Presented by Joan Kossow Data Compliance Manager

1. The Changing Face of Claims Processing & Presented by Joan Kossow Data Compliance Manager

2. Overview • ICD-10 • SSI’s approach • What’s changing? • Provider’s responsibilities • Next Steps ICD-10 Compliance

3. ICD-10 Transition to ICD-10 codes is 20 years in the making There will be no transition period, the initiative is date driven – 10/1/14 Comprehensive testing models will change the “face” of testing ICD-10 initiative is a “value-based” proposition for the industry Workman’s Compensation – not all will transition to ICD-10

4. SSI ICD-10 Project • SSI’s Core Team formed in 2009 • Subject Matter Experts Cross Multiple Departments • Cross-Product Design Team formed 2010 • Focus on Consistency • EDI payer acceptance rates • NO CROSSWALKS • Industry Advocacy • Committee involvement with governmental and non-governmental agencies, AAHAM, WEDI, HIMSS, HFMA, HBMA, AHIMA, etc. • ICD-10 information in software i.e., product report cards, FAQ’s, webcasts….and more

5. ICD-10 • Project analysis and timelines • Product updates on schedule • Internal and external testing • Training internal and external • Collaborations established • Governmental and non-Governmental Agencies • HIMSS/WEDI ICD-10 committees • HIMSS ICD-10 Playbook • CORE certified Phase I & II for Eligibility and Claims Status for Operating Rules

6. ICD-10 Testing Elements Performance Testing Usability Considerations Software Quality Goals/Checkpoints Ensuring Backward Compatibility Minimize “Day 1” Impacts – Software Apps Implementation Procedures – Software Apps Outside the Box Testing

7. ICD-10 R&D Software developers testing their “code” Integrated Testing – All software changes tested together to ensure all works “as designed” System Testing – Testing software implementation process Beta Testing – Software delivered to customers to test in own environment General release – providers to test in their own test environments. Test systems for ICD-10 a necessity!

8. Provider Considerations Usability – Volume of New Codes Productivity – will decline initially, until comfortable with ICD-10 coding Payers – How they will approach testing? ICD-9 & ICD-10 Concurrently – will your vendor/payer be able to support both versions after 10/1/14 New Scenarios for Testing (date-based, syntax/content, or medical based scenario testing) Out of the box!!!

9. Provider Considerations Pre-requisite Release/Version for ICD-10 Ready Software Remember, ICD-10 affects any software that currently utilizes ICD-9, includes Electronic Health Records systems Project timelines for internal software integration Documentation – software updates Training for ICD-10 Software enhancements Software integrated testing with each vendor

10. SSI EDI Clearinghouse Payer Testing • Payer Matrix • Payer Testing Process • Tracking Testing Status • Go-Live 10/1/2014 • Post Go-Live Monitoring

11. Plan Ahead • Clearinghouse capabilities include the ability to continue to submit ICD-9 transactions post 10/1/2014 • Payers must continue to accept re-bills with ICD-9 codes • With ICD-10, don’t expect clearinghouses to crosswalk ICD-9 claims if Provider’s systems are not ready or capable of generating transactions with ICD-10 codes • Documentation is key with coding ICD-10. Medical records must be used for correct coding. Crosswalks inaccuracies have been identified and abandoned by many clearinghouses, payers and other organizations • Plan ahead, if you know your systems are not going to be ready for ICD-10, internal decisions should be made now to define alternative steps to ensure no interruption in billing occurs

12. Post Go-Live • Monitor your systems and reports • Data analytics is your best friend! • 835s should always be monitored. Patient accounting system postings, payments and adjustments, of the adjudication of the claim should be included in your activities • Coordinate activities throughout your organization with Medical Records, Contracts Management, etc.

13. Post Go-Live • ICD-10 is an opportunity for increased reimbursements based on greater specificity of services provided • Ensure that your payer contracts demonstrate greater revenue potential • Data analysis will provide information crucial to your organizations profitability and afford information to make negotiated modifications with your payers in management of your contracts

14. Post Go-Live • Verify that every aspect of your systems are functioning correctly. Identify and address issues quickly • Keep track of post go-live issues and resolutions. They may be beneficial lessons learned for not only your organization, but others in the industry • Communicate and Collaborate with trading partners • Ultimate goal – successful transition with minimal disruption

15. Contingency Planning Obtain advanced approval for loans for your organization in case of impacts to your revenue stream Develop contingency plans in case your systems and software are not update timely for compliance by 10/1/14 Validation of ICD-9 to 10 remittances to assist in your historical and future revenue streams Assist Physicians by developing guidance for appropriate documentation associated with ICD-10 coding

16. Contingency Planning Ensure that plans incorporated internal resources pre and post implementation needs Payers are developing new testing initiatives for ICD-10. If your facility is not selected as a BETA test site, use the time to concentrate on readiness internally Determine what type of testing is needed internally with updated ICD-10 integrated systems to ensure that the appropriate information is integrated in the financial systems

17. Challenges Not all system errors may be related to ICD-10 Remember that many systems are being updated and you must do your due diligence in identifying were the issue actually resides and in which product Infrastructure capabilities, protocols and procedures must be updated to accommodate ICD-10 from Eligibility to denial management. Continue your ICD-10 project teams well past the implementation date of 10/1/14

18. Get Ready! Time is Short!!

19. Thank you!