Presentation is loading. Please wait.

Presentation is loading. Please wait.

Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services January 3, 2013 10:00 am to 11:00.

Similar presentations


Presentation on theme: "Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services January 3, 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 3, 2013 10:00 am to 11:00 am EST

2 Welcome 2

3 Agenda  Welcome/Opening RemarksJulie McBee5 minutes  ICP AttendanceDavid Carrier5 minutes  Ground RulesJulie McBee5 minutes  Goals, Intended Outcomes & Overview  DefinitionsDavid Carrier  ReadinessOpen Floor20 minutes  ComplianceOpen Floor20 minutes  Readiness Specific ( Provider, Payer, Vendor )Tentative  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 Medicare FFS 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.

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 Readiness Webinar Feedback #1 Stanley Nachimson - you need to drop the time reference "prior to the regulatory implementation date", no need for time stamp in this particular definition. They should be allowed to be ready at any time. Crosswalk approach - should be expanded, should just be referred to the ones who uses a crosswalk. George Agnes - one item missing, needs to establish a communication mechanism b/n Trading Partners, some can get lost where you're at on the process without having effective communication. Robin Isgett - Readiness definition - repeated the word "completing". Stanley Nachimson – suggests to get rid of "prior to the regulatory implementation date" Michele Davidson - move the "establishing communication mechanism" after “completing testing”. 9

10 Readiness Readiness is a state of preparedness that includes defining needs, identifying risk and implementing a planned sequence of actions to successfully operate and maintain a new/upgraded system, and or processes, with each published standard by the regulatory implementation date. *Our revised definition is as follows: Readiness is a state of preparedness in which an Entity has completed internal testing of applicable policies, procedures, guidelines, laws, regulations, and contractual arrangements with expected results. Additionally, entities will demonstrate readiness by completing internal documentation, testing and establishing communication mechanisms with external trading partners, internal and external training, scheduled deployments, and software migration for each published standard. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of readiness based on Industry feedback and participation on January 3rd, 2013 webinar. 10

11 Compliance Webinar Feedback Stanley Nachimson - needs to look at legal implication, make sure we're not violating any legality. Voice concern about CMS, violating HIPAA rules by definition Compliance. Michele Davidson - agree with Stanley. Compliance should not be tied with Readiness, in reference to the sentence "conditions described in Readiness" Cathy Carter - if you're trying to achieve compliance, she doesn't see the need to have the regulatory implementation date. Compliance is a state you achieve. Achieving something by a date, not necessarily implementation date. Elizabeth Reed - likes the regulatory implementation date. Otherwise, it can mean you can be ready anytime. George Agnes - referencing to Stanley's comment, should the word “Compliance” be removed? Suggested to maybe remove Compliance and talk about preparation for Readiness. Robin Isgett - likes the regulatory implementation date on the definition. George Agnes - put "in advance" to the regulatory implementation date. He likes the HIMMS definition better. Tammy Banks - Should it be one or more requirement(s) may apply? This process doesn't negate the implementation deadlines and enforcement measures determined by HHS or other authority. Would suggest leave general - by regulatory implementation date. Stanley Nachimson – when referring to the “regulatory implementation date”, he suggests not only to say “by” but needs to be even "after" that date, going forward. Stanley Nachimson - issue is not just switching the word to “Adherence”, it’s using the word "Compliance" itself. Lack of compliance can force an entity in Enforcement actions. He would like to remove the word "Compliance". Stanley Nachimson - make sure to capture the legal review of the Compliance definition. 11

12 Compliance *Our revised definition is as follows: Compliance – Demonstrated adherence to those policies, procedures, guidelines, laws, regulations, and contractual arrangements to which the business process is subject in advance of, by and 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 Compliance based on Industry feedback and participation on January 3rd, 2013 webinar. 12

13 Provider Readiness Webinar Feedback Cathy Carter – the list of items included, if it should be listed as an example. It seems to be too specific to list all the different transactions. Stanley Nachimson – concerned about the phrase, "confirmation of successful production" - should be after the fact (testing). This is the first time of mentioning that. Suggest taking out the word "production". This is an End-to-End exercise vs. Production. Cathy Carter - she would second Stanley's suggestion. Michele Davidson - when talking about Provider Readiness, providers may not be familiar with the specific transaction types such as the 277CA response since they don’t see it, and they just rely on the Vendor's or Clearinghouse who interprets the reports and send to the provider. Cathy Carter – even if the providers don’t see those certain types of transaction, they still need to be responsible as far as being ready. On the definition slide, we can add the phrase like “A provider” or "in behalf of the provider". Has issue as Medicare would not be able to support testing these, think the list is length. Can lead to more questions and what this might mean to a payer. 13

14 Provider Readiness *Our revised definition is as follows: A Provider is considered ready when they or their business associates have completed internal testing and tested with a (%) of mission critical external trading partners including vendors, clearinghouses and payers. Additionally, they will have completed internal documentation and established communication mechanisms with external trading partners, internal and external training, scheduled deployments and/or software migration for each published standard in advance of, by and 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 3rd, 2013 webinar. 14

