A Provider View on ICD-10 and the 2015 Delay


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How are providers coping with the delay of the ICD-10 implementation to 2015, when many had established budgets and training for being live 2014? Guests from Prime Health Physicians LLC and Harbor Oaks Eye join our Open Line Friday panel to share their experience. Visit floridablue.com/icd10 for a complete repository of tools and information.

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A Provider View on ICD-10 and the 2015 Delay

  1. 1. 900-3571-0213 Open Line Friday: ICD-10 Edition A Provider View on ICD-10 and the 2015 Delay Cesar Ortiz, Prime Health Physicians LLC Lori Ferguson, Harbor Oaks Eye May 16, 2014 9:30 a.m. – 10:30 a.m. EST Dial Toll-Free: (800) 882-3610 Conference Passcode: 6829655# 900-4451-0514
  2. 2. Open Line Friday: ICD-10 Panelists Deborah Stewart, MD Medical Director Florida Blue Gale Scott EDI Regulatory Compliance Administrator Tampa General Hospital Laurie Darst Revenue Cycle Regulatory Advisor Mayo Clinic (MN) Matthew Ketterman Director, Business Solutions Availity®1 Joseph Gonzalez VP of Business Development Secure EDI Lee Ratliff Clinical Business Technology Consultant Baptist Health South Florida Mary Rita Hyland CPO and VP Regulatory Affairs The SSI Group, Inc. Diana Brijbag, CMM, CPC, CCP, CMSCS Office Manager The Springs Family Medical Center George Vancore Senior Manager, Delivery Systems Mandates Florida Blue 1 Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit www.availity.com 2
  3. 3. Open Line Friday: ICD-10 May 16, 2014 Special Guests 3 Cesar Ortiz Chief Executive Officer Note: Practitioner guests are subject to unforeseen clinical or other emergencies. Should our guest(s) lack availability at the time of our program, Florida Blue will attempt to reschedule guest(s) for a future session. Lori Ferguson Billing Manager Harbor Oaks Eye Clearwater
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  5. 5. Open Line Friday: ICD-10 ICD-10 Delayed to 2015. Now What? Agenda May 16, 2014 5 1. Objectives 2. Healthcare Industry Updates 3. Florida Blue Updates 4. A Provider View on ICD-10 and the 2015 Delay 5. Next Steps
  6. 6. Open Line Friday Objectives 1. Promote collaboration, communication and coordination between providers, payers and electronic trading partners. 2. Expand your understanding of the current state of ICD-10, recent regulatory decisions and industry perspectives. 3. Raise your awareness and understanding of the unique opportunities and challenges that ICD-10 brings to the entire health care industry including providers, payers and electronic trading partners. 4. Provide you with tools, techniques, best practices and helpful hints from your peers that can be used as you continue (or begin) your ICD-10 journey. **** Please remember that during the call all attendees will be placed on “mute” except for any guest speakers and all panelists. If you have a question, please email it to FloridaBlueOpenLineFriday@FloridaBlue.com. 6 Open Line Friday: ICD-10
  7. 7. Open Line Friday: ICD-10 Health Care Industry & Regulatory Update On May 1, the Centers for Medicare & Medicaid Services (CMS) announced: • “On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.” • American Health Information Management Association (AHIMA), who launched a heavy lobby effort in late March to prevent another delay of the new code set, has applauded CMS for deciding to limit the delay to the one year minimum called for by Congress. “We know that the industry has already invested considerable time and money in implementation. We have long advocated for a coding system that offers flexibility and specificity, enables us to properly assess healthcare services, understand public health needs, and get the best rate of return from our national investment in EHRs and meaningful use,” said AHIMA officials in a press release. “All along, AHIMA has urged our members to „stay the course‟ of preparing for implementation. During the coming year, we recommend that the industry keep its momentum going, continuing to prepare by strengthening clinical documentation improvement programs, working with vendors on transition readiness, training coders and other stakeholders, and proceeding with dual coding.” 7
  8. 8. Open Line Friday: ICD-10 Health Care Industry & Regulatory Update (continued) • NUCC recently announced changes to the CMS 1500 professional paper claim form to accommodate ICD-10 (www.nucc.org); the following is the recommended transition timeline: • January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12). • January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05). • April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12). • CMS previously announced an ICD-9 and ICD-10 code set freeze which has been in effect since October 1, 2013. Do these code sets require “unfreezing”? • Several organizations are continuing their ICD-10 testing efforts. Are you planning to? 8
