What s Up Wednesday Together Let s Get ICD-10 Ready Date: January 21, 2015 Time: 2 3 p.m. Phone Number: 800-882-3610 Passcode: 5411307 Presented by the Pennsylvania Blues Plans
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 e-mail any questions you would like addressed during or after the call to ICD10ProviderCommunication@capbluecross.com.
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
The Hospital & Healthsystem Association of Pennsylvania Martin Ciccocioppo Vice President, Research martinc@haponline.org 717-561-5363
ICD-10 changes EVERYTHING. Are You Ready? ICD-10 Survey Implementation Progress and Testing Efforts Results for Pennsylvania Hospitals March 2014
Data Source The AHA s Response to the ICD-10 survey was sent to more than 4,900 hospitals nationwide in January 2014. 747 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 2014 6
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 2014 7
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 2014 8
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 2014 9
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 2014 10
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, 2014 11
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 2014 12
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 2014 4% 13% 0% 0% 0% Mar-Apr 2014 8% 8% 16% 52% 60% May-Jun 2014 46% 46% 28% 12% 20% Jul-Aug 2014 17% 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 2014 13
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 2014 14
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% 1 2 3 4 5 NOT CONFIDENT VERY CONFIDENT Mean confidence rating = 3.80 Source: AHA Quick Response ICD-10 Survey, Results for Pennsylvania acute care hospitals, Jan-Mar 2014 15
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 4 3.7 3.6 3.8 4.0 3.7 3 3.0 2 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 2014 16
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 2015. 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 Industry Letter from America s Hospitals and Healthsystems to the US House of Representatives and United States Senate
Pennsylvania Medical Society
Pennsylvania Medical Society Steps for a Successful ICD-10 Transition
Pennsylvania Medical Society Make sure everyone is informed about ICD-10 How is practice going to implement? What areas will be impacted
Pennsylvania Medical Society Conduct impact analysis Consider all processes linked to diagnosis Estimate potential cost impact Vendor readiness
Pennsylvania Medical Society Everyone will require some level of training ICD-10 Resources Review and communicate changes in documentation PAMED Crosswalks Code Set Training
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: www.ibx.com/providers/claims_and_billing/icd_10/index.html What s Up Wednesday: www.ibx.com/providers/claims_and_billing/icd_10/whatsupweds.html IBC ICD-10 Mailbox: icd10@ibx.com
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: ICD-10Inquiries@highmark.com
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. 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
ICD-10 Testing: The majority of work in 2015 will be focused on end-to-end testing. Slated to begin Q1 2015 and end Q2 2015. 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, 2015. CBC ICD-10 Mailbox: ICD10ProviderCommunication@capbluecross.com
Questions
If You Have A Question. If you have a question, please e-mail 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
Helpful Links Pennsylvania Medical Society http://www.pamedsoc.org/ The Hospital & Healthsystem Association of Pennsylvania https://www.haponline.org/ CMS (Center for Medicare & Medicaid Services http://www.cms.gov/medicare/coding/icd10/index.html?redirect=/icd10 ICD-10 WATCH http://www.icd10watch.com/ ZIRMED Innovating Connected Healthcare http://icd.zirmed.com/ WEDI http://www.wedi.org/workgroups/icd-10 ICD-10 HUB http://www.icd10hub.com/
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 https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/forhealthprofessionals/icd-10/icd-10home Blue Cross Northeastern PA https://www.bcnepa.com/privacy/icd-10.aspx Independence Blue Cross http://www.ibx.com/providers/claims_and_billing/icd-10.html Highmark Blue Shield https://prc.highmark.com/rscprc/hbs/pub?document=https%3a//www.highmarkblueshield.com/health/docume nts/prof-pub/icd10-library.html We would like to hear from you so please send your feedback to ICD10ProviderCommunication@capbluecross.com