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900-3571-0213
Open Line Friday: ICD-10 Edition
ICD-10: A Prospective View from
Two Social Media Pros
Dec. 19, 2014
9:30 a.m. – 10:30 a.m. EST
Dial Toll-Free: (800) 882-3610 or (412) 380-2000
Conference Passcode: 6829655#
900-581-1204
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
Special Guests for Dec. 19, 2014:
3
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.
Open Line Friday: ICD-10
Steve Sisko
Senior IT Project Manager, Healthcare
Government Programs & Pharmacy,
Cambia Health Solutions
(follow @ShimCode on Twitter)
Joe Lavelle
Executive Healthcare IT and
Management Consultant
(follow @Resultant on Twitter)
Open Line Friday: ICD-10
4
ICD-10: A Prospective View from Two Social Media Pros
Agenda for Dec. 19, 2014
1. Objectives
2. Healthcare Industry Regulatory Update
3. Role of Social Media in ICD-10 Landscape
4. Next Steps
Follow us on Twitter @FLBlue
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.
5
Open Line Friday: ICD-10
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
6
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.
7
Open Line Friday: ICD-10
8
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
.
Send ICD-10 questions, comments or feedback to
floridablueopenlinefriday@floridablue.com.
9
Open Line Friday: ICD-10
12
ICD-10
The most effective
way to do it,
is to do it!
– Amelia Earhart
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
11
Open Line Friday: ICD-10
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:
12
Open Line Friday: ICD-10

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ICD-10 Open Line Friday Meeting December 2014

  • 1. 900-3571-0213 Open Line Friday: ICD-10 Edition ICD-10: A Prospective View from Two Social Media Pros Dec. 19, 2014 9:30 a.m. – 10:30 a.m. EST Dial Toll-Free: (800) 882-3610 or (412) 380-2000 Conference Passcode: 6829655# 900-581-1204
  • 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 Dec. 19, 2014: 3 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. Open Line Friday: ICD-10 Steve Sisko Senior IT Project Manager, Healthcare Government Programs & Pharmacy, Cambia Health Solutions (follow @ShimCode on Twitter) Joe Lavelle Executive Healthcare IT and Management Consultant (follow @Resultant on Twitter)
  • 4. Open Line Friday: ICD-10 4 ICD-10: A Prospective View from Two Social Media Pros Agenda for Dec. 19, 2014 1. Objectives 2. Healthcare Industry Regulatory Update 3. Role of Social Media in ICD-10 Landscape 4. 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. 5 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 6
  • 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. 7 Open Line Friday: ICD-10
  • 8. 8 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. . Send ICD-10 questions, comments or feedback to floridablueopenlinefriday@floridablue.com. 9 Open Line Friday: ICD-10
  • 10. 12 ICD-10 The most effective way to do it, is to do it! – Amelia Earhart
  • 11. 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 11 Open Line Friday: ICD-10
  • 12. 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: 12 Open Line Friday: ICD-10