ICD-10 Compliance Project Status - Indiana Medicaid Provider

August Update

ICD-10 Compliance Project Status

Statement of Confidentiality: This information is privileged and confidential. It is intended only for the use of this specific audience. You are hereby notified that disseminating, distributing, forwarding, or copying this information is strictly prohibited.

Presented by Hewlett-Packard Enterprise Services

1

August 2012

Topics         

Estimated timeline ICD-10 news Your ICD-10 questions Cost of ICD-10 non-compliance ICD-10 education HP ICD-10 readiness ICD-10 Information pages Contact information Questions?


2

August 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



Provider testing activities* . . . . . . . . . . . . . January 2013 – September 2013



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



Go Live* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . October 1, 2013

* Dates are subject to change pending the CMS final rule regarding an ICD-10 delay. Presented by Hewlett-Packard Enterprise Services

3

August 2012

ICD-10 news


4

August 2012

ICD-10 news Implementation delay announcements  February 16, 2012, the Department of Health and Human Services (HHS) announced the intent to delay implementation of the ICD-10 code set.  February 23, 2012, the Indiana Family and Social Services Agency (FSSA) issued a response stating that the Indiana Medicaid migration to ICD-10 remains unaltered.  April 9, 2012, HHS announced the proposed date for ICD-10 implementation is October 1, 2014.

See the ICD-10 Information page on the Indiana Medicaid website for ICD-10 news updates.


5

August 2012

ICD-10 news CMS 1500 announcement March 27, 2012, the National Uniform Claim Committee (NUCC) announces the release of a revised version of the 1500 Health Insurance Claim Form (version 02/12). This revised version will update the current 1500 Claim Form (version 08/05). Once the revised 1500 Claim Form has been officially approved by OMB, the NUCC will release the final version of the form, which will include the OMB numbers added to the bottom of the form. A timeframe for when this will be completed is not known at this time. The preceding information was excerpted from the announcement published on the NUCC website.


6

August 2012

ICD-10 news Diagnosis-related group (DRG) On May 30, 2012, a letter of intent was sent to 3M™ Health Information Systems for scheduling of installation of the APR DRG to the Indiana MMIS. This new grouper will be used for ICD-10, but will not replace the AP version 18, currently in use, for dates of service (DOS) prior to the ICD-10 effective date. It is our intent to move forward with APR DRG methodology on the CMS ICD-10 effective date. Updated information about this action will be featured in future communications.


7

August 2012

Your ICD-10 questions


8

August 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? ICD-9 and ICD-10 claims are processed using the date of service (DOS) or THROUGH date. If the THROUGH date is prior to the ICD10 effective date, no matter when the claim is adjusted it should be adjusted with ICD-9 data. If the date of service or THROUGH date is being adjusted from prior to the ICD-10 effective date to after the ICD-10 effective date, then the ICD-9 claim would be reversed using ICD-9 data and resubmitted using ICD-10 data. Presented by Hewlett-Packard Enterprise Services

9

August 2012

Your ICD-10 questions What is the difference between the ICD-9-CM procedure codes and ICD-10-PCS procedure codes? The following table shows an overview of the differences in code structure between the ICD-9-CM (clinical modification) and the ICD-10PCS (procedural coding system). ICD-10-PCS is a system of medical classification used for inpatient procedural coding. Diagnostic information is not included in the procedure description. The diagnosis codes, not the procedure codes, contain the specific information regarding the disease or disorder. There is no ICD-9-PCS because both procedure and diagnosis codes were included in ICD-9-CM. Some of the this information has been excerpted from the 3M Health Information Systems publication ICD-10-CM and ICD-10-PCS — Frequently asked questions. Presented by Hewlett-Packard Enterprise Services

10

August 2012

Your ICD-10 questions What is the difference between the ICD-9-CM procedure codes and ICD-10-PCS procedure codes? (continued) ICD-9-CM

ICD-10-PCS

Three to five characters in length

Seven characters in length

E, V, or numeric first character

Alphanumeric first character excluding the letters “O” and “I”

Remaining characters are numeric

Remaining characters are alphanumeric

Procedure code structure: category, subcategory, anatomic site and/or severity

The first character of the procedure code specifies the section. The second through seventh characters have a consistent meaning within each section, but may have different meanings across sections. In most sections, the third character specifies the type of procedure being performed, while the other characters specify additional information, such as the body part on which the procedure is being performed.


