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AHCCCS Update Meeting – Systems Update

AHCCCS Update Meeting – Systems Update. May 2014. Cost Sharing (Copays). Addition modifications under evaluation and planned for 10/1/2014: Populations currently subject to mandatory and optional (nominal) copayments Populations exempt from copayments Amounts for applicable copayments

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AHCCCS Update Meeting – Systems Update

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  1. AHCCCS Update Meeting – Systems Update May 2014

  2. Cost Sharing (Copays) • Addition modifications under evaluation and planned for 10/1/2014: • Populations currently subject to mandatory and optional (nominal) copayments • Populations exempt from copayments • Amounts for applicable copayments • And services for which copayment apply are planned • Will begin to share details in upcoming Technical Consortiums Reaching across Arizona to provide comprehensive quality health care for those in need

  3. Data Exchange/Blind Spots • AHCCCS will manage an ongoing exchange of encounter and claims data to Contractors in order to eliminate “blind spots” for services provided to a member shared by multiple programs (In compliance with Federal privacy regulations); Contractors should use this information to develop short- and long-term strategies to improve care coordination • Ongoing – provide at least quarterly; First 1/4ly report for January – March 2014 was run and distributed in April Reaching across Arizona to provide comprehensive quality health care for those in need

  4. Data Exchange/Blind Spots (cont.) • Planned additions to the Data Exchange include the integration of - Medicare Paid Claims Data (Part D; D-SNP; Medicare FFS) – In progress Reaching across Arizona to provide comprehensive quality health care for those in need

  5. DRG’s • On schedule for 10/1/2014 Implementation (based upon Dates of Discharge) • Technical Workgroup Formed for this project; Meeting on a regular/as needed basis; Meeting materials available at http://www.azahcccs.gov/commercial/EDIresources/EDITechnicalWorkgroups.aspx • 3 Key Forms of Project Documentation – • AHCCCS Policy Document – Final Distributed • AHCCCS Rule – Revisions based on Comments in Progress • AHCCCS DRG Calculator – Final Distributed Reaching across Arizona to provide comprehensive quality health care for those in need

  6. DRG’s (cont.) • Finalized all Policy decisions and shared with all Contractors as a component of the DRG Technical Workgroup • Testing 3M APR-DRG software • Contractors will be provided with and will be required to successfully execute a defined set of test scenarios • Contractor monthly project Milestone Reporting began in February, 2014; Status Summary developed for internal tracking and publication to the web Reaching across Arizona to provide comprehensive quality health care for those in need

  7. DRG’s (cont.) • Current DRG Project Milestones:   • Complete Requirements and Design - Completed- March 2014 • Complete Coding – In Progress - May 2014 • Internal Testing Begins - May 2014 • Internal Testing Ends - July 2014 • External Testing Begins (all Contractors/providers/ATR) - June 2014 • System Implementation - September 2014 • External Testing Ends (No earlier than) - September 2014 Reaching across Arizona to provide comprehensive quality health care for those in need

  8. ICD-10 • The AHCCCS ICD10 Project was impacted by Federal Legislation; direction from CMS as to timeframes and implementation requirements specifies a delay in implementation to 10/1/2015 • No impact to APR-DRG project timeframes Reaching across Arizona to provide comprehensive quality health care for those in need

  9. ICD-10 (cont.) • Communication to Contractors – “It is AHCCCS’sintent, as previously communicated, to continue to pursue finalization of our ICD10 system changes and to utilize the delay to expand the External Testing window afforded to our Trading Partners. We will also be soliciting feedback from each of our Contractors over the next few weeks as to your ability to or barriers from being able to follow the aforementioned approach to project timelines.  Please do not stop work on your current timelines related to ICD10 project without first discussing revisions to your timelines with us.” Reaching across Arizona to provide comprehensive quality health care for those in need

  10. ICD-10 (cont.) • “Revised” AHCCCS ICD10 Project Milestones • Complete Requirements and Design – Reference Completed • Begin Coding – Reference Completed • Complete Requirements and Design – All other Completed • Internal Testing Begins – Reference Completed • Begin Coding – All other System Areas In Progress • Freeze Begins..... • System Implementation – Reference Completed • Initial Reference Table Loads Completed Reaching across Arizona to provide comprehensive quality health care for those in need

