Property and Casualty Electronic Medical Bill (ebill) Subworkgroup

Transcription

1 Property and Casualty Electronic Medical Bill (ebill) Subworkgroup Thursday, November 5, 2015

2 Welcome & Introductions Welcome and Introduction WEDI P&C Co-Chairs Tammy Banks, Optum Cloud Tina Greene, Mitchel International Sherry Wilson, Jopari Solutions WEDI P&C Secretary Alicia Bell, Jopari Solutions 2

3 Agenda Industry Update - P&C Impact ICD-10 Post Implementation Update Sherry Wilson Early Findings -Top ICD-10 Rejections ICD-10 Benchmark Metrics Industry ICD-10 Early Trending Workgroup ICD-10 Report In Findings Update on ebill States Open Forum 3

4 Early Findings Workers Compensation Results * October 1 thru October 27 th Total % ICD-10 bills rejected/ Total bills Less than 1% received Volume % of ICD-10 to ICD-9 Clean Claims Received 46% Trend in clean claim errors post ICD-10 Less than 1% % of ICD Denials Too early to trend % of increase Customer Support Calls No increase calls reported *Comment: Results reflect reported industry trend across all lines of healthcare business. Too early to determine payment impact. Jopari Solutions 4

5 Top 5 Reported Provider Coding Errors ICD-9 claims with ICD-10 qualifiers (top error) Incorrect ICD-9 to ICD-10 code crosswalks due to PMS vendor applications ICD-9 and ICD-10 services on the same bill Invalid ICD-10 Qualifiers Invalid Diagnosis Pointers 5

6 Vendor Reported Issues Vendor date edit error creating rejections for run off ICD-9 claims post Oct 1 effective date Vendor coding errors- creating rejections ( all reported issues have been resolved) Few vendors reported system issues, however were quickly addressed and not necessarily related to ICD-10 coding Reported Payer Comments To date Payers reporting the ICD-10 claims submission as a nonevent, again attributed to solid ICD- 10 testing with trading partners. Too early to project post adjudication impact. 6

7 ICD-10 Recommended Provider Benchmark Metrics % of ICD-10 Rejects/ Total Bills submitted % of 277 CA front end rejections by status code Revenue Payment Cycle Variance Metrics - Average time ( days) from claims submission to payment - Denial Rate Variance Metrics ( Payer/Provider Benchmark) - $ amount submitted on claim/ $ Denied - % of ASCX payment denials by type of denial code (CARC/RARC) 7

8 ICD-10 Recommended Payer Benchmark Metrics Standard Operating Metrics: The payers standard operating metrics will become increasingly important with the implementation of ICD-10 to monitor the automation efficiency and deviation from prior claim payment cycle times. Some of these operational metrics will include: Customer Service Call Volumes Payers can expect an increase in the numbers of calls from providers as they question diagnosis/procedure code billing procedures; check on the status of pended claims; and question the reason for denied claims for billing errors due to policy changes related ICD-10. This increase in volume may require additional resource to handle the volume at least during the initial transition period. Calls by Type Monitor the types of calls to proactively identify the root cause of underlying issues. A payer may want to monitor call volumes by: Source of initiation (provider, vendor, etc.), Primary purpose of call (authorization, payment discrepancy, payment cycle, medical necessity, etc.) Speed of Answer - Consider FAQ Prerecorded Responses 8

9 ICD-10 Recommended Payer Benchmark Metrics Claims Operations The payers claim adjudication performance and operating metrics will become increasingly important with the implementation of ICD-10 to monitor the claim payment automation efficiency and any deviation from prior adjudication baselines. Some of these metrics will include: Claims Auto Adjudication Rate Percent of total claim for a defined period of time that are adjudicated without manual intervention. Claims Accuracy or Rework Percentage of claims not adjudicating correctly and resulting in rework due to an ICD-10 impact. Claim Adjudication Cycle Time Average days to adjudicate the claim. This metric could be presented by claim or provider type. Suspended or Pended Claim Rates - The count and/or percentage of suspended claims by provider type and claim type 9

10 Workgroup Experience Tell us about the first few weeks of your ICD-10 transition. Are you seeing any particular challenges/issues that seem to be consistent across all of your providers? How are you addressing those challenges/issues? If you could give one piece of advice to providers to ensure a smooth processing of their claims, what would it be? Have you seen any impact on pended/denied claim rates with ICD-10 claims? How are referrals being affected? Do you have a designated line for providers to call with questions? If so, how has the traffic been? What are the wait times? If you do not have a designated line, how are you handling provider inquiries? 10

11 Update on ebilling States 11

12 Open Forum- New Business New Business What are the 3 areas that you would like to see the Workgroup focus on? Other 12

13 Thank You! WEDI P&C Subworkgroup Always Recruiting New Members! Next WEDI P&C Subworkgroup meeting is Dec, , 2:00 3:00 PM ET WEDI members sign up for P&C listserv at Nonmembers contact [email protected] for more information. 13