Below are some frequently asked questions that may assist your practice.

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1 Dear Providers: With the recent announcement in the delay for the implementation for ICD-10-CM/PCS we wanted to provide an update on Blue Cross and Blue Shield of Vermont s (BCBSVT) implementation. We will continue to work on our internal systems. All of our medical policies have been remediated and we will continue to keep the ICD-9-CM and ICD-CM-10 codes. Testing has been moved to the first quarter of Claim submissions need to continue to report ICD-9-CM until the newly determined go live date. For the paper billing of professional claims on a CMS 1500, we will continue to accept both the old and new forms ( or ) until October 1, 2015 when we will begin to require the use of the new form only ( ). Below are some frequently asked questions that may assist your practice. Q: When is the ICD-10 compliance deadline? The ICD-10 deadline is on or after October 1, Q: What does ICD-10 compliance mean? ICD-10 compliance means that a HIPAA-covered entity uses ICD-10 codes for health care services provided on or after October 1, ICD-9 codes cannot be used for services provided on or after this date. BCBSVT plans to be fully ICD-10 compliant by October 1, Q: Who is affected by the transition to ICD-10? Everyone covered by HIPAA must use ICD-10 starting on or after October 1, This includes health care providers who do not deal with Medicare claims.

2 Page 2 Q: Why is the switch to ICD-10 happening? The Transition to ICD-10 codes will allow for necessary details on patient medical conditions and on procedures performed during a patient s hospitalization. Plus, ICD-9 codes have outdated and obsolete terminology and are also inconsistent with current medical practices. Q: What happens if I don t switch to ICD-10? Claims for all health care services and hospital inpatient procedures performed on or after October 1, 2015, must use ICD-10 diagnosis and inpatient procedure codes. Claims that do not use ICD-10 codes after the compliance date will not be processed. It is important to note, however, that claims for services provided before October 1, 2015, must use ICD-9 diagnosis and inpatient procedure codes. Q: Where can I find the ICD-10 codes? The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge on the 2014 ICD-10-CM and GEMs and 2014 ICD-10-PCS and GEMs pages of the CMS ICD-10 website. Q: What is GEM? General Equivalence Mappings (GEM) were developed by NCHS and CMS, with collaboration of AHIMA and AHA. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10-CM coding systems and are used to help develop crosswalks that provide important information linking codes of one system with codes in the other. Q: Will ICD-10 replace Current Procedural Terminology (CPT) coding? No. The transition to ICD-10 does not affect CPT and HCPCS coding for outpatient procedures and physician services. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only. Q: Will BCBSVT use a crosswalk for claims processing? No, we will not use a crosswalk for claims processing. Q: If I transition early to ICD-10, will BCBSVT be able to process my claims? No. BCBSVT will not process claims using ICD-10 until on or after the October 1, 2015, compliance date.

3 Page 3 Q: What if we simply include BOTH I-9 and I-10 codes? Claims possessing ICD-9 codes when ICD-10 is mandated will be rejected. The regulation states ICD-10 must be used on all outpatient claims with dates of service October 1, 2015 and later, and all inpatient claims with dates of discharge October 1, 2015 and later. Q: How will professional and outpatient claims be handled before and after October 1, 2015? Professional and outpatient facility claims can only contain one version of ICD code. When dates of services are before Oct. 1, 2015, claims must be filed with ICD-9 codes. When dates of service span Oct. 1, 2015, the claim must be split into multiple claims: - All services prior to Oct. 1, 2015, should be filed on one claim with ICD-9 codes. - All services on or after Oct. 1, 2015, should be filed on one claim with ICD-10 codes. When dates of services are on or after Oct. 1, 2015, the claim must be filed with ICD-10 codes. Q: How will inpatient claims be handled when the patient was admitted prior to Oct. 1, 2014, and discharged on or after October 1, 2015? For facility inpatient claims, the discharge date determines the code set (ICD-9 or ICD-10) that should be filed on your claim. When the discharge date is prior to Oct. 1, 2015, the facility claim should be filed with ICD-9 codes. When the discharge date is on or after Oct. 1, 2015, the facility claim should be filed with ICD-10 codes, even when the admission date is prior to Oct. 1, Q: What are the Authorization date rules for ICD-10 compliance? Authorization request for inpatient stays for an admission date on or after Oct. 1, 2015, must be submitted with ICD-10 codes. Authorization requests for outpatient services for dates of service on and after Oct. 1, 2015, must use ICD-10 codes. Q: Will both electronic and paper claims require ICD-10 coding? A Yes, all claims need to be compliant.

4 Page 4 Q: Will DRG groupers (inpatient and outpatient facility) continue to be based on ICD-9 codes after the adoption of ICD-10 codes? Our groupers will be both ICD-9 and ICD- 10 compliant so that BCBSVT can process services correctly based on the date of service or date of discharge. Q: Will the ICD-10 conversion have an effect on provider reimbursement and contracting? We are evaluating the impact of ICD-10 on our contracting and clinical operations. The ICD-10 conversion is not intended to transform payment or reimbursement. However, there could be potential shifts in DRG assignments for inpatient claims which could in turn impact reimbursement levels. Q: Will medical policies be updated to reflect ICD-10? Yes. BCBSVT s medical policies are being reviewed and appropriate ICD-10 codes will be incorporated into the policies. Q: Do you anticipate any delays in payments to result from the switch to ICD-10? We do not anticipate any delays in payments for claims that are submitted correctly. Q: What is your approach to testing? Will BCBSVT conduct testing with providers? Internal testing of ICD-10 has started at the beginning of 2014 and will continue until October 1, We will also test with several key providers and clearing houses. We will contact you directly if we plan to test with you. BCBSVT will be unable to test ICD-10 readiness with every provider and clearinghouse. So, it is essential for providers to validate readiness on their own. Q: If my organization is interested in testing with BCBSVT, who should we contact? Please contact your provider relation consultant at (888) Q: What type of training will providers and staff need for the ICD-10 transition? Training needs will vary for different organizations, but it is projected by AHIMA that a maximum of 16 hours of training may be sufficient for experienced coding professionals on ICD-10-CM. Physician practices may not need as much training due to the fact that they may utilize a limited number of codes. It is estimated that the ICD-10- PCS will likely require an additional hours of training.

5 Page 5 ICD 10 CM Q: What training opportunities are available for coders and physicians? AAPC offers different online as well as on-site training options: - For physicians - For coders - For managers AHIMA has several options available covering ICD-10 coding: visit E- Learning section. ICD-10 Coders Academy offers three different options for certification: - For medical coders and billers - For office managers and coding auditors - For coding trainers, HIM consultants and coding consultants Q: Where can I find the latest ICD-10 news and resources? Visit CMS Provider Resources portal for information designed specifically for providers. For large practices, check ICD-10 Implementation Guide for Large Practices created by CMS. For small practices and medium provider practices, check CMS s Road to 10 - the Small Physician Practice's Route to ICD-10. Go to CMS ehealth University, a resource featuring a full curriculum of materials and information on ICD-10 transition. Check the HIMSS ICD-10 Playbook. Go to AAPC to get more information on ICD-10 coding and training. Thank you for your time. If you have any questions regarding these changes, please feel free to contact your provider relations consultant at (888) or through e- mail at Business hours are Monday through Friday, 8 a.m. 4:30 p.m. Sincerely, Cynthia E. Horan Director, Provider Relations

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