11

August 2012

Your ICD-10 questions Regarding the proprietary file, does the expansion of the related diagnosis field to 8 alphanumeric characters – to allow up to 4 related diagnoses at 2 characters each – apply to MCEs? Yes. The diagnosis is increased to two characters in order to accommodate diagnosis fields 10 – 12 in the IndianaAIM system for internal processing. For paper claims, you will be using an alpha character that is converted to two characters (numeric) when the claim is processed. For EDI claims (837P transactions) you must submit the twocharacter pointer which will always be numeric. Presented by Hewlett-Packard Enterprise Services

12

August 2012

Your ICD-10 questions Will denied encounter claims be subject to ICD-10 validation during Edifecs front end processing? Yes. All encounter claims will be subject to EDI/Edifecs front end processing.

Will a denied encounter claim containing ICD-9 diagnoses with a date of service (DOS) prior to the ICD-10 implementation date be subject to Edifecs front end validation? Yes. All encounter claims will be subjected to EDI/Edifecs front end processing for both ICD-9 and ICD-10 validation editing.


13

August 2012

Your ICD-10 questions Is an encounter claim that is denied due to invalid ICD10 data, considered unclean; and therefore, should it not be included in encounter submissions? As defined in the Hoosier Healthwise and Healthy Indiana Plan MCE Policies and Procedures Manual, Section 10: Information Systems: Rejected claims should not be submitted as encounter data. A rejected claim is a claim that the MCE cannot accept into its inventory for future adjudication. Rejected claims include: •

Misdirected claims: A claim submitted to the wrong entity for processing (for example, claim submitted to the wrong MCE)

•

Claims for members not currently enrolled

•

Claims for which the MCE or Managed Behavioral Healthcare Organization (MBHO) is not financially responsible (for example, a provider submits a claim to the MCE for an MBHO covered service)

•

Unclean claims (a claim in which all the information required for processing is not present – per IC 12-15-13.0.6).


14

August 2012

Your ICD-10 questions Is an encounter claim that is denied due to invalid ICD10 data, considered unclean; and therefore, should it not be included in encounter submissions? (continued) Claims that were rejected or received and denied by the MCE because they did not pass HIPAA compliancy edits should not be submitted as encounter data. . . this subsequent submission [resubmission of rejected or denied claims] would be available for utilization data as either a paid encounter or denied encounter from resubmission. Denied Encounters include all clean claims that do not fall into one of the aforementioned categories [and] should be submitted as encounter data. This includes all clean paid claims (partially paid and fully paid) and all clean fully-denied claims. A clean claim is a claim submitted by a provider for payment that can be adjudicated without obtaining additional information from the provider of the service or a third party.

The complete verbiage from this manual is available from the MCO Q&A site maintained by HP.


15

August 2012

Your ICD-10 questions It is not clear if intermediate care facilities for the developmentally disabled (ICD/DD) and/or Home and Community-Based Services (HCBS) Waiver providers are expected to comply with ICD-10. The Banner Page, BR201210, explains that all claims must include a primary diagnosis code (ICD-9 code) and therefore will need to transition to ICD-10 codes when they become effective. This applies to all providers.


16

August 2012

Your ICD-10 questions I am unable to find intermediate care facilities for the developmentally disabled (ICF/DD) and/or Home and Community-Based Services (HCBS) Waiver providers on the table outlined on the ICD-10 Decisions page. An updated version of the span date information from the ICD-10 Decisions page is included in this presentation. The web page is being updated to include this additional information.


