Medicaid Webinar 11-2-2011

1. Medicaid Webinar11-2-2011 Kathy WhitmireChris Scarborough HomeTown Health, LLC

2. Learning Outcomes • Define the benchmark of readiness for transition to HIPAA 5010 on January 1, 2012. • Identify the need for the 5010 conversion. • Define benchmarking and monitoring actions to engage in following the Jan 1st transition. • Define the date that HIPAA 5010 goes into effect.

3. Countdown to HIPAA 5010 • Begins November 2nd with training and checklists to ensure that all hospitals are ready! • Discuss Example of changes • Next Webinars • Nov 9th • Dec 7th • Dec 14th ALSO • 12 month - ICD-10 Readiness Program • Led by Sherry Milton, Coding & Documentation Expert • Begin in January

4. HIPAA Agenda • Overview / Background • Changes • Expectations • How to be Prepared • Toolkit / Checklist • What’s Next

5. HIPAABackground • Healthcare reform of the 90’s • Provide greater access to healthcare • Address administrative concerns • HIPAA enacted in 1996 • Need for changes to streamline healthcare • Standard format • Designated code sets • Goal • Decrease administrative costs by standardization

6. HIPAABackground • Standardize transfer of information • Specific to electronic transactions • Important to understand what is or is not permitted under HIPAA

7. HIPAA Electronic Transactions

8. HIPAA Background • Implementation Guides • Serve as instructions to vendors to program systems to ensure they are able to transmit data in compliance with HIPAA • Standardized Code Sets • Identified as “medical” or “non-medical” • ICD-9 • CPT • HCPCS

9. HIPAA Background • Need to upgrade from 4010 to 5010 • 4010 developed in 2000, revised 2002 • Technical issues • Accommodate new business needs • Remove inconsistencies • 5010 • Developed in 2006 – 2007 • Approved by HHS in January 2009

10. Moving to 5010 • January 1, 2012 • 59 days • Only 5010 transactions • 4010 rejected as non-compliant • Can use 5010 before Jan 1 • 5010 needed to change from ICD-9 to ICD-10 • Required October 1, 2013

11. HIPAA 5010 Implementation Steps • Step #1- Impact Analysis • Step #2 – Contact your Vendors, Payers, Billing Services, & Clearinghouse • Step #3 –Installation of Vendor Upgrades • Step #4 – Internal Testing and Staff Training • Step #5 – External Testing with Clearinghouse, Billing Services, and Payers • Step #6 – Make the Switch to 5010

12. HIPAA 5010 Implementation Dates • January 1, 2012 • Must use only 5010 transactions • After Jan 1, 2012 • Monitor the submission and receipt of these transactions • October 1, 2013 • Switch from ICD-9 to ICD-10

13. HIPAA 5010 Compliance • Level I compliance • means "that a covered entity can evidently create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." We (CMS) expect covered entities to be testing throughout calendar year 2011, and to schedule testing as early as possible, to ensure sufficient time for corrective actions and re-testing. • Level II compliance • means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.”

14. WHAT’S DIFFERENT IN HIPAA 5010 • Changes on claims • Anesthesia minutes revised – only total minutes • Max number of diagnosis codes increased from 8 to 12 • Need to check with vendors to fully understand all changes

15. WHAT’S DIFFERENT IN HIPAA 5010

16. TESTING YOUR READINESS • Work closely with vendors • Internal • Organizational level • Software / programming changes • 5010 transactions installed correctly • Vendor to assist • Benchmark – successfully create / receive 5010 compliant transactions • Contact clearinghouse if used

17. TESTING YOUR READINESS • External • Sending / receiving 5010 compliant transactions to business associates and trading partners through the channels used today • Identify issues during transmission • End-to-End testing • Ready to go Live • Test with sample of largest portion of revenue • Have you tested?