  9. 9. Florida Blue Update: • Florida Blue is deploying a full remediation strategy to implement ICD-10. • Florida Blue‟s ICD-10 initiative is proceeding on plan. We are in the process of completing our internal Compliance Level 1 testing and are engaged in Compliance Level 2 testing with providers and external entities. • Open Line Friday ICD-10 Edition teleconferences will continue every 3rd Friday of each month. Audio podcast recordings are available through the Podcast link located at www.floridablue.com/icd-10. • ICD-10 Testing with Providers: We are continuing to engage providers in Phase I and Phase II Testing. Phase III is in beta-test mode and will be generally available in the late May timeframe. Details of our provider testing, including a self-service option, are available at www.floridablue.com/icd-10. • Florida Blue‟s ICD-10 Provider Toolkit will be maintained going forward and is accessible from www.floridablue.com/icd-10. • Attention Small to Medium sized providers: “Build your action plan and start your transition to ICD-10 now with the CMS “Road to 10” tool. It‟s simple. Visit the www.roadto10.org” Open Line Friday: ICD-10 9
  10. 10. Cesar Ortiz, MBA, FACMPE , Chief Executive Officer, PrimeHealth Physicians, LLC, Miami, FL Lori Ferguson, Billing Manager, Harbor Oaks Eye, Naples, FL (refer to speakers’ supplemental material*) 10 Open Line Friday: ICD-10 A Provider View on ICD-10 and the 2015 Delay * If applicable, supplemental (guest speaker) program material can be accessed at www.floridablue.com/ICD-10 under Open Line Friday located in right margin.
  11. 11. . Send general ICD-10 questions and comments to floridablueopenlinefriday@floridablue.com. 11 Open Line Friday: ICD-10 A Provider View on ICD-10 and the 2015 Delay
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  13. 13. Next Steps Next Steps and Contact Information Access our Open Line Friday podcasts at www.floridablue.com/icd-10 ICD-10 Open Line Friday email list: send us your email by contacting us at floridablueopenlinefriday@floridablue.com Test ICD-10 with us. Visit www.floridablue.com/icd-10 and select our “Test ICD-10 icon” for details. Testing questions? Email us at ICD-10Testing@floridablue.com Access Florida Blue‟s ICD-10 Provider Toolkit and more at www.floridablue.com/ICD-10 Visit the Availity Learning Center (www.availity.com/learningcenter) to access live and webinars including information about Ready10 - a popular ICD-10 project management tool (see “There’s Ready and There’s Ready10”). Add/update your email address so we can keep you informed via email (Bluemail) Add, update or delete your email and contact information at any time using Availity's secure website. Log on to Availity at www.availity.com, select Payer Resources, Florida Blue and Update My Email Information with Florida Blue then follow the prompts. Open Line Friday: ICD-10 Follow us on Twitter @FLBlue 13
  14. 14. Addendum ICD-10 Helpful Resources and Reference Material • www.cms.gov/ICD10 • www.wedi.org • www.ama-assn.org • www.ahima.org/icd10 • www.availity.com • www.fha.org • www.hbma.com • www.mgma.com • www.floridablue.com/ICD-10 • www.fmaonline.org/HomePage.aspx • www.cdc.gov/nchs/icd/icd10.htm  For regular CMS ICD-10 email updates, subscribe at:  https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608  WEDI's Survey on Industry ICD-10 progress:  http://www.wedi.org/docs/comment-letters/2013-wedi-icd-10-survey-results-letter.pdf?sfvrsn=0  FREE CMS and WEDI ICD-10 End-to-End Testing Webinars available for download:  http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=220AC00000156  HIMSS/WEDI National ICD-10 Pilot Program Update:  http://www.himss.org/library/icd-10/national-pilot-program?navItemNumber=13477 Though not inclusive, the following list includes several public websites that can help increase general awareness and understanding of the ICD-10 mandate and its impact to the health care industry: The links below were referenced during this presentation. The actual URLs below are provided for your convenience: 14 Open Line Friday: ICD-10
  15. 15. Addendum Cesar Ortiz, MBA, FACMPE Cesar Ortiz is the Chief Executive Officer of PrimeHealth Physicians, LLC. Most recently, Cesar directed and managed physician practices for Tenet Florida Physician Services and HCA Physician Services. Previously, he was the Vice-Chair for Administration for the Department of Otolaryngology and Urology at the University of Miami, Miller School of Medicine. Cesar graduated from Miami-Dade College as a Respiratory Therapist working directly with patients and physicians. He has a Bachelor‟s degree in Health Services Administration from Florida International University and a Master‟s Degree in Business Administration from the University of Miami. Cesar has dedicated his professional career to the advancement of the professional management of physician practices. He is one of the elite members of the Medical Group Management Association to achieve Fellow Status through the American College of Medical Practice Executives. He currently serves on the national board of the Medical Group Management Association. He is a past-President of the Florida Medical Group Management Association and is co-founder of the South Florida chapter. Cesar has authored and published articles and peer review journals related to the field of medical practice management and taught at Barry University‟s Master of Health Services Administration Program. 15 Open Line Friday: ICD-10