17

August 2012

Your ICD-10 questions Our mental health center is interested in acquiring or purchasing an ICD-10 training kit but hasn’t been able to find a training kit for purchase. On the ICD-10 Training page there are associations offering materials and/or classes. Some require that you be a member, but others do not. Some have an associated cost; some are downloadable and free. For an “ICD-10 Training Kit”, visit the American Health Information Management Association (AHIMA) and the World Health Organization (WHO) sections of the ICD-10 Training page. They have resource links and tools specific to ICD-10. For information specific to mental health providers, search by the provider type to access any specific information; otherwise, the general information should supply the basics. Presented by Hewlett-Packard Enterprise Services

18

August 2012

Your ICD-10 questions The Association for Retarded Citizens (ARC) provides Group Home services as well as Waiver services. How will ICD-10 affect ARC? The Banner Page, BR201210, explains that all claims must include a primary diagnosis code (ICD-9 code) and therefore will need to transition to ICD-10 codes when they become effective. This applies to all providers.


19

August 2012

Your ICD-10 questions When are you planning on implementing ICD-10? We are awaiting the announcement from CMS regarding the proposed implementation delay for ICD-10. We are continuing to work toward an October 1, 2013, date for having all of our systems processes ready and tested, but we will not “flip the switch” until the date that the CMS announces as the new implementation date. This means that ICD-10 will go live on the date that CMS announces.


20

August 2012

Your ICD-10 questions Will Indiana Medicaid be doing any ICD-10 testing with trading partners? If yes, when will testing information be available? Yes. There will be vendor testing January 2013. The plan is to begin providing testing information and training by November 2012. Information will be disseminated through the usual publication channels and the “What’s New for Vendors” feature on indianamedicaid.com.


21

August 2012

Cost of ICD-10 non-compliance


22

August 2012

Cost of ICD-10 non-compliance Your vendor is ICD-10 ready. Does that mean you are? Possibly not. If you have been notified that your vendor is ready for ICD-10 implementation, this does not mean that you are ready for ICD10 implementation. Your vendor only handles a portion of your business and thinking about ICD-10 implementation is not enough. Consider the following short checklist of preparations as a start. How many of these apply to you and your business?  Staff trained in clinical documentation and charting  Updated superbill and/or charge slip  Patient questionnaires/reason for visit surveys accurately reflects ICD-10-related information needs  Electronic health records evaluated and updated to reflect ICD-10 information needs Presented by Hewlett-Packard Enterprise Services

23

August 2012

Cost of ICD-10 non-compliance Where do you begin? Visit the ICD-10 Training page on the indianamedicaid.com website. It offers links to training materials, assessment and planning materials, and classroom opportunities. It is frequently updated to provide new links. Assess the impact of ICD-10 on your business, create business process and training plans, and execute them. Do not wait. All of this takes more time than you imagine (ask others who are already preparing). Being ready ahead of the ICD-10 implementation date helps to ensure the continuity of your business. Be proactive. Do it now. Now that X12 5010 is in place, CMS is turning it’s outreach efforts to ICD-10. Presented by Hewlett-Packard Enterprise Services

24

August 2012

Cost of ICD-10 non-compliance Steps to Assess How the ICD-10 Transition will Affect your Organization (CMS News Updates, July 12, 2012) Although the final rule on the proposed ICD-10 deadline change has yet to be published, it is important to continue planning for the transition to ICD-10. The switch to the new code set will affect every aspect of how your organization provides care, from registration and referrals, to software/hardware upgrades and clinical documentation. A critical step in planning for the transition is to conduct an impact assessment of how the new code sets will affect your organization. Your impact assessment should include:


25

August 2012

Cost of ICD-10 non-compliance • Documentation Changes: You will need to consider the increased specificity of ICD-10 codes compared to ICD-9 codes, and ensure that patient encounters are documented with appropriately comprehensive clinical descriptions. You should: o

Train staff to accommodate the substantial increase and specificity in code sets

o

Consider physician workflow and patient volume changes

o

Revise forms, documents, and encounter forms to reflect ICD-10 codes

o

Evaluate processes for ordering and reporting lab/diagnostic services to health plans

• Reimbursement Structures: You should coordinate with payers on contract negotiations and new policies that reflect the expanded code sets, since they can affect reimbursement schedules. Presented by Hewlett-Packard Enterprise Services