18. PREVENTING CASH FLOW INTERRUPTIONS DURING TRANSITION • CMS “no delay in 5010 compliance deadline” • Unanticipated problems = delays • Most important steps • TEST! • Speak with trading partners

19. USING ACKNOWLEDGEMENT TRANSACTIONS • Decrease miscommunications • Payer may not receive • Duplicates • Errors • Typical claims submitted in batches • A dozen to hundreds • Problem with a transaction – need to know if it’s all, some, or one

20. USING ACKNOWLEDGEMENT TRANSACTIONS • TA1 – report the receipt of the transmission • Received • Received with errors • Rejected • 999 – report any syntactical errors identified at the claim level • 277CA – report total number accepted, pending, or rejected • Provides reasons

22. 5010 CHECKLIST • PROJECT PLAN • ASSESSMENT • IMPLEMENTATION • MONITORING

23. 5010 CHECKLIST 1. PROJECT PLAN • Gain an understanding of the impact of the update to the 5010 transactions • Look to your professional association(s) for information & resources • Identify a project leader/project team • Develop a project plan

24. 5010 CHECKLIST 2. ASSESSMENT • Identify all HIPAA transactions you are currently doing • Identify any HIPAA transactions that you are not currently doing, but want to implement now electronically • Create a list of your payers, including a contact person, phone number, & email address • Identify your clearinghouse’s contact person’s phone/email

25. 5010 CHECKLIST ASSESSMENT cont’d • Contact your vendor to determine their implementation plans for 5010 transactions • Contact your billing service to determine their implementation plans for 5010 transactions • Contact your clearinghouse to determine their implementation plans for 5010 transactions

26. 5010 CHECKLIST ASSESSMENT cont’d • Contact your payers to determine their implementation plans for 5010 transactions • Identify any work flow processes that need to be modified

27. 5010 CHECKLIST 3. IMPLEMENTATION • Identify when your vendor will install your updates • Identify when your billing service’s system changes will be installed • Contact your clearinghouse to determine when it can begin testing • Contact your payers to determine when they can begin testing • Complete internal testing

28. 5010 CHECKLIST IMPLEMENTATION cont’d • Complete external testing with billingservice • Complete external testing with clearinghouse • Complete external testing with payers • Conduct staff training • Beginusing 5010 transactions before or on January 1, 2012

29. 5010 CHECKLIST 4. MONITORING • Monitor the exchange of the 5010 transactions • Report any issues identified with the transactions to the appropriate organization DATES January 1, 2012 – Compliance with version 5010 transactions October 1, 2013 – Compliance with ICD-10 code sets www.ama-assn.org/go/5010

30. RESOURCES AMA Transaction Code Set Standards GetReady5010.org – Free Webinars GetReady5010.org/Resources ICD-10 Code Set to Replace ICD-9 HIPAA 5010 Toolkit Questions??

31. HomeTown News & Events NEWS: • New Members – Elbert Memorial & Chatuge Regional • New Partners – VendorMate and Data Rx – 340B for hospitals • New DCH Commissioner David Cook confirms keynote at Fall Conference EVENTS: • Nov 2nd, 9th, Dec 7th, 14th – Countdown to HIPAA 5010 • Nov 16th -18th – HTH Fall Conference • Dec 12th -13th – HIPAA Compliance Officer Training • Jan 25th – 26th – GA Rural HIT Conference – Macon • Jan – Sherry Milton ICD-10 Readiness Training begins

33. Learning Outcomes • Define the benchmark of readiness for transition to HIPAA 5010 on January 1, 2012. • Identify the need for the 5010 conversion. • Define benchmarking and monitoring actions to engage in following the Jan 1st transition. • Define the date that HIPAA 5010 goes into effect.

34. ANNOUNCING HOMETOWN HEALTH 12TH ANNUAL FALL CONFERENCE November 16 - 18 – Callaway Gardens SPEAKERS AND SESSIONS INCLUDE: KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health DCH Medicaid – HP - CMO – Navigant Discussion PANEL:  Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP Georgia Redistricting Update  - David Tatum, CHOA A New Day in the Future of Health Care SPEAKER: Kirk McGhee, Vice President and Regional Counsel for Kaiser Permanente GA Health Information Exchange – GA-HITREC – Dr Denise Hines Value Based Purchasing / ACO Discussion – Led by Michelle Madison, Attorney Health Insurance Exchange – What Hospitals Need to do to Prepare- Ryan Teague 4 Requirements for Survival in 2012 and Beyond – PANEL: Change -Sue Spivey, Technology- Brenda Jarrett, Leadership – Jeff Dunn, Revenue Mgmt – Lynn Byrd