navItemNumber=13477

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:

14

Open Line Friday: ICD-10

15

Addendum

Open Line Friday: ICD-10

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

Vice President of ICD-10 Education and Training, AAPC

Rhonda Buckholtz has more than 20 years of experience in healthcare, working in the

reimbursement, billing, and coding sectors, in addition to being an instructor. She is

responsible for all ICD-10 training and curriculum at AAPC. She has authored many

articles for health care publications and has spoken at conferences across the country.

She is co-chair for the WEDI ICD-10 Implementation Workgroup and has provided

testimony ongoing for ICD-10 and standardization of data for NCVHS. She also sits on

the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark

Medicare Services).