7 What will I talk about? The plan going into 5010 The results of the conversion to 5010 compared with the planLessons learned from 5010The plan going into ICD-10Actions needed
8 Original 5010 Planned Timeline Jan Begin Gap Analysis, design and developmentJan Begin internal testing for HIPAA 5010Dec Achieve Level 1 Compliance by completing internal testing and can send/receive compliant transactionsJan Begin external testing with trading partners (parallel processing of 4010/5010) and move to production.Jan compliance date for all covered entitiesOct Compliance date for ICD-10
14 Workgroup for Electronic Data Interchange (WEDI) Survey of :778 hospital providers109 payers87 vendors
15 WEDI Survey- Providers 20% have not started education or training55% have not started training their Coding Staff47% have not started document improvement education to their medical staff40% have not started training their coding staff on ICD-10 clinical modification31% not planning to duel code before Oct. 1, 201425% will begin testing in Jan. 201413% will begin testing in July, 2014 or later
16 WEDI Survey- Providers Top Five Obstacles:1. Staffing2. Budget3. Competing priorities4. Vendor readiness5. IT impacts
17 WEDI Survey -Payers Impact assessment and gap analysis 50% have completed assessments25% are at 75% complete
18 WEDI Survey- Payers, cont. Internal business process design and development33% are done or almost doneVery few indicate that they have not started
19 WEDI Survey- Payers, cont. Testing75% will start internal testing in 201350% will start external testing with partners in 2013
20 WEDI Survey- Payers, cont. Top Three Reasons for Delays or Obstacles1. Competing internal priorities2. Staffing issues3. Other regulatory mandates
21 WEDI Survey- Payers, cont. ICD-10 Claims Processing66% plan on direct ICD-10 processing25% plan on using combination direct processing and crosswalkVery few plan on using crosswalk exclusively
22 Claims Management system Readiness Existence of interpretive billing editsComplexity of the logicComplete understanding of payersScalability of rulesFunctionality of eligibility and benefit edits
23 ICD-10 The Plan5010 was HUGE with all parties – provider, clearinghouse and payer.We see what’s coming with ICD-10 is BIG with the provider and the payers.It is more of a format change for clearinghouses and that work has essentially been accomplished.
24 ICD-10 The PlanQ: What are the expected system changes to accommodate ICD‐10?A: Increase in the number and length of Diagnosis Code fields; use of the Diagnosis Qualifier field (FL66); editlogic updated to accommodate ICD‐10 codes; increase in Diagnosis Code database table size.
25 ICD-10 The PlanQ: Will my clearinghouse need to accommodate both the ICD‐9 and ICD‐10 code sets in a dual use testing strategy? What about after ICD-10 implementation in production?A: Yes. But because ICD‐9 and ICD‐10 codes cannot be used on the same claim, it is incumbent on providers to specify which code set is being used on each individual claim via the Diagnosis Qualifier field (FL66).
26 ICD-10 The Plan Q: How will ICD‐9 ‘legacy data’ be accommodated? A: Quadax and, I presume, all clearinghouses will have to prohibit ICD‐9 codes on claims with dates of service 10/01/14 and after, but allow them on claims with dates of service before the transition date and have editing modified in conjunction with Payer readiness to prohibit/allow ICD‐9 or ICD-10 codes.
27 ICD-10 Questions to ask Vendors General1. Do you have an ICD-10 plan in place?2. Has development begun or is it finished?3. When were products first able to accommodate 5010?4. How many 5010 updates were necessary following the general release?
28 ICD-10 Questions to ask Vendors System Updates1. What is the timeline?2. When will data values be available for use?3. What version numbers?4. Purchase additional hardware or other IT services?
29 ICD-10 Questions to ask Vendors Cost1. Update Costs covered in Maintenance Plan?2. Cost of Necessary Software updates?3. Modify the contract?4. Cost of features not part of Maintenance Plan?
30 ICD-10 Questions to ask Vendors Testing1. Types of testing services and functionality?2. When available?3. Pre-release testing prior to updates?4. Tested with HIS and EMR- vice-versa?5. Other systems?6. Automated or Self-Administered?7. Communication?
31 Lessons Learned 5010 “ready” was meaningless Successful testing was in the eye of the beholderGo-Live date was payer specificIt’s not just a “technical” problemMajor problems were not anticipatedFew payers currently offer eligibility (271) or claims status (277)
32 Actions Needed Ask for Timeline and Follow-up Don’t Underestimate Past ExperienceListenBegin Communication Early