15 Provider Readiness Dependent on the regulation, one or more of the following examples may apply: All analytics, clinical, Electronic Healthcare Records (EHR’s), Electronic Medical Records (EMR’s) and practice management system upgrades have been completed Confirmation of successful testing with submission payers Confirmation of successful testing with vendors Confirmation of successful testing with clearinghouses Confirmation of successful submission of claims (837) and receive TA1, 824, 999, 277CA responses. Confirmation of successful retrieval of the claims’ associated remittance (835) Confirmation of successful acceptance of claim status inquiry submission (276) Confirmation of successful return of claim status inquiry response (277) Confirmation of successful receipt of claims eligibility status request(270) Confirmation of successful return of claims eligibility status (271) Confirmation of successful submission of services review inquiry (278) Confirmation of successful receipt of services review response (278) 15

16 Payer Readiness A Payer is considered ready when they have completed all internal testing and tested with a (%) of mission critical external trading partners including vendors, clearinghouses and providers. Additionally, they will have completed internal documentation, completed internal and external training, completed scheduled deployments and/or software migration for each published standard prior to the regulatory implementation date. 16

17 Payer Readiness Dependent on the regulation, one or more of the following will apply: All system upgrades – front end translation and back end adjudication system – have been loaded Confirmation of successful testing with submitting providers Confirmation of successful testing with submitting vendors Confirmation of successful testing with clearinghouses Confirmation of successful acceptance of production like claims (837) submission Confirmation of successful return of the claims’ associated remittance (835) Confirmation of successful acceptance of claim status inquiry submission (276) Confirmation of successful return of claim status inquiry response (277) Confirmation of successful receipt of claims eligibility status request (270) Confirmation of successful return of claims eligibility status (271) Confirmation of successful receipt of services review inquiry (278) Confirmation of successful return of services review response (278) Confirmation of successful receipt benefit enrollment (834) Confirmation of successful return of benefit maintenance (834) 17

18 Vendor Readiness A Vendor is considered ready when they have completed internal testing and tested with a (%) of mission critical external trading partners including providers, clearinghouses/vendors and payers. Additionally, they will have completed internal documentation, completed internal and external training, completed new/change processes, completed scheduled deployments and/or software migration for each published standard prior to the regulatory implementation date. 18

19 Vendor Readiness Depending on the type of vendor your organization is and the regulation change, one or more of the following will apply: All system upgrades – front end translation and back end adjudication system – have been loaded Confirmation of successful testing with submitting providers Confirmation of successful testing with submitting payers and/or vendors Confirmation of successful testing with clearinghouses Confirmation of successful acceptance of production claims submission (837) Confirmation of successful return of the claims’ associated remittance (835) Confirmation of successful acceptance of claim status inquiry submission (276) Confirmation of successful return of claim status response (277) Confirmation of successful acceptance of eligibility status (270) Confirmation of successful return of eligibility status (271) Confirmation of successful receipt of services review inquiry (278) Confirmation of successful return of services review response (278) Confirmation of successful receipt benefit enrollment (834) Confirmation of successful return of benefit maintenance (834) 19

20 Questions ? 20

21 Closing Remarks Hope to finalize the Readiness and Compliance Definitions soon. If you have any feedback on the definitions, please send it no later than Friday, January 11, 2013. Next ICP webinar session is Tuesday, January 8, 2013 from 10am to 11am EST First Listening Sessions start today, Thursday, January 3, 2013 – Participants can join via a CMS website link. Below is the link for those sessions. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/index.html http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/index.html 21 Listening Sessions Topic Thursday, January 03, 20131:00 pm - 2:00 pmWelcome, Intro, DefinitionsSmall Provider Group 1 Thursday, January 03, 20133:00 pm - 4:00 pmWelcome, Intro, DefinitionsLarge Provider Group 1 Tuesday, January 08, 20131:00 pm - 2:00 pmWelcome, Intro, DefinitionsVendor Tuesday, January 08, 20133:00 pm - 4:00 pmWelcome, Intro, DefinitionsPayers Thursday, January 10, 20131:00 pm - 2:00 pmWelcome, Intro, DefinitionsSmall Provider Group 1 Thursday, January 10, 20133:00 pm - 4:00 pmWelcome, Intro, DefinitionsSmall Provider Group 2 Tuesday, January 15, 20131:00 pm - 2:00 pmWelcome, Intro, DefinitionsLarge Provider Group 1 Tuesday, January 15, 20133:00 pm - 4:00 pmWelcome, Intro, DefinitionsLarge Provider Group 2

22 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. 22

23 How to contact us All questions may be sent to ngs.compliancetesting@wellpoint.comngs.compliancetesting@wellpoint.com Our expected level of service is to acknowledge all e-mails within 24 hours Additional Contact Resources: 23


Download ppt "Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services January 3, 2013 10:00 am to 11:00."

Similar presentations


Ads by Google