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1 ICD-10 Update All Blue 2014 Workshops. Agenda All Blue Workshops 2014 > ICD-10 Provider Readiness Steps for Provider Preparedness BCBST Readiness Summary.

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Presentation on theme: "1 ICD-10 Update All Blue 2014 Workshops. Agenda All Blue Workshops 2014 > ICD-10 Provider Readiness Steps for Provider Preparedness BCBST Readiness Summary."— Presentation transcript:

1 1 ICD-10 Update All Blue 2014 Workshops

2 Agenda All Blue Workshops 2014 > ICD-10 Provider Readiness Steps for Provider Preparedness BCBST Readiness Summary BCBST ICD-10 Testing Information Questions & Next Steps 3

3 ICD-10 Provider Readiness All Blue Workshops 2014 > ICD-104 WEDI surveyWEDI survey showed roughly 80% of health care providers had not completed business changes or begun testing before 2014. Twenty percent of vendor respondents said they were halfway or less than halfway complete with product development in support of ICD-10 Thirty-seven percent of today’s documentation is ready for the transition, according to the American Association of Professional Coders Roadmaps are available at CMS.gov that include the following: - Small and Rural clinical practices - Small Hospitals - Large Practices - Communications Plan guidance - Checklists

4 Activities for Provider Preparedness All Blue Workshops 2014 > ICD-106 Assess Workflow and Systems - Complete a gap analysis on the expected workflow and process changes - Include IT systems Assess System Vendor Readiness - Upgrade or replace the practice’s IT systems - Include forms and reports Documentation Considerations - Assess whether current clinical documentation will support the level of specificity necessary - Priority list of diagnoses requiring more detailed documentation Revenue and Cash Flow Considerations - Know which payers have fully transitioned to ICD-10-CM - Professional services are paid based on the procedure code, but the diagnosis code supports medical necessity Train on New Processes and Systems - Ensure staff can be trained prior to the compliance date on all changes

5 BlueCross Preparedness All Blue Workshops 2014 > ICD-107 BCBST Systems Testing - Quality Assurance Testing is complete for Core Systems - System Integration Testing and End-to-End testing is in process - UAT Testing is in process Provider Testing - Pilot Testing began October 2013 - Provider Testing Tools are being implemented - Provider Testing is open for professional and institutional providers Provider Communications - Provider Administration Manual updates throughout the year - BlueAlert SM articles for the remainder of the year will focus on ICD-10 updates - Compliance statement on BCBST.com and FAQs Training of BCBST Employees - Training began in 2013 and will continue in 2014 and 2015 ICD-10 Delay Planning has concluded

6 Professional Testing Tool – Web-Based Self Help Browser Requirements (Chrome, Safari, Internet Explorer, or FireFox) Give health care providers (physicians, etc.) pre-defined, clinically based medical scenarios to review and determine the ICD-10 codes Enter the data in an easy, efficient manner Provide peer reports and/or notification of the correlation between input and output codes Provider Steps for tool registration and testing Provider Registers on the website Provider users access application Provider completes scenarios Provider reviews results To express interest in testing, send email to ICD10_GM@BCBST.com ICD-10 Provider Testing Tool All Blue Workshops 2014 > ICD-109

7 Each Specialty has a maximum of ten narratives available. Each Narrative defines a specific healthcare encounter (Narratives include Chief Complaint, Past Medical History and Office Visit Notes pertaining to a Patient) Providers register via a website, and will receive an email inviting them to participate with an embedded link to the testing tool ICD-10 Provider Testing Tools - Narratives All Blue Workshops 2014 > ICD-109

8 ICD-10 Provider Testing Tools – Provider Report Sample All Blue Workshops 2014 > ICD-109 Chief Complaint : Pt presented to the E.R. with chest pain and shortness of breath Cardiology Narrative 1 Past Medical History: Pt. takes Crestor 10 mg. daily and Zestril 30 mg daily for HTN. Pt is a 1 -2 pack/day smoker who has smoked for about 35 years. Office Visit Notes: I was consulted to see this patient who was admitted to the hospital yesterday with chest pain that radiated down his left arm and shortness of breath. Pt. was tachycardic, hypertensive and complaining of pain at an 8 on a scale of 1-10. CBC was normal, pt. has a history of hyperlipidemia and poor diet. He smokes 1 - 2 packs/cig/day and doesn't exercise. Pt was given Nitro yesterday and oxygen @ 2l/NC with minimal relief, so was placed in ICU on a continuous Nitroglycerin drip. He has also been given 2mg Morphine Sulfate I.V. prn pain. A cardiac catheterization was performed and found that the patient has atherosclerotic heart disease of one native coronary artery. His LAD coronary artery is blocked over 80%, so after discussion with the patient and his wife, it was decided that the best option will be to undergo a Coronary bypass in the am. Will continue to monitor vital signs and nursing staff is to call if there is any change in patient's status. Total Providers:3 Total Unique Answers:3 Your Answer:R0789 SAMPLE

9 ICD-10 Provider Testing Tool – Provider Specialties MedTenn Conference 2014 > ICD-109 Specialty Total Narratives SpecialtyTotal Narratives Allergy/Immunology 9 Obstetrics & Gynecology10 Audiologist 6 Occupational Therapist in Private Practice9 Cardiovascular disease 9 Ophthalmology9 Certified Nurse Midwife 6 Optometry9 Chiropractic 9 Orthopedic Surgery9 Clinic or Group Practice 9 Otolaryngology9 Dermatology 9 Pediatric Medicine10 Emergency Medicine 9 Physical Medicine and Rehabilitation9 Endocrinology 9 Physical Therapist in Private Practice9 Family Practice 10 Plastic and Reconstructive Surgery10 Gastroenterology 9 Podiatrist10 General Practice 9 Psychiatry9 General Surgery 10 Psychologist9 Hematology 9 Psychologist, Clinical9 Hematology-Oncology 9 Pulmonary Disease9 Infectious Disease 9 Radiation Oncology9 Internal Medicine 10 Rheumatology9 Nephrology 9 Thoracic Surgery9 Neurology 10 Urology9 Nurse Practitioner 10 Vascular Surgery9 Grand Count 363

10 Facility Testing Tool – Web Based Self Service Browser Requirements (Chrome, Safari, Internet Explorer or FireFox) Providers can test scenarios with DRG code being returned (Grouper 30) Scenarios can be selected by the testing provider Largely based upon DRGs of interest Evaluation of results To express interest in testing send e-mail to ICD10_GM@BCBST.com Provider Steps for tool registration and testing Provider contacts BCBST, BCBST loads claim scenarios Provider Registers on the website Provider users access application Provider completes scenarios Provider reviews results Provider can express interest in testing by sending an email to ICD10_GM@BCBST.com ICD-10 Provider Testing Tool - Institutional 10ICD-10 Program

11 Questions & Next Steps All Blue Workshops 2014 > ICD-1010

12 Appendix All Blue Workshops 2014 > ICD-1011 Useful Links Tennessee Hospital Association (THA) www.THA.com Tennessee Medical Association (TMA) www.tnmed.org BCBST ICD-10 Page (BCBST.COM) www.bcbst.com/providers/icd-10.page American Association of Professional Coders (AAPC) www.aapc.com/icd-10/index.aspx American Health Information Management Association (AHIMA) www.ahima.org/icd10 Implementation Planning (CMS) www.cms.gov/Medicare/Coding/ICD10/inde x.html?redirect=/ICD10/02b_Latest_News.as p CMS “Road to ICD-10” Toolkit http://www.roadto10.org/

13 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association


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