26

August 2012

Cost of ICD-10 non-compliance • Systems and Vendor Contracts: Ensure your vendors can accommodate your ICD-10 needs. Find out how and when your vendor plans to update your existing systems. You will need to review existing and new vendor contracts and to evaluate vendor offerings and capabilities against your organization's expectations. Work with your vendors to draft a schedule for needed tasks. • Business Practices: Once you have implemented ICD-10, you will need to determine how the new codes affect your processes for referrals, authorizations/pre-certifications, patient intake, physician orders, and patient encounters. • Testing: Work with your vendors to determine the amount of time needed for testing and schedule accordingly. Presented by Hewlett-Packard Enterprise Services

27

August 2012

Cost of ICD-10 non-compliance ICD-10 will affect nearly all areas of your practice, but with a thorough impact assessment, you can keep your day-to-day activities running smoothly while you transition to ICD-10. This information is available on the ICD-10 Training page. More information is available on the CMS website at cms.gov.


28

August 2012

ICD-10 education


29

August 2012

ICD-10 education Claims – the basics Some of this information has been relayed in earlier presentations and articles, but it all bears repeating.  Providers cannot bill ICD-9 codes and ICD-10 codes on the same claim submission.  Claims may not be submitted without an ICD version indicator if submitted on or after October 1, 2013.  CMS 1500 claim form has been expanded to include 12 diagnosis codes and a version indicator.


30

August 2012

ICD-10 education Claims – the basics Two new validity EOB edits will be introduced. EOB/Edit Applies to

Description

243

Outpatient, home health, and outpatient crossover

Claims with the FROM and THROUGH dates spanning the ICD-10 implementation date cannot be billed on one claim.

245

All claim types

The ICD version indicator on the claim does not match the diagnosis codes billed on the claim.

All other validity editing related to ICD diagnosis and procedure codes will use existing EOB edit codes.


31

August 2012

ICD-10 education Claims – the basics  The ICD version indicator (radio button) will default to “9” for claims submitted via Web interChange until the ICD-10 effective date. As of the ICD-10 effective date, the version indicator will default to “0”.  ICD procedure codes are only used on inpatient or inpatient crossover claims.  All claims require a diagnosis code regardless of provider type. See BR201210 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.

The following tables show how span dates are being addressed in ICD-10. Presented by Hewlett-Packard Enterprise Services

32

August 2012

ICD-10 education Claim span dates – Institutional provider Facility Type/Services

Claims Processing Requirement

Inpatient Hospital (hospital, prospective payment system [PPS] hospital, long-term care hospital [LTCH], critical access hospital [CAH])

• Occurrence Code 51 will continue to be required to indicate discharge, but will not be used to validate the ICD-10 code. • Use of the FROM date of service for Inpatient (I) and ( A) claim types will change to use of the THROUGH date with ICD 10 implementation. • Providers are not allowed to mix ICD-9 and ICD-10 codes on the same claim.

Claim Type I (Inpatient) and A (Inpatient Crossover)


33

Use FROM or THROUGH Date THROUGH

August 2012

ICD-10 education Claim span dates – Institutional provider Use FROM or THROUGH Date

Facility Type/Services


Outpatient

• For services that span the ICD-10 implementation date, providers must separate claims submissions so that ICD-9 codes remain on one claim (services prior to the ICD-10 implementation date) and ICD-10 codes remain on the other claim (services on or after the ICD-10 implementation date). • Continue to use the FROM date.

FROM

FQHC crossovers from Medicare are processed as outpatient crossover claims. However, when an FQHC claim is for a member with no Medicare, the claim is submitted on a CMS-1500.

FROM

Claim Type C (Outpatient Crossover) and O (Outpatient)

Federally Qualified Health Clinic (FQHC) (eff. 4/4/2010)


34

August 2012

ICD-10 education Claim span dates – Institutional provider Facility Type/Services


Skilled Nursing (includes intermediate care facility [ICF]/developmentally disabled [DD])

If the LTC claim has a discharge and/or THROUGH date on or after the ICD-10 implementation date, then the entire claim is billed using ICD-10.

Use FROM or THROUGH Date THROUGH

Claim Type L (Long Term Care [LTC]) and A (Inpatient Crossover) Home Health Claim Type H (Home Health)

For services that span the ICD-10 FROM implementation date, providers separate claims submission so ICD-9 codes remain on one claim (services prior to ICD-10 implementation date) and ICD-10 codes remain on the other claim (services on or after ICD-10 implementation date).


