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5010 and ICD-10

5010 and ICD-10. Are you preparing?. Who are Covered Entities?. Health care provider that conducts certain transactions in electronic format Clearinghouse Health plan . What is 5010?.

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5010 and ICD-10

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  1. 5010 and ICD-10 Are you preparing?

  2. Who are Covered Entities? • Health care provider that conducts certain transactions in electronic format • Clearinghouse • Health plan

  3. What is 5010? • 5010 is an electronic data interchange version of the ANSI X12 formats for all HIPAA financial and administrative transactions for claims, remittance advice, eligibility, and claim status query and response transaction, plan enrollment, and referral authorization transactions • 5010 will be the format that will allow the exchange of the larger size of ICD-10 code set • 5010 must be implemented in order to implement ICD-10 code sets.

  4. 5010 • The implementation of 5010 aka HIPAA2, is rapidly approaching • 5010 will be the new HIPAA format • Medicare contractors will begin testing with submitters as early as January 2011 • The 5010 formats must be used as of January 2012 • It is important that you discuss your 5010 preparations and readiness with your vendor and/or clearinghouse • Medicare does not anticipate any extension on the 2012 compliance date. • January 2012 is quickly approaching!

  5. Why 5010? • Current HIPAA ASC X12 Transactions • Published over 8 years ago • Implemented over 6 years ago • Hundreds of industry requested changes were received and processed via the Designated Standards Maintenance Organizations (DSMO) • Approximately 500 resulted in changes to subsequent version(s) • A significant number of industry requested changes were submitted directly to the X12N Work Groups • Subrogation • Ambulance • Anesthesia • Condition Codes • More • Fixed Imperfections from previous guide • Ambiguity • Removed content not used • Supported the NPI regulation • Introduced consistency

  6. Affected Business Processes • Claims (837 Institutional, Professional, and Dental) • Claim Status (276/277) • Claim Payment (835) • Enrollment (834) • Premium Payment (820) • Eligibility (270/271) • Referrals and Prior Authorizations (278) • Claims Acknowledgements (277CA) • Acknowledgement for Health Care Insurance (999)

  7. Are you preparing for 5010? • Start now • Ask your vendor and/or clearinghouse about their plans and timeframes implementing 5010 • 4010A1 to 5010 gap analysis – identify: • New content • Deleted content • Modified content • Impact to business needs • Communicate and coordinate • Test: internally and externally • Know your vendor’s schedule • Know your trading partner’s schedule • Communicate within entire organization to insure all impacts identified early.

  8. ICD-10 Timeframes • NPRM • Published August 22, 2008 with comments by October 21, 2008 • Final rule • Published January 16, 2009 • Compliance date • OCTOBER 1, 2013 • for all covered entities with no exceptions

  9. Why ICD-10? • Improve accuracy and efficiency of coding • Reduce training effort • Improve communication with physicians • Completeness - All substantially different procedures have a unique code • Expandability - The structure of the system allows incorporation of new procedures as unique codes • Standardize terminology - Includes definitions of the terminology used. • While the meaning of specific words can vary in common usage, ICD-10-PCS defines a single meaning for each term used in the system.

  10. Preparing for ICD-10 • More complete than ICD-9-CM, greater specificity • Easy to expand the system • Multi-axial structure makes it easier to analyze • Standardized terminology makes it easier to use once the coder has initial training • Initial training time will be a factor since it differs significantly from ICD-9-CM • Having all terms defined makes it easier to teach • Once basic knowledge is acquired, the coder does not use the index

  11. ICD-9 3-5 characters First character is numeric or alpha (E or V) Characters 2-5 are numeric Always at least 3 characters Use of decimal after 3 characters Alpha characters are not case-sensitive IDC-10 3-7 characters Character 1 is alpha Character 2 is numeric Characters 3-7 are alpha or numeric All letters except U Always at least 3 characters Use of decimal after 3 characters Alpha characters are not case-sensitive Structure of ICD-9 vs ICD-10

  12. ICD-10-CM Structure:3 to 6 position code with leading alpha (+extension)

  13. 5010 and ICD-10 Milestones

  14. Compliance Dates • Compliance deadlines were set per public comments • CMS expects compliance deadlines to be met – no extensions • Success will depend on starting early!

  15. Our Message to You… • Start preparing now! • Work with your vendor and/or clearinghouse. • It is your responsibility to be compliant. • CMS expects compliance deadlines to be met – no extensions. • If you fail to prepare, it will be your business and cash flow that will be affected!

  16. EDI Ask The Contractor Teleconference (ACT) • These teleconferences are to address your EDI questions. • No reservations are required. • Who should attend? Providers, billing staff, vendors and clearinghouses with Medicare EDI questions. • 2010 calls (all times 1-2:30pm cst): Date Dial In ID • May 13, 2010 800-305-2862 35459364 • July 8, 2010 800-305-2862 35459365 • September 9, 2010 800-305-2862 35459366 • November 11, 2010 800-305-2862 35459367

  17. EDI Addresses & Numbers EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com Medicare Part A Legacy A Medicare J5 MAC Part A & B (multiple states) (Iowa, Kansas, Missouri, Nebraska) WPS Medicare EDI WPS Medicare EDI PO Box 1602 1717 West Broadway Omaha, NE 68101 Madison, WI. 53713 Fax: (402) 351-6188 Fax: (608) 223-3824 Med A Hotline: (866) 734-6656 J5 Hotline: (866) 503-9670 Medicare Part B LegacyMedicare Part B Legacy (Illinois, Michigan, Minnesota, Wisconsin) (EFT) WPS Medicare Electronic Data Services WPS Medicare Electronic Data Services 912 N Pentecost Drive 8120 Penn Ave. S., Suite 200 Marion, IL 62959 Bloomington, MN 55431 Fax : (618) 998-5170 Fax: (952) 885-2899 Med B EDI Hotline: (877) 567-7261 Phone: (952) 885-2811 (952) 885-2881 (952) 885-2882

  18. Resources • General ICD-10 information http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm • ICD-10-CM files, information, and General Equivalence Mappings (GEM) between ICD-10-CM and ICD-9-CM http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm • Washington Publishing for 5010 Technical Report Type 3 guides: WWW.WPC-EDI.com • CMS: http://www.cms.hhs.gov/HIPAAGenInfo

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