ICD-10 Compliance Project Status - Indiana Medicaid Provider

November Update

ICD-10 Compliance Project Status

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Presented by Hewlett-Packard Enterprise Services

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November 2012

Topics          

Estimated timeline ICD-10 news Your ICD-10 questions From CMS ICD-10 education ICD-10 Vendor Readiness Survey 6 HP ICD-10 readiness ICD-10 Information pages Contact information Questions?


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November 2012

Estimated timeline  Assessment Phase (Gap Analysis/Impact Report) . . . . . . . . . . . . . . . . . . . . . . . September 2011  Implementation Options, Recommendations, and Strategy Report to FSSA . . . . . . . . . . . . . . . . . . . . . . . September 2011  Steering committee review and approval . . . . . . . . . . . . . . . . . October 2011  Master Design, Development, and Implementation (DDI) Work Plan . . . . . . . . . . . . . . . . . . December 31, 2011  Integrated DDI Master Project Schedule . . . . . . . . . . . . December 31, 2011 

Implementation Phase complete . . . . . . . . . . . . . . . . . . December 31, 2012

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Vendor/provider testing activities . . . . . . . . . . . . January 2013 – June 2014

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Operational Readiness Review . . . . . . . . . . . . . . . . . . . . . . . . August 2013

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Go Live . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . October 1, 2014


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November 2012

ICD-10 news


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November 2012

ICD-10 news Implementation date is October 1, 2014 The ICD-10 implementation date is October 1, 2014, with no exceptions. See the ICD-10 Information page on the Indiana Medicaid website for ICD-10 news updates.


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November 2012

ICD-10 news ICD-10 countdown clock Have you seen the ICD-10 countdown clock? The ICD-10 Information page on the Indiana Medicaid website now displays an ICD-10 countdown clock that displays the number of days until the October 1, 2014, implementation date.


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November 2012

Your ICD-10 questions


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November 2012

Your ICD-10 questions If an ICD-9 claim is submitted before the compliance date, but an adjustment is completed after the compliance date, should the adjustment be submitted with ICD-9 or ICD-10 data? Both ICD-9 and ICD-10 claims are processed using the date of service (DOS). ICD-9 codes are effective for DOS prior to October 1, 2014, and ICD-10 codes are effective for DOS on or after October 1, 2014. No matter when the claim is adjusted, it should be adjusted with ICD-9 data if the Date of Service (DOS) is prior to October 1, 2014. If the DOS is being adjusted from a DOS prior to the ICD-10 effective date of October 1, 2014, to a DOS on or after the ICD-10 effective date, the ICD-9 claim would be reversed using ICD-9 data and resubmitted using ICD-10 data. Presented by Hewlett-Packard Enterprise Services

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November 2012

Your ICD-10 questions If an ICD-9 claim is submitted before the compliance date, but an adjustment is completed after the compliance date, should the adjustment be submitted with ICD-9 or ICD-10 data? (continued) NOTE: Claim types I (inpatient), A (inpatient crossover), and L (long-term care) will use the THROUGH DOS to validate the ICD version. All other claim types will use the FROM DOS.


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November 2012

Your ICD-10 questions The Healthy Indiana Plan (HIP) may or may not be coming to an end. If it continues, how is it affected by ICD-10? With the implementation of the Affordable Care Act , the Healthy Indiana Plan (HIP) is slated to end as of the end of calendar year 2014 – December 31, 2014.This means that HIP will transition to ICD10 on October 1, 2014, the same as all other Indiana Health Coverage Programs.


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November 2012

Your ICD-10 questions How does the Supreme Court’s acceptance of the Affordable Care Act affect ICD-10 implementation? Introduction of the plan to move the health care industry from the ICD9 code set to the ICD-10 code set (2009) pre-dates the Affordable Care Act (2010). The ruling by the U.S. Supreme Court (2012) has no impact on the implementation of ICD-10 scheduled for October 1, 2014. Congressional action would be required to suspend or dispense with implementation of ICD-10.


