Emdeon Medical Claims Processing Services. ICD-10 Frequently Asked Questions. Published Q3 2013

Transcription

1 Emdeon Medical Claims Processing Services ICD-10 Frequently Asked Questions Published Q3 2013

2 Preface This information is provided by Emdeon for education and awareness use only. Even though Emdeon believes that all the information in this document is correct as of the date of the publication of this version, Emdeon does not warrant the accuracy, completeness, or fitness for any particular purpose of this information. All use is at the reader s own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon Emdeon Business Services LLC, 3055 Lebanon Pike Suite 1000, Nashville, TN All Rights Reserved. Printed in the USA.

3 Contents Readiness & Planning... 4 Pharmacy Edits... 4 Customer Testing... 5 Customer Impact... 5

4 Readiness & Planning Q: When will Emdeon s Pharmacy DME solutions be ready for the ICD-10 conversion? A: Emdeon intends that its Pharmacy DME status will be fully remediated for ICD- 10 by the end of 2013, well in advance of the October 1, 2014, compliance date. Q: Will Emdeon provide training or resources associated with Payer ICD-10 based changes for the following products: Emdeon Medicare DME, Emdeon Medicaid DME, Emdeon Commercial MedRx? A: Emdeon will continue to update its governmental and commercial billing instructions as implementation details are released by payers. Note that at this time there is no indication from payers that they will put new or different editing into place that would necessitate any changes other than using an ICD-10 code for dates of service on/after October 1, CMS has not released ICD-10 versions of its Local Coverage Determinations (LCDs) which define item coverage based on diagnosis code or a range of diagnosis codes. When CMS releases its ICD-10 coverage policies, Emdeon will be able to provide more detailed guidance. Pharmacy Edits Q: Will Emdeon support ICD-9 codes after October 1, 2014? A: ICD-9 codes will be supported based on the payer s readiness and their planspecific policies. If a payer continues to require ICD-9 after October 1 st due to implementation delays or other circumstances, Emdeon will support the transmission of ICD-9 codes until the payer is prepared to receive ICD-10. Some payers, like Medicare Part B, will continue to require ICD-9 when billing dates of service prior to October 1 st, In those cases Emdeon will validate

5 the diagnosis code submitted against the claim date of service to help ensure the correct version is being used. Customer Testing Q: How and when can I test with Emdeon for Pharmacy DME processing? A: Coordination for ICD-10 testing will begin during the first quarter of Customer Impact Q: How does the change to ICD-10 impact claims for which a Certificate of Medical Necessity (CMN) has already been submitted with a different diagnosis code? A: To date, CMS has not specified how their system will handle editing claims that require a Certificate of Medical Necessity for Medicare Part B DME claims. It is not yet known whether CMS will require an updated form to be submitted for dates of service on/after October 1, If CMS does require an updated form, Emdeon has the ability to notify providers that new documentation must be submitted. Q: Will Emdeon offer a map or crosswalk between ICD-9 and ICD-10 code sets? A: At this time Emdeon does not intend to offer an ICD-9 to ICD-10 crosswalk. Q: Are there any new hardware requirements for Pharmacy DME associated with ICD- 10-related software changes? A: No hardware requirements or upgrades are required for Pharmacy DME. Your software vendor can assist you with any Pharmacy Management System hardware or software changes necessary to support ICD-10.

6 Q: Will modifications and upgrades be covered by existing contracts? A: The ICD-10 remediation work is part of the 2013 product plan for Pharmacy DME. There are no additional customer costs associated with the ICD-10 remediation. Q: Will customer support and training be provided for any new ICD-10-related functionality, and is there a charge? A: Emdeon s pharmacy DME solutions plan to have customer support in place for any ICD-10 questions with no additional related charges. Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S. Healthcare system. Emdeon s product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon s comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle and clinical information exchange processes. For more information, visit Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )