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Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services January 22, 2013 10:00 am to 11:00.

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Presentation on theme: "Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services January 22, 2013 10:00 am to 11:00."— Presentation transcript:

1 Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services January 22, :00 am to 11:00 am EST

2 Welcome 2

3 Agenda  Welcome/Opening RemarksJulie McBee5 minutes  ICP AttendanceDavid Carrier5 minutes  Ground RulesJulie McBee2 minutes  Goals, Intended Outcomes & Overview  DefinitionsDavid Carrier  Provider, Payer, Vendor Open Floor5 minutes  Payer ChecklistOpen floor30 Minutes  Questions Team  Closing RemarksTeam  How to contact usJulie McBee 3

4 Industry Collaborative Partners Introductions 4 Aetna American Health Insurance Plans (AHIP) American Hospital Association (AHA) American Medical Association (AMA) CMS Medicaid CMS Medicare Fee For Service Emdeon Healthcare Billing & Management Association (HBMA) IVANS Medicaid – CSG Government Solutions Medical Group Management Association (MGMA) Nachimson Advisors, LLC Providence Health and Services TIBCO Foresight TRICARE UNC Health Care Walgreens WellPoint Veteran’s Affairs

5 Ground Rules 5  All participants will be muted upon log in for the start of the webinar.  Once the opening presentation is done, we will open it up for questions.  Please provide your name when asking a question so that we know who is speaking.  Additionally, we ask that only the primary and back-up points of contact be your designated speakers on the webinar. With the number of participants we expect to participate on our webinars, we want to give each Industry Leader ample time to contribute.  Listen to and value all contributions equally. We are trying to make sure this is a collaborative effort where all Industry leaders can be heard.  We value your time so please keep your discussion focused.  Specifically for today’s call, we will be opening the floor for each contributor up to 3 minutes to speak. We will let you know when you are at 2 and 2:30 minutes to finalize your comments.  Silence equals agreement

6 Goals The goals of the pilot are: To develop and implement a process and methodology for end-to-end testing of the transaction standards, operating rules, code sets, identifiers, and other Administrative Simplification requirements adopted by the Secretary of Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act of 2010 (ACA) based on industry feedback and participation. To develop an industry wide “Best Practice” for end-to-end testing that lays the ground work for a more efficient and less time consuming method for health care provider testing of future standards, leading to more rapid adoption of the future standards. 6

7 Intended Outcomes The intended outcomes of the pilot are: To provide documents and artifacts to all industry segments outlining the critical check-points needed to ensure compliance with the current mandates To provide documents and artifacts to all industry segments outlining the critical check-points which can be used as foundations with future mandates To provide a universal testing process and methodology that can be adopted by all industry segments To provide a framework and common understanding around the End-To-End testing process and definitions 7

8 Overview Phase I – Business and Gap Analysis started on September 24, 2012, and will run through December 21, 2012 (Completed) Phase II - Development of Pilot Testing started on December 10, 2012, and will run through June 27, 2013 (approximately six months)* The planned start date for Phase III - Implementation and Quality Assurance is July 1, 2013, and will run through September 23, 2013 (approximately three months)* *Actual dates are subject to change during detailed schedule development 8

9 3 High-Level Definitions These 3 definitions for End-To-End, Readiness, and Compliance are considered complete and have been sent for review by CMS Legal. 9

10 Provider Readiness Webinar Feedback - the Payer Readiness information was included on the Provider Readiness definition slide. 10

11 Provider Readiness *Our revised definition is as follows: Provider Readiness is a state of preparedness in which the Provider and the Provider’s business associates have completed internal testing and tested with a Provider- determined percentage** of mission-critical external trading partners. Additionally, the Provider and the Provider’s business associates will have completed internal documentation and established communication mechanisms with external trading partners, training of appropriate personnel, scheduled testing, deployments, and/or software migration for each published standard in advance of, and/or by, and continued support after, the regulatory implementation date. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of Provider Readiness based on Industry feedback and participation on January 15, 2013 webinar. **acceptable risk percentage will vary from Provider to Provider and should be documented in checklist(s) 11

12 Provider Readiness Depending on the regulation, one or more of the following examples may apply*: All administrative, analytical, and clinical system upgrade(s) have been completed. (Electronic Healthcare Records (EHRs), Electronic Medical Records (EMRs), and Practice Management Systems) Confirmation of successful testing with submission payer(s) Confirmation of successful testing with vendor(s) Confirmation of successful testing with clearinghouse(s) Confirmation of successful acceptance of production-like claim(s) (837) submission(s) Confirmation of successful submission(s), acceptance, and response(s) of NCPDP/D.0 /1.2/3.0 pharmacy billing transaction claim(s) Confirmation of successful return of TA1, 824, 999, 277CA acknowledgement(s) Confirmation of successful retrieval of the claim(s) associated remittance(s) (835) Confirmation of successful acceptance of claim(s) status inquiry submission(s) (276) Confirmation of successful return of claim(s) status inquiry response(s) (277) Confirmation of successful receipt of claim(s) eligibility status request(s) (270) Confirmation of successful return of claim(s) eligibility status(es) (271) Confirmation of successful submission(s) of service(s) review inquiry(ies) (278) Confirmation of successful receipt of service(s) review response(s) (278) *this list is not all-inclusive 12

13 Payer Readiness *Our revised definition is as follows: Payer Readiness is a state of preparedness in which the Payer and the Payer’s business associates have completed all internal testing and tested with a Payer-determined percentage** of mission-critical external Trading Partners. Additionally, the Payer and the Payer’s business associates will have completed internal documentation and established communication mechanisms with external trading partners, training of appropriate personnel, scheduled testing, deployments, and/or software migration for each published standard in advance of, and/or by, and continued support after, the regulatory implementation date. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of Provider Readiness based on Industry feedback and participation on January 15, 2013 webinar. **acceptable risk percentage will vary from Payer to Payer and should be documented in checklist(s) 13

14 Payer Readiness 2 Feedback - what's the criticality of putting "this list is not inclusive". It should be removed until the Listening Session is held and receive feedback. – disagreed with Shawn - suggest to leave out the version codes on the NCPDP and just put "billing transactions" so it will cover all future transaction types. She'll send an w/ few suggestions. 14

15 Payer Readiness Depending on the regulation, one or more of the following examples may apply*: All administrative, analytical, and clinical system upgrade(s) have been completed All system upgrades (front-end translations and back-end adjudication systems) have been loaded and tested Confirmation of successful testing with submitting provider(s) Confirmation of successful testing with submitting vendor(s) Confirmation of successful testing with clearinghouse(s) Confirmation of successful acceptance of production-like claim(s) (837) submission(s) Confirmation of successful submission(s), acceptance, and response(s) of NCPDP/D.0/1.2/3.0 pharmacy billing transaction claim(s) Confirmation of successful return of TA1, 824, 999, 277CA acknowledgement(s) Confirmation of successful retrieval of the claim(s) associated remittance(s) (835) Confirmation of successful acceptance of claim(s) status inquiry submission(s) (276) Confirmation of successful return of claim(s) status inquiry response(s) (277) Confirmation of successful receipt of claim(s) eligibility status request(s) (270) Confirmation of successful return of claim(s) eligibility status(es) (271) Confirmation of successful submission(s) of service(s) review inquiry(ies) (278) Confirmation of successful receipt of service(s) review response(s) (278) Confirmation of successful submission(s) of payment order(s) or remittance advice(s) (820) Confirmation of successful receipt of payment order(s) or remittance advice(s) (820) Confirmation of successful receipt benefit enrollment(s) (834) Confirmation of successful return of benefit maintenance(s) (834) *this list is not all-inclusive 15

16 Vendor Readiness *Our revised definition is as follows: Vendor Readiness is a state of preparedness in which the Vendor and the Vendor’s business associates have completed internal testing and tested with a Vendor-determined percentage* of mission-critical external trading partners. Additionally, the Vendor and the Vendor’s business associates will have completed internal documentation and established communication mechanisms with external trading partners, training of appropriate personnel, new/change processes, scheduled testing, deployments, and/or software migration for each published standard in advance of, and/or by, and continued support after, the regulatory implementation date. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of Provider Readiness based on Industry feedback and participation on January 15, 2013 webinar. **acceptable risk percentage will vary from Vendor to Vendor and should be documented in checklist(s) 16

17 Vendor Readiness Depending on the type of vendor your organization is and the regulation change, one or more of the following examples may apply*: All administrative, analytical, and clinical system upgrade(s) have been completed All system upgrades (front-end translations and back-end adjudication systems) have been loaded and tested Confirmation of successful testing of analytics (reporting) Confirmation of successful testing with submitting provider(s) Confirmation of successful testing with submitting payer(s) and/or vendor(s) Confirmation of successful testing with clearinghouse(s) Confirmation of successful acceptance of production-like claim(s) (837) submission(s) Confirmation of successful submission(s), acceptance, and response(s) of NCPDP/D.0/1.2/3.0 pharmacy billing transaction claim(s) Confirmation of successful return of TA1, 824, 999, 277CA acknowledgement(s) Confirmation of successful retrieval of the claim(s) associated remittance(s) (835) Confirmation of successful acceptance of claim(s) status inquiry submission(s) (276) Confirmation of successful return of claim(s) status inquiry response(s) (277) Confirmation of successful receipt of claim(s) eligibility status request(s) (270) Confirmation of successful return of claim(s) eligibility status(es) (271) Confirmation of successful submission(s) of service(s) review inquiry(ies) (278) Confirmation of successful receipt of service(s) review response(s) (278) Confirmation of successful submission(s) of payment order(s) or remittance advice(s) (820) Confirmation of successful receipt of payment order(s) or remittance advice(s) (820) Confirmation of successful receipt benefit enrollment(s) (834) Confirmation of successful return of benefit maintenance(s) (834) *this list is not all-inclusive 17

18 Payer Checklist Feedback -Feels it looks like an implementation plan, rather than testing plan. If the intent is to give a project plan, this checklist would work. But if the intent is to give an E2E testing plan, this checklist is a little bit too much. – feels we need to have a high-level disclaimer statement to go along with the checklist. Is there a need to list a disclaimer statement for E2E testing? Rather than including all the tasks, there can be tasks missing. - agrees w/ Elizabeth on disclaimer statement, it's not all inclusive at all.

19 Questions ? 19

20 Closing Remarks Next ICP webinar session is Thursday, January 24, 2013 from 10am to 11am EST ICD-10 website Listening Sessions have begun: – Participants can join via a CMS website link. Below is the link for those sessions January 15, :00 pm, ESTLarge Provider Group 1https://webinar.cms.hhs.gov/end15end/ January 15, :00 pm, ESTLarge Provider Group 2https://webinar.cms.hhs.gov/end15end/ January 17, :00 pm, ESTVendor Group 1https://webinar.cms.hhs.gov/end17end/ January 17, :00 pm, ESTVendor Group 2https://webinar.cms.hhs.gov/end17end/ January 23, :00 pm, ESTPayer Group 1https://webinar.cms.hhs.gov/end23end/ January 23, :00 pm, ESTPayer Group 2https://webinar.cms.hhs.gov/end23end/ January 24, :00 pm, ESTSmall Provider Group 1https://webinar.cms.hhs.gov/end24end/ January 24, :00 pm, ESTSmall Provider Group 2https://webinar.cms.hhs.gov/end24end/

21 Suggested Audience for Listening Session Definitions Small providers will include small/medium sized organizations comprised of 99 or less physicians/staff, independent practices, dentists, durable medical suppliers, pharmacy, home health agencies/hospices, and specialty practices. Large providers will include organizations comprised of 100 or more physicians/staff, clinical labs, hospitals, critical access hospitals, nursing homes, rehab centers, skilled nursing facilities, ambulatory surgical centers, pharmacy, and Federally Qualified Health Centers (FQHC). Payers will include organizations comprised of Commercial, Medicaid, Medicare, Pharmacy Benefit Management (PBM), and Workers Compensation Government Contractors. Vendors will include organizations comprised of Billing Services, Clearinghouses, Electronic Health Record/Electronic Medical Record Systems, Network Service Vendors, Practice Management Systems, and Value Added Networks. 21

22 How to contact us All questions may be sent to Our expected level of service is to acknowledge all s within 24 hours Additional Contact Resources: 22


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