Emdeon FVT Paper-to-EDI Conversion ICD-10 Frequently Asked Questions. Published Q2 2014

Transcription

1 Emdeon FVT Paper-to-EDI Conversion ICD-10 Frequently Asked Questions Published Q2 2014

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. 2013, 2014 Emdeon Business Services LLC, 3055 Lebanon Pike Suite 1000, Nashville, TN All Rights Reserved. Printed in the USA.

3 Contents Customer Communications... 4 Readiness & Planning... 4 ICD Code Utilization... 5 Cross-Walking Position... 6 Contingency Planning... 6 Customer Impact... 7 External Testing Approach... 7

4 Customer Communications Q: Who is the primary contact for discussing questions regarding Emdeon's ICD-10 remediation and implementation activities? A: Please contact your Emdeon Payer Service Manager. Q: Do you have a mechanism in place to distribute or publish information about your organizations ICD-10 preparations, project status and conversion plan? A: Emdeon has published an ICD-10 Playbook that provides a progress and status timetable for our ICD-10 implementation. This Playbook is available at Readiness & Planning Q: Will your products be ready for the ICD-10 compliance date? A: Yes, Emdeon s FVT Paper-to EDI (P2E) ICD-10 remediation is targeted to be completed for all three P2E lines of business well in advance of the compliance date. Q: What is the communication schedule for keeping customers informed of remediation milestone progress? A: Communication regarding ICD-10 remediation will be provided in the regular monthly client scorecards and client updates. Q: What are the most significant risks or obstacles for your organization regarding ICD- 10 implementation? A: Based on historical experience with other regulatory effective dates, Emdeon's belief is that some health care organizations (both providers and health plans) will not be ready on the compliance date. Because ICD-10 will be a point in time cutover, both Emdeon and the industry at large will have little insight into the actual readiness and production experience until after the compliance date.

5 Q: When do you expect to start internal testing? A: Emdeon began internal testing in Q ICD Code Utilization Q: Will the product allow for coding in both ICD-9 and ICD-10 to accommodate transactions with dates of service before the compliance date and transactions with dates of service after the compliance date? A: Emdeon Paper-to-EDI will be able to extract and validate both ICD-9 and ICD- 10 transactions with dates of service before and after the mandated usage date. Emdeon will implement ICD-10 on the compliance date. Until a new regulation from HHS is provided or further guidance from CMS is received, early adoption of ICD-10 for providers and health plans will not be supported, and ICD-10 coded transactions will not be accepted in our production environments prior to the compliance date. Q: For data files sent to Emdeon by customers, does Emdeon have the capability to differentiate ICD-9 and ICD-10 records in the same file? A: Emdeon will determine whether records utilize ICD-9 or ICD-10 code format based upon the format of the primary diagnosis field. Q: Will Emdeon no longer support ICD-9 codes after the compliance date? A: Emdeon expects that there will be late filings and adjustments which will require ICD-9 codes for service dates or discharge dates that are prior to the compliance date. ICD-9 Codes will continue to be supported for: Non-covered entities (i.e. Workers Compensation), corrected, resubmitted, run-out claims, secondary (COB) and subrogation claims. Q: What data validation changes are required to support ICD-10 related changes to the application?

6 A: Diagnosis code format and content validation has been modified to allow for either ICD-9 or ICD-10 code format and content. Logic validating the length and format of the codes was modified. Q: Will Emdeon support the use of both ICD-9 and ICD-10 codes on the same claim? A: Per CMS Guidance, both ICD-9 and ICD-10 codes cannot be on the same claim; claims that span the compliance date must be split. Q: Will Emdeon require ICD-10 based on the service/discharge date on or after the compliance date? A: Emdeon s standard approach, consistent with the level of editing performed for ICD-9, will be to validate the accuracy of the code against the scanned claim. If a provider sends an ICD-9 code with an ICD-9 qualifier after the ICD-10 compliance date, and the code is valid, Emdeon will pass the claim on to the health plan (this approach provides health plans visibility as to which providers are continuing to use ICD-9 codes). Cross-Walking Position Q: Will a mapping or cross-walk strategy be used between ICD-9 and ICD-10 code sets? A: No, Emdeon software does not include an ICD-9 to ICD-10 mapping or crosswalk strategy. Contingency Planning Q: Has there been any contingency planning / thoughts around what to do if Emdeon is not ready? A: Emdeon has allocated significant resources toward ICD-10 and all remediation activities are planned to be completed long before the compliance date..

7 Customer Impact Q: Do you anticipate any pricing changes (financial or contractual impact) to the Emdeon services due to ICD-10 implementation? A: Emdeon P2E clients will incur no cost for standard ICD-10 migration. However, any payer specific logic for custom ICD-10 handling may incur charges. Emdeon is reviewing the effort required to process the additional fields on the new form. Based on our analysis once the forms are in use there may be some cost adjustments implemented to cover the increased effort. Q: Are there any new hardware requirements associated with ICD-10-related software changes? A: There are no new customer hardware requirements associated with ICD-10 related modifications. Q: Must a contract addendum be signed before work on the system modifications? If so, what are the terms of the contract addendum? A: No contract addendum is required for work to make Emdeon products ICD-10 ready. Contract addenda will be required for optional services (non-standard). External Testing Approach Q: When will Emdeon be ready for partner testing (external)? A: Emdeon is ready to test with external customers now. Q: Has Emdeon scheduled a date to test your system for ICD-10 upgrade? A: Each P2E client may contact their payer service manager to schedule testing. Although it is not imperative that each client perform ICD-10 P2E testing, it is recommended that the client participate in ICD-10 P2E testing.

8 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 , 2014 Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )