What s Up Wednesday. Together Let s Get ICD-10 Ready. Date: January 21, 2015 Time: 2 3 p.m. Phone Number: Passcode:

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1 What s Up Wednesday Together Let s Get ICD-10 Ready Date: January 21, 2015 Time: 2 3 p.m. Phone Number: Passcode: Presented by the Pennsylvania Blues Plans

What s Up Wednesday and ICD-10 Increase Collaboration, communication, education and coordination between hospitals,

industry perspectives Raise Awareness and understanding of the unique challenges that ICD-10 brings to the entire

implementation Please remember that during the call all attendees are on mute except for any guest speakers and

2 What s Up Wednesday and ICD-10 Increase Collaboration, communication, education and coordination between hospitals, physicians, payers and vendors Expand Understanding of the current state of ICD-10, recent regulatory decisions and industry perspectives Raise Awareness and understanding of the unique challenges that ICD-10 brings to the entire health care industry Provide Tools, techniques, best practices, and helpful hints that can be used to support ICD-10 implementation Please remember that during the call all attendees are on mute except for any guest speakers and panelists. Please any questions you would like addressed during or after the call to ICD10ProviderCommunication@capbluecross.com.

3 Today s ICD-10 Agenda HAP (Hospital & Healthsystem Assn of PA) Martin Ciccocioppo Vice President, Research Pennsylvania Medical Society Lara Brooks CPC, Associate Director, Practice Economics and Payer Relations PA Blues Independence Blue Cross Tim Wadsworth, Director Provider Communications Highmark Deb Cotter, Director, Strategic Programs Blue Cross of Northeastern Pennsylvania Kevin J. Quaglia, Senior Manager Provider Services Capital BlueCross Lisa McNaughton, ICD-10 IT Project Manager

4 The Hospital & Healthsystem Association of Pennsylvania Martin Ciccocioppo Vice President, Research

5 ICD-10 changes EVERYTHING. Are You Ready? ICD-10 Survey Implementation Progress and Testing Efforts Results for Pennsylvania Hospitals March 2014

747 hospitals nationwide participated In Pennsylvania, 26 general acute care (GAC)

6 Data Source The AHA s Response to the ICD-10 survey was sent to more than 4,900 hospitals nationwide in January hospitals nationwide participated In Pennsylvania, 26 general acute care (GAC) hospitals responded 16% response rate Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

7 Is your hospital doing the following, in preparation for ICD-10 implementation? 100% 80% 80% 72% Working with vendors to upgrade information systems 60% 40% 20% 12% 20% 16% 0% 0% Yes, ready for implementation Yes, efforts underway and on track Yes, efforts underway, but behind schedule 0% 0% No, have not started Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

8 Do you anticipate hiring, or have you hired, additional coding staff for ICD-10 implementation? No 20% Yes, both temporary and permanent staff 20% Yes, temporary staff 28% Yes, permanent staff 32% Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

Will your hospital code claims in both ICD-9 and ICD-10?

not started 16% Yes, efforts underway and on track 52%

9 Will your hospital code claims in both ICD-9 and ICD-10? Yes, efforts underway, but behind schedule 32% No, have not started 16% Yes, efforts underway and on track 52% NOTE: No hospitals (0%) reported being ready for implementation. Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

10 Is your hospital educating staff physicians on the changes needed to support ICD-10? Yes, but not yet started 92% No 4% Yes, already underway 4% Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

ICD-10 Testing Efforts Internal Testing: Allows a hospital to assess whether system changes are working properly, documentation is sufficient, and the coding process is working appropriately.

11 ICD-10 Testing Efforts Internal Testing: Allows a hospital to assess whether system changes are working properly, documentation is sufficient, and the coding process is working appropriately. It can also support simulations of the impact of the new coding system on payments. External Testing: Allows assessment of whether claims can be transmitted, and whether the payer and hospital are interpreting codes and documentation requirements in the same manner. Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals,

Has your hospital conducted internal testing of

(Feb- Apr) 28% Unsure 4% Already underway 12%

12 Has your hospital conducted internal testing of your coding and claims preparation in advance of ICD-10? Planned for Summer (Mar-Jun) 56% Planned for Spring (Feb- Apr) 28% Unsure 4% Already underway 12% Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

13 External testing of ICD-10 coded claims with health plans: 70% 60% 50% 40% 30% 20% 10% 0% BCBS Other Commercial Medicaid Medicare Other insurer* Prior to Mar % 13% 0% 0% 0% Mar-Apr % 8% 16% 52% 60% May-Jun % 46% 28% 12% 20% Jul-Aug % 17% 16% 16% 20% No testing plans 25% 17% 40% 20% 0% *Other insurers named were Geisinger Health Plan, Aetna, managed care plans. Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

14 If your hospital has already begun external testing with health plans, have you experienced any of these problems? Issues with connectivity and transmission Issues with processing the ICD-10 codes Other issues No hospitals (0%) reported having problems or issues. Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

How confident are you that your hospital is going to be ready to report the new ICD-10 diagnosis and procedure codes by the compliance date of October 1, 2014?

15 How confident are you that your hospital is going to be ready to report the new ICD-10 diagnosis and procedure codes by the compliance date of October 1, 2014? 60% 50% 48% 40% 30% 20% 10% 0% 0% 8% 24% 20% NOT CONFIDENT VERY CONFIDENT Mean confidence rating = 3.80 Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

To what degree do the following factors pose a risk to your hospitals timely

VERY SIGNIFICANT 5 Mean Scores 4 3.7 3.6 3.8 4.0 3.7 3 3.

upgrades Timely testing with Medicare Timely testing with Medicaid Timely

16 To what degree do the following factors pose a risk to your hospitals timely meeting of the ICD-10 compliance date of October 1, 2014? VERY SIGNIFICANT 5 Mean Scores NOT SIGNIFICANT 1 Capital resources Coding staff resources Timely vendor upgrades Timely testing with Medicare Timely testing with Medicaid Timely testing with commercial insurers Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar

17 Ongoing ICD-10 Efforts HAP encourages members to volunteer to participate in Medicare End-to-End testing. HAP will work with the American Hospital Association in fielding a ICD-10 readiness survey in January HAP will work with the AHA and the Blue plans to increase awareness of ICD-10 readiness deadline and testing progress. HAP will fight any attempts at further delays in implementing ICD-10.

18 18 Industry Letter from America s Hospitals and Healthsystems to the US House of Representatives and United States Senate

19 Pennsylvania Medical Society

20 Pennsylvania Medical Society Steps for a Successful ICD-10 Transition

21 Pennsylvania Medical Society Make sure everyone is informed about ICD-10 How is practice going to implement? What areas will be impacted

22 Pennsylvania Medical Society Conduct impact analysis Consider all processes linked to diagnosis Estimate potential cost impact Vendor readiness

23 Pennsylvania Medical Society Everyone will require some level of training ICD-10 Resources Review and communicate changes in documentation PAMED Crosswalks Code Set Training

24 Independence Blue Cross is committed to supporting provider readiness by: Continuing our communication efforts Publishing monthly articles in our Partners in Health Update SM newsletter Participated in a phone interview earlier this month with local radio station to support compliance and convey our efforts to date Implementing external testing Currently in the process of revising our testing plan, we will resume testing within the next few months Maintaining a dedicated ICD-10 website Extensive coding exercises available for our providers FAQ is updated on a continuous basis, as new questions are submitted from providers and clearing houses What s Up Wednesday website contains detailed information on upcoming calls and a complete archive of past calls and materials Websites ICD-10: What s Up Wednesday: IBC ICD-10 Mailbox: icd10@ibx.com

25 Since 2010, iterative internal functional testing in execution mode. In 2014, testing expanded to include external clinical coding testing. 1st Quarter 2015 Continue with iterative internal testing Expand clinical coding testing to any interested provider or facility Analyze clinical coding test execution results Monitor vendor readiness Monitor trading partner and clearinghouse readiness 2nd Quarter 2015 Continue with iterative internal testing Expand clinical coding to any interested provider or facility Publish clinical coding testing findings via the Provider Resource Center Complete limited end-to-end testing Monitor vendor readiness Monitor trading partner and clearinghouse readiness Highmark ICD-10 Mailbox:

End- to-end testing targeted to begin in the 1st Quarter of 2015. Testing may be limited to only a portion of the test claims submitted.

26 End- to-end testing targeted to begin in the 1st Quarter of Testing may be limited to only a portion of the test claims submitted. Test claims are limited to the First Priority Health (FPH) product. We will not be able to test with every provider who submits test claims through their clearinghouse. Testing must be conducted through the providers existing EDI connection. BCNEPA ICD-10 Mailbox: ICD10Inquiries@bcnepa.com

27 ICD-10 Testing: The majority of work in 2015 will be focused on end-to-end testing. Slated to begin Q and end Q We will not test with every provider, but we will test with any provider that requests testing. We will test with large volume and specialty providers and large volume clearinghouses. What will be Tested: Claims submission, processing, and payment. On February 1, 2015, Capital will open Content-Based Testing for Professional Providers. It will be available until April 1, CBC ICD-10 Mailbox:

28 Questions

29 If You Have A Question. If you have a question, please it to ICD10ProviderCommunication@capbluecross.com so we can address it during the call. We would like to hear from you so please send your feedback to: o Capital BlueCross: ICD10PC@capbluecross.com o Highmark: ICD-10Inquiries@highmark.com o Independence BlueCross: icd10@ibx.com o BCNEPA: ICD10Inquiries@bcnepa.com

30 Helpful Links Pennsylvania Medical Society The Hospital & Healthsystem Association of Pennsylvania CMS (Center for Medicare & Medicaid Services ICD-10 WATCH ZIRMED Innovating Connected Healthcare WEDI ICD-10 HUB

31 Next What s Up Wednesday Call Next What s Up Wednesday Call: February 18, 2015 from 2 to 3PM EST Visit a PA Blue s Plan website for more information: Capital BlueCross Blue Cross Northeastern PA Independence Blue Cross Highmark Blue Shield nts/prof-pub/icd10-library.html We would like to hear from you so please send your feedback to ICD10ProviderCommunication@capbluecross.com

What s Up Wednesday. Together Let s Get ICD-10 Ready. Date: August 21, 2013 Time: 2pm 3pm Phone Number: Pass Code:

What s Up Wednesday. Together Let s Get ICD-10 Ready. Date: August 21, 2013 Time: 2pm 3pm Phone Number: Pass Code: What s Up Wednesday Together Let s Get ICD-10 Ready Date: August 21, 2013 Time: 2pm 3pm Phone Number: 1-800-882-3610 Pass Code: 5411307 Presented by the Pennsylvania Blues Plans Today s Agenda Introduction