35

August 2012

ICD-10 education Claim span dates – Professional Facility Type/Services


All anesthesia claims

Anesthesia procedures that begin before the ICD-10 implementation date (FROM), but end on or after the ICD-10 implementation date (THROUGH), are to be billed with ICD-9 diagnosis codes and use the FROM date as both the FROM and THROUGH date.

All specialties billed on Professional Claims (includes waiver)

Use FROM or THROUGH Date FROM

Claim Type M (Medical) and B (Medical Crossover)


36

August 2012

ICD-10 education Claim span dates – Supplier Facility Type/Services


Use FROM or THROUGH Date

FROM Durable medical equipment Billing for certain items or supplies (such as (DME) capped rentals or monthly supplies) may span the ICD-10 compliance date. Claim Type M (Medical) and B (Medical Crossover) Example: The FROM date of service occurs prior to ICD-10 implementation date and the THROUGH date of service occurs after the ICD-10 implementation date.


37

August 2012

ICD-10 education Claims – MCEs only These two EOB edits also apply to shadow claims submitted by the Managed Care Entities (MCEs) and will be set to deny. EOB/Edit Applies to

Description

243

Outpatient, home health, and outpatient crossover

Claims with the FROM and THROUGH dates spanning the ICD-10 implementation date cannot be billed on one claim.

245

All claim types

The ICD version indicator on the claim does not match the diagnosis codes billed on the claim.


38

August 2012

ICD-10 education Waiver service providers All providers submitting claims must use ICD-9 codes as the primary diagnosis code and then transition to ICD-10 codes when ICD-10 is implemented. See BR201210. Waiver providers should bill diagnosis code 7999 as the primary diagnosis code for claim submissions when the actual diagnosis is not known. “Primary diagnosis is required.” Paper claims missing the primary diagnosis code will be denied for edit 258 – Primary Diagnosis code missing. Presented by Hewlett-Packard Enterprise Services

39

August 2012

ICD-10 education Waiver service providers The ICD-10 code manuals do not address Waiver service codes separately. The Waiver service codes are included with all the other diagnosis codes, but are not labeled as Waiver codes. If you are a Waiver provider, you must research the Waiver codes that will apply to your business. In the case where your providers supply the ICD-10 code, you must make sure your providers are ICD-10 ready.


40

August 2012

ICD-10 education Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM codes are not used for claims processing. They are used for clinical assessments. Currently, ICD-9 codes are used for claim submissions and processing. Upon implementation of ICD-10, the ICD-10 codes must be used for claim submissions. Migration from DSM IV to DSM V is a project outside of the scope of the ICD-10 project. Information about the migration of DSM and Medicaid Rehabilitation Option (MRO) service packages will be forthcoming in IHCP publications such as the Bulletin, Banner Page, and Newsletter. Presented by Hewlett-Packard Enterprise Services

41

August 2012

HP ICD-10 readiness


42

August 2012

HP ICD-10 readiness Where we are  Requirements are finalized  ICD-10 Gap Remediation completion status is as follows: • Business design: 100% • Technical design: 99% • Produce: 65% • Testing: – Testing strategy: SIT, UAT, Vendor 100% – Test plan: SIT 82%, UAT 5%, Vendor not started – Testing: SIT, UAT, Vendor not started

 Group I of the redefined policies has been delivered to the state for review and approval. Groups II and III are in development.  HP continues to be on track for implementation October 1, 2013 Presented by Hewlett-Packard Enterprise Services

43

August 2012

ICD-10 Information pages


44

August 2012

ICD-10 Information pages The ICD-10 Information web pages may be accessed from the General Provider page on the IHCP website (indianamedicaid.com). The web pages are frequently updated. The ICD-10 information is divided onto four pages, each containing unique and useful information.  ICD-10 Information page  ICD-10 Decisions page  ICD-10 Frequently Asked Questions (FAQs) page  ICD-10 Training page


45

August 2012

Contact information


46

August 2012

Contact information You are encouraged to submit your ICD-10-related questions to FSSA and HP throughout this project. Submit your 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.


47

August 2012

Questions?


48

August 2012