Our November 2014 Open Line Friday call brings you updates from three major payers on their ICD-10 testing: Aetna, United, and Florida Blue. Follow our live tweeting of the call @FLBlue, or go to www.floridablue.com/icd-10 for a comprehensive list of resources.

1. 900-3571-0213
Open Line Friday: ICD-10 Edition
ICD-10: A Payer Update with
Aetna & United Health Group
Nov. 21, 2014
9:30 a.m. – 10:30 a.m. EST
Dial Toll-Free: (800) 882-3610 or (412) 380-2000
Conference Passcode: 6829655#
900-518-1104

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
Jackie Griffin
VP, U.S. Operations
Secure EDI
Lee Ratliff
Clinical Business Technology Consultant
Baptist Health South Florida
Mary Rita Hyland RN, BS, MBA, CHP Healthcare Industry Consultant
Diana Brijbag
CMM, CPC, CCP, CMSCS, HITCM-PP
Office Manager
The Springs Family Medical Center
George Vancore Senior Manager, Delivery Systems Mandates and Compliance Florida Blue
*Panelists are subject to availability.
1 Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit www.availity.com
2
Joseph Nichols, MD Principal, Health Data Consulting

3. Special Guests for Nov. 21, 2014:
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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.
Brian Parkany Senior Director Strategic Initiatives
Shirley Reynolds
Senior Product Manger
Open Line Friday: ICD-10

4. Open Line Friday: ICD-10
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ICD-10: A Payer Update with Aetna & United Health Group Agenda for Nov. 21, 2014
1.Objectives
2.Healthcare Industry Regulatory Update
3.Brian Parkany, Aetna
4.Shirley Reynolds, United Health Group
5.Next Steps
Follow us on Twitter @FLBlue

5. 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.
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Open Line Friday: ICD-10

6. Open Line Friday: ICD-10
Health Care Industry & Regulatory Update
•Medicare announced two rounds of ICD-10 testing with physicians/provider:
•Functional Acknowledgement Testing: this is where you test the “chain of trust” partners from the provider to the payer (Medicare) using an ICD-10 coded claim; Medicare will edit and compliance check the claim and return a response to the sender; there is no claim adjudication or ERA is being generated during this round of testing; test claims can be sent to Medicare anytime up to the October 1, 2015 implementation date;
•Special Functional Acknowledgement Testing Weeks: Medicare submitters will have access to real-time help desk support during the weeks of November 17th through the 21st, 2014; March 2nd through the 6th, 2015 and June 1st through the 5th, 2015.
•End-to-end testing: this is where ICD-10 coded claims are sent to the Medicare (the payer), adjudicated and an ERA is generated back to the provide; participation in Medicare’s end-to-end testing requires enrollment and selection by your MAC; on a national basis, Medicare is limiting the number of testing providers to 2550.
•For additional details, please see the following:
•http://medicare.fcso.com/ICD-10/267332.pdf
•www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/SE1409.pdf
•http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/MM8858.pdf
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7. Health Care Industry & Regulatory Update (cont’d)
•NUCC changed the CMS 1500 professional paper claim form to accommodate ICD-10 (see www.nucc.org); the transition to this new form began in January 2014 and continues across the health care industry.
•Partial code freeze continues until one year after the implementation of ICD-10:
•Only codes for new diagnosis or new technologies will be considered for exception inclusion.
•Last regular updates to ICD-9-CM and ICD-10 occurred on October 1, 2011.
•Regular ICD-10 updates will begin on October 1, 2016.
•Miscellaneous health care industry and regulatory updates will be provided from our panelists when applicable and when time permits.
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Open Line Friday: ICD-10

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Visit www.floridablue.com/icd-10 and select the Test ICD-10 Icon:
ICD-10 Provider Testing
Testing ICD-10 is one of the more critical success factors in achieving ICD-10 compliance and managing
your revenue interruption risk. Florida Blue is recommending ICD-10 provider testing in the three phases
below. Links to testing instructions and other important details are available below for initiating testing with
us. Questions? Email us at ICD-10Testing@floridablue.com.
Testing Results may be accessed following Phase III Instructions below.
ICD-10 Testing Phase
Start
Date(s)
Instructions for Test Phase
Phase I
“Code Validation”
Now
Phase I testing (click here for overview) involves coding a selection
of clinical diagnosis scenarios developed by Florida Blue Nurse
Coders. You can print out the scenarios for your staff to code in both
ICD-9 and ICD-10 for you to compare. This is a manual process and is
available for you on a self-service basis. Clinical Scenarios are
available in the instructions below.
Phase I Instructions: (click here)
ICD-10 Testing Phase
Start
Date(s)
Instructions for Test Phase
Phase II
“Internal End-to-End”
Now
Phase II testing (click here for overview) consists of electronic
receipt and internal processing of ICD-10 coded claims transactions
that were previously processed by Florida Blue with ICD-9 codes.
The instructions contain contact information for a Florida Blue ICD-10
testing coordinator in order to initiate Phase II testing
Phase II Instructions:
Providers (click here)
Vendors (click here)
ICD-10 Testing Phase
Start
Date(s)
Instructions for Test Phase
Phase III
“Round-Trip”
Now
Phase III testing (click here for overview) pertains to the “Round-trip”
processing of ICD-10 coded electronic claim and remittance
advice transactions. Phase II testing is a prerequisite.
(click here)
Phase III Instructions:
Providers (click here)
Vendors (click here)
Open Line Friday: ICD-10
A Florida Blue Update

9. 9
ICD-10: A Payer Update with Aetna
Brian Parkany
Senior Director, Strategic Initiatives
Open Line Friday: ICD-10

10. 10
ICD-10: A Payer Update with United Health Group
Shirley Reynolds
Senior Project Manager
Open Line Friday: ICD-10

11. .
Send ICD-10 questions, comments or feedback to
floridablueopenlinefriday@floridablue.com.
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Open Line Friday: ICD-10

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ICD-10
The most effective
way to do it,
is to do it!
– Amelia Earhart

13. Next Steps
Next Steps Build your ICD-10 action plan now with the CMS “Road to 10” tool. Visit www.roadto10.org 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 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.
Follow us on Twitter @FLBlue
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Open Line Friday: ICD-10

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
•www.AAPC.com
For regular CMS ICD-10 email updates, subscribe at:
https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608
WEDI's 2014 Survey on Industry ICD-10 Readiness:
http://www.wedi.org/news/press-releases/2014/08/04/WEDI-Releases-ICD10-Readiness-Survey
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:
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Open Line Friday: ICD-10