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November 2012

Your ICD-10 questions With the implementation date for ICD-10 moving to October 1, 2014, how does that affect vendor testing? Vendor testing is scheduled to begin in January 2013. Information about vendor testing is available on the ICD-10 Testing page. The ICD-10 Vendor Testing Timeline is on the following slide.


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November 2012


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November 2012

Your ICD-10 questions Currently our ICD-9 crossover B claims with a future date of service are processing. How will the implementation of ICD-10 on October 1, 2014, affect this? Crossover B claims will continue to process with a future date of service. The effective date of the ICD-10 diagnosis codes is October 1, 2014. On the crossover B claims, the diagnosis codes are validated based on the detail first date of service. So, claims submitted prior to the October 1, 2014, implementation date must have the first date of service prior to October 1, 2014, and the diagnosis codes must be ICD-9. If the first date of service is on or after October 1, 2014, then the diagnosis codes must be ICD-10. This is consistent with how Medicare processes claims. Presented by Hewlett-Packard Enterprise Services

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November 2012

From CMS


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November 2012

From CMS Planning checklist The following is from the CMS News Update issued October 3, 2012. With the ICD-10 transition deadline set for October 1, 2014, providers, payers, and vendors need to focus on planning their ICD-10 transitions. Below is a checklist of essential planning activities. The ICD-10 Planning Checklist Whether you've already started or are just beginning your ICD-10 transition, you will need to thoughtfully plan for the transition and then communicate those strategies to internal staff and external partners. Below are a few steps to help guide your planning process:  Seek Resources on the ICD-10 transition. CMS and professional and membership organizations have developed information and resources to guide you through ICD-10 implementation. Presented by Hewlett-Packard Enterprise Services

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November 2012

From CMS Planning checklist  Establish an ICD-10 Project Team. This team will be responsible for overseeing the ICD-10 transition, and will vary based on the size of your organization. Larger practices should have a team with representatives from different departments (e.g., executive leadership, physicians, and IT). Smaller practices may only have one or two individuals responsible for helping the practice make the switch to ICD-10.  Develop an ICD-10 Communication and Awareness Plan. This plan will map out how your organization will communicate with internal staff and external partners about ICD-10 throughout the transition.  Revisit and Revise Your Implementation Timeline. Since the ICD-10 compliance deadline is now October 1, 2014, your timeline for ICD-10 implementation activities will need to be updated. Presented by Hewlett-Packard Enterprise Services

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November 2012

From CMS Planning checklist  Share Your Implementation Plans and Timelines. Discuss the new ICD-10 compliance deadline and share your revised implementation plans and timelines with internal staff and external partners to ensure transition activities are coordinated. Share Best Practices and Lessons Learned Communication and collaboration will help organizations as they transition to ICD-10. As you continue planning, share lessons learned and best practices with others in your area. You can do this through organization newsletters and social media as well as at conferences, workshops, and other educational events. Remember, ICD-10 will affect everyone currently using ICD-9 codes!


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November 2012

From CMS Planning checklist CMS News Updates has also offered the following referenced topics, available on the ICD-10 Information page.  Develop Your ICD-10 Communication and Awareness Plan, August 16, 2012.  Assembling an ICD-10 Project Team, August 1, 2012.


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November 2012

ICD-10 education


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November 2012

ICD-10 education Effective on October 1, 2013 The following are changes to claim submissions, entries, and windows that will be effective on October 1, 2013. They are ICD-10-related changes.  Claims must be submitted with an ICD version indicator (paper claim or Web interChange) or qualifier (electronic claim [837 transaction]) if submitted on or after October 1, 2013.  The ICD version indicator (radio button) will default to “9” for claims submitted via Web interChange beginning October 1, 2013. As of October 1, 2014, the version indicator will default to “0”.  ICD procedure codes must only be submitted on inpatient or inpatient crossover claims.


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November 2012

ICD-10 education Effective on October 1, 2013  ICD diagnosis code pointers (professional claims) will expand from 4 positions to 8 positions (4, 2-character fields).  Additional "E" code (external cause of injury) fields will not be allowed; processing will continue with using only one field.  Professional ICD diagnosis codes will increase to 12 entries per transaction.  ICD diagnoses fields will increase from 5 characters in ICD-9 to 7 characters in ICD-10.  ICD procedure fields will increase from 4 numeric characters in ICD-9 to 7 alphanumeric characters in ICD-10.


