ICD-10 Checkpoint: Update for NJ-HFMA Jim Hennessy June 2015 e4 - - PowerPoint PPT Presentation
ICD-10 Checkpoint: Update for NJ-HFMA Jim Hennessy June 2015 e4 Services LLC Discussion Topics Industry Checkpoint on ICD-10 Readiness and Compliance Date Checkpoint on NJ-specific actions and activities for ICD-10 Readiness
e4 Services LLC
Readiness
for consideration:
stated their desire to see ICD-10 implemented this year with no further delays
Act)- Propose a 18 month transition period for CMS acceptance of claims – During this period, no reimbursement claim submitted to CMS could be denied due solely to the "use of an unspecified or inaccurate subcode."
to be introduced and passed by these dates
risk will remain until October that another delay may be introduced.
– 875 participating provider organizations – 23,138 test claims received – 20,306 test claims accepted (88%) – 2% rejected due to invalid submission of ICD-10 codes – 50% professional claims, 43% Institutional, 7% Supplier
– Technical Claim Acknowledgement validates that a claim submitted with ICD-10 data is able to get to payer and accepted for processing – Most rejections were unrelated to use of ICD-9 or -10 codes
– Advance Claim Testing validates that payer was able to process claim for payment and provide remittance advice back to provider – Regional participants reported success in getting payment results on their test claims and that the payments were in line with expectations – Virtua, Cape Regional, Kennedy, Cooper, Meridian
1. Will my organization be able to get bills out in a timely manner?
2. Will there be additional operational costs to get bills out?
3. Will my key payers be able to accept my claims?
4. Will my key payers continue to reimburse my organization based
activities, including areas such as: – System Testing – Payer/Clearinghouse Testing – Business Processes Testing – Documentation and Coding Validation – Other External Stakeholder Testing
and other collaborative testing opportunities
sessions
– Provider Organizations – Payer Organizations – Software Vendors – EDI/Clearinghouse Vendors – Other stakeholders
– Availability and commitment to attend/participate calls/meetings and share information on your organization’s test plans, activities, and results
stakeholder organization types
Has a comprehensive testing plan been established – and being executed
systems, including all billing systems
validate readiness
1. Can I generate claims with ICD-10 information from ALL of my billing systems? – “Can I get bills out the door after October 1st?” 2. Can I successfully transmit my claims through my trading partners and get them to all of my payers, especially my key payers? – “Will all of my key payers be able to accept ICD-10 based claims?” 3. Can I learn how my key payers will handle my claims once I start sending them with ICD-10 information? – “Are my expected reimbursements going to change with any of my payers?”
considered for all of your billing system and key payer combinations
Provider Organization Payer Organization EDI/ Clearinghouse
Internal system and “scenario” tests Pt Intake ICD10 Claim Generated
“Level 1” Validation
Technical Claim Validation test ICD10 Claim File ICD10 Claim Acceptance By EDI vendor ICD10 Claim Acceptance By payer
“Level 2” Validation
Technical Claim Validation test ICD10 Claim File ICD10 Claim accepted and processed by payer Reports and/or 835 transmission Claim Remittance Advise
“Level 3” Validation
(DRG), Virtua (Professional focus and Institutional), DaVita Dialysis
including AtlantiCare, Inspira, Hackensack, and others
be testing thru Emdeon
(CHOP, Cooper (prof/Institutional), Virtua)
sets for that chart
– What should I expect my increased cost for coding to be? – What impact on my DNFB should I be preparing for?
weaknesses
– What gaps and opportunities will we identify in being able to code a chart in ICD-10 based on clinical documentation practices?
identification of “uncodable” charts
Dual Coding Coder Education Tools Data Capture
While Coders should have basic ICD-10 skills in order to start dual coding, it is not necessary to wait until all education is
education early will help build confidence. Encoder or code books? Either will work at the beginning stages. Access to a grouper is a must to obtain MCC/CC and MS-DRG information. Work aggressively towards upgrading and configuring the production environment so that ICD-10 codes and MS-DRG data can be saved, used for testing, and contribute to your ICD-10 knowledge base. Doing so will also make best use of Coders’ time.
– Coder codes chart in ICD-9 and then in ICD-10
– Coder A codes chart in ICD-9; Coder B code same chart in ICD-10
– Several Coders code the same chart in ICD-10
– Coder codes chart in ICD-10 and allows encoder to generate corresponding ICD-9 codes for billing purposes
Codes be able to successfully support business operations after the October 1st transition, and during that transition period?
stakeholders to perform their jobs – register, provide patient care, get bills out
inventory that
needed
Systems in any of these statuses are a risk to your
1. Claim Submission and Handling with DOS surrounding Sept 30-Oct 1st
2. What if Medicare or any payer has processing problems
required to? What is an acceptable delay in processing? Do they have a means
1. How will Payers handle Authorization and Referral Requests
1. When will you be able to accept authorization/referral requests with ICD- 10 Dx codes for services expected to be delivered after October 1st
2. How will your systems handle claims with DOS after October 1st but associated with an auth/referral approved using ICD-9 Dx
between the authorization request and the submitted claim
3. How will your systems handle claims with DOS before October 1st but the auth/referral was submitted with ICD-10 Dx (since they thought the patient would not present until after October 1)
between the authorization request and the submitted claim
1. Will my organization be able to get bills out in a timely manner?
2. Will there be additional operational costs to get bills out?
3. Will my key payers be able to accept my claims?
4. Will my key payers continue to reimburse my organization based
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