Here Comes ICD-10! Is a non-intrusive implementation even possible?

Transcription

1 A discussion on how Florida Blue has prepared for ICD-10 and what we can expect on October 1, 2015 Friday, September 25, FPTA Conference & Assembly of Representatives Orlando, Florida

2 Primary Objectives To increase your awareness and understanding of ICD-10 and its impacts to the health care industry. To provide a health care industry and legislative and regulatory update on the current state of ICD-10. To highlight what Florida Blue has done and is currently doing to prepare for ICD-10 and what we can all expect after October 1, To provide some helpful hints for physicians and providers as they get ready for the implementation of ICD-10 on October 1,

3 Objective #1 To increase your awareness and understanding of ICD-10 and its impacts to the health care industry! The ICD-10 codes are the new medical diagnosis and procedure codes that are used to codify inpatient and outpatient diagnosis (ICD-10 CM) and inpatient procedures (ICD-10 PCS) for dates of discharge or dates of service beginning October 1, 2015; ICD codes are a part of the HIPAA-AS Code Set standard. Effective October 1, 2015, all HIPAA-AS covered entities MUST utilize ICD-10 codes in any standard covered HIPAA-AS electronic transaction where they identify a medical diagnosis or inpatient procedure. 3

4 Objective #2 To provide a health care industry and legislative and regulatory update on the current state of ICD-10. Most HIPAA-AS covered entities (Health Plans/Payers; clearinghouses; institutional providers and medium-to-large sized physician practices) are generally prepared and ready for ICD-10. Individual physicians and small physician practices (1 to 5) continue to be problematic across the health care industry. Electronic chain-of-trust partners (PMS and HIS system vendors; billing service entities; EHR vendors) are generally prepared for ICD-10. There are four legislative bills (HR 2126, HR 2247, HR 2652 and HR 3018) that are currently in-flight; these bills have been referred to the House Energy and Commerce and the Ways and Means committees for comment; none of these bills have any Senate sponsorship; the industry believes that none of these bills will gain any traction. CMS remains committed to an ICD-10 October 1, 2015 implementation date. 4

5 Objective #3 To highlight what Florida Blue has done and is currently doing to prepare for ICD- 10 and what we can all expect after October 1, Florida Blue s internal and external technical and business system capabilities have been ready for ICD-10 since August 2013: Technical Capabilities: all technical business system capabilities are remediated, are currently operating in production and are currently being maintained. Business Processes and Policies: all business processes, policies (medical and operational) and standard operating procedures have been remediated and are currently being maintained. External 3 rd parties, delegated entities and business associates have been assessed, remediated and mitigation plans have been established when and where necessary. Internal business areas, external 3 rd parties, delegated entities, business associates and electronic trading partners have attested to their ICD-10 readiness; verification and validation continues on existing and new relationships. 5

6 Objective #3 (continued - has done ) Established an ICD-10 Training Program for internal staff including technical code-set training for coder certification. Established a Physician and Provider Communication, Collaboration and Education Program that focuses on increasing the awareness and understanding of ICD-10 across our provider population. Established an external facing ICD-10 End-to-End Testing Platform that uses previously processed ICD-9 claims that have been re-coded to ICD-10 by the provider using the original medical record; this capability is for any willing physician, provider or electronic trading partner; this capability has been recognized as an industry best practice. Established internal (Open-Line Thursday) and external (Open-Line Friday) monthly teleconferences where ICD-10 information, lessons learned and best practices are shared among constituents; this has been recognized as an industry best practice. 6

7 Objective #3 (continued - has done ) Established an external ICD-10 Lunch-and-Learn bi-monthly teleconference series for individual physicians and small physician practices who are not prepared for ICD-10; this has been recognized as an industry best practice. Established an ICD-10 landing page on our corporate website that is used to share our current ICD-10 status and to provide a single portal of ICD-10 learning and engagement opportunities for external constituents (providers; electronic trading partners, etc.) Established and utilized Twitter capabilities for key message distribution and to increase industry collaboration during our monthly Open-Line Friday calls; hosted several Tweet Chats with industry experts; this has been recognized as an industry best practice Modeled multiple years of ICD-9 based claims data through premier picks to determine financial impacts; findings were consistent with industry results to-date that financial neutrality is achievable in ICD-10 for both professional and institutional providers 7

8 Objective #3 To highlight what Florida Blue has done and is currently doing to prepare for ICD- 10 and what we can all expect after October 1, Physician, Provider and external 3 rd party ICD-10 End-to-End Testing Executing our internal ICD-10 Training Program and ICD-10 Coder Certification Courses Physician and Provider Communication, Collaboration and Education Program including the delivery of ICD-10 presentations at medical association and society conferences Open-Line Thursday, Open-Line Friday and Lunch-and-Learn teleconferences Internal end-to-end 2-day parallel processing for ICD-10 enabled claims continues Testing Authorization and Referral processing under ICD-10 Re-attest to the ICD-10 preparedness and readiness of internal functional business areas, external 3 rd parties, delegated entities and business associates 8

9 Objective #3 (continued - is currently doing ) Continue collaboration activities with Blue Plan partners, competitors, electronic trading partners and CMS Continue to model ICD-9 claims with ICD-10 codes using premier picks and identify and mitigate any abnormalities Created an ICD-10 Operational Readiness Go-Live Plan Established monitoring and operational metrics Continue to monitor legislative and regulatory activities 9

10 Objective #3 To highlight what Florida Blue has done and is currently doing to prepare for ICD-10 and what we can all expect after October 1, Established and using a common internal ICD-10 communication process and Florida Blue source of truth location (internal ICD-10 Share Point site). Established and using a common external ICD-10 communication process and Florida Blue source of truth location for physicians, providers and electronic trading partners (ICD-10 landing page on the corporate website). Florida Blue will host weekly internal ICD-10 Open-Line Thursday and external ICD-10 post-implementation teleconferences where we will share results-to-date and describe common issues, problems and mitigation activities. Florida Blue will see increases in physician and provider calls due to uncertainty. Florida Blue will participate in industry collaboration calls to share post-implementation lessons learned and anomalies. Chaos? Here Comes ICD-10! 10

11 Objective #4 To provide some helpful hints for physicians and providers as they get ready for the implementation of ICD-10 on October 1, Train yourself and your staff to raise awareness and understanding of ICD-10: or purchase a coding book NOW 2. Try It (you really can t break anything!): Using your current desktop capabilities (PMS; Clearinghouse; Billing Service, etc.) try entering in an ICD-10 code on a claim. 3. Practice Practice Practice: Take current ICD-09 coded claims and using the original medical record, recode it using ICD-10 diagnosis and procedure codes where applicable. Coder productivity will be an issue practice now! 11

12 Next Steps Six Helpful (recommended) Resources Powered by 12

13 Next Steps Questions & Discussion Thank you! (904)