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November 2012

ICD-10 education Effective on October 1, 2013  Claims from all provider types, except for pharmacy claims and dental claims, require a diagnosis code. See BR201210 and BR201219 for complete details. This includes, but is not limited to transportation, waiver, long term care (LTC), home health, Medical Review Team (MRT), and durable medical equipment (DME) providers.  As of October 1, 2013, Web interChange will no longer allow use of a decimal point in the ICD diagnosis or procedure codes.


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November 2012

ICD-10 vendor testing update


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November 2012

ICD-10 vendor testing update The ICD-10 Vendor Testing Kick-off Meeting was held on October 17, 2012, and provided an overview of upcoming testing activities. The following is the vendor testing timeline:  January 1- March 30, 2013 • Regression testing by HP of MCE and Electronic Data Interchange (EDI) trading partner production files • Transactional testing for MCE, EDI trading partners, and clearinghouses  April 1- June 30, 2013 •

Vendor extract/interface testing

 May 1- August 31, 2013 •

Formal EDI transactional testing


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November 2012

ICD-10 vendor testing update  October 1, 2013 • ICD-10 fields and format qualifiers go live  October 1 – December 31, 2013 • Continued transactional testing  January 1 – June 30, 2014 • Focused ICD-10 vendor testing • Vendor testing of natively-coded ICD-10 full daily submissions  October 1, 2014 •

Implementation of ICD-10


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November 2012

ICD-10 vendor testing update See the ICD-10 Testing page on indianamedicaid.com for more information on the following:  Vendor Testing Expectation documents  Vendor Testing Survey 1 results (Survey 2 is scheduled for 2nd quarter 2013)  Mailbox and contact information for testers  Kick-off-related documents  Testing-related documents  Testing timeline


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November 2012

ICD-10 Vendor Readiness Survey


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November 2012

ICD-10 Vendor Readiness Survey 6 November is survey month The ICD-10 Vendor Readiness Survey 6 will begin on Monday, November 5 and complete on Friday, November 16. Look for the survey invitation in your inbox and respond within the 10-day survey period. It is very important that you respond to this survey. We need to know where you are in the planning process.


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November 2012

HP ICD-10 readiness


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November 2012

HP ICD-10 readiness Where we are as of October 31, 2012 The following is an update of where HP is in preparation for the implementation of ICD-10 on October 1, 2014:  Requirements are finalized  ICD-10 Gap Remediation completion status is as follows: • Business design: 100% • Technical design: 100% • Produce: 99% • Testing strategy: SIT, UAT, and Vendor – 100% • Test plan: SIT, UAT, Vendor – 100% • Testing: SIT – in progress; UAT and Vendor – not started


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November 2012

HP ICD-10 readiness Where we are  Remediated policies have been delivered to the state for review and approval. Group III is in development.  HP continues to be on track for implementation October 1, 2013* and October 1, 2014 *October 1, 2013, implementation includes items outlined in the What to expect on October 1, 2013 presentation available on the ICD-10 Training page of indianamedicaid.com, in the IHCP IN Time Training section.


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November 2012

ICD-10 Information web pages


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November 2012

ICD-10 Information pages The ICD-10 Information web pages can be accessed from the General Provider page of the IHCP website (indianamedicaid.com). The web pages are frequently updated.  ICD-10 Information page  ICD-10 Decisions page  ICD-10 Frequently Asked Questions (FAQs) page  ICD-10 Training page  ICD-10 Testing page - This is a new resource for testing information. Currently it contains mostly vendor testing information, but the scope will expand as provider testing information becomes available. Presented by Hewlett-Packard Enterprise Services

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November 2012

Contact information


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November 2012

Contact information You are encouraged to submit your ICD-10-related questions to FSSA and HP throughout this project. You may submit questions to your Provider Representative or to the [email protected] mailbox. Questions will be acknowledged and answered directly to the submitter and, as appropriate, posted to the ICD-10 FAQs page and included in articles and presentations.


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November 2012

Questions?


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November 2012