  11. ICD-10 (cont.) • Internal Testing Begins – System Areas In Progress • Other than Reference • Internal Testing Ends – All System Areas September 2014 • External Testing Begins (all Contractors/providers/ATR) (see detail) • 837 Submissions – Claims/Encounters January 2014 • Claims/Encounters Editing and Results Reporting March 2014 • Reports June 2014 • ICD9/DRG Integrated End to End June 2014 • ICD10/DRG Integrated End to End TBD Reaching across Arizona to provide comprehensive quality health care for those in need

  12. ICD-10 (cont.) • System Implementation (with 10/1/2015 effective dates) – All Systems September 2014 • Freeze Ends..... • External Testing Ends No earlier than September 2015 ICD10 Effective Date - October1 2015 (OP Dates of Services or IP Dates of Discharge) Reaching across Arizona to provide comprehensive quality health care for those in need

  13. ICD-10 (cont.) • Status Summary developed for publication to the web based on ongoing Contractor Milestone Reporting and Tracking Reaching across Arizona to provide comprehensive quality health care for those in need

  14. FQHC/RHC • FQHC/RHC Payment Alignment • Contractor’s will need to pay FQHC/RHC unique PPS rates for each “visit” (separate service not with same discipline) • Timeline • October 1, 2014 implementation • Provider registration letter and spreadsheet (In progress, due by 8/15/14) • Testing window for Contractors and providers (late July 2014 – early August 2014) Reaching across Arizona to provide comprehensive quality health care for those in need

  15. FQHC/RHC (cont.) • AHCCCS Proposal for FQHC/RHC Processing • AHCCCS will establish a unique provider type for FQHCs and a unique provider type for RHCs; Provider types 29 and C2 • AHCCCS is requesting that all FQHCs and RHCs register and obtain a unique AHCCCS Provider ID under these applicable provider types • To facilitate this registration and AHCCCS claims processing, AHCCCS is requesting that FQHCs or RHCs have a unique NPI (not already associated with any other active AHCCCS Provider ID) to be on file and utilized for related claims submissions • AHCCCS will provide a streamlined approach for provider registration Reaching across Arizona to provide comprehensive quality health care for those in need

  16. FQHC/RHC (cont.) • FQHC and RHC claims will identify the unique NPI of the FQHC or RHC as the service/rendering provider • FQHCs and RHCs can be reimbursed on same day for each “unique” visit, (.e. a separate service not within same discipline (e.g. dental and medical)); no change from the current process • FQHCs and RHCs will bill AHCCCS and its Contractors for each “unique” visit utilizing appropriate CPT Evaluation and Management codes and including all related services for the visit utilizing a 1500 claim format (standard practice for most facilities) • FQHCs and RHCs will be paid an all inclusive "visit" rate per visit that will serve a full reimbursement for the individual visit regardless of other related services for the visit Reaching across Arizona to provide comprehensive quality health care for those in need

  17. FQHC/RHC (cont.) • Visit payments will be paid associated with the billed E&M “visit” codes and any other related services will be valued at $0.00 • AHCCCS will implement a unique Provider specific fee schedule (equivalent to the PPS rate) for each FQHC and RHC where visit E&M codes will reflect the appropriate per visit rate effective for the date of service and in which all other related service codes will reflect a rate of $0.00 (due to bundling under the per visit rate as noted above) • Current FQHC Pharmacy (340B) billing will remain as is under the Pharmacy provider type, etc... and will not be impacted by this change Reaching across Arizona to provide comprehensive quality health care for those in need

  18. FQHC/RHC (cont.) • AHCCCS will continue to have a quarterly payment and reconciliation process but the amounts that are part of the quarterly payments will be updated to reflect that fact that Contractors will be paying considerably more to avoid recoupments as part of the reconciliation Reaching across Arizona to provide comprehensive quality health care for those in need

  19. PCP Rate Parity • AHCCCS will make quarterly cost-settlement payments to the Contractor based upon adjudicated/approved PCP Rate Parity encounter data • Contractors will be required to refund payments to AHCCCS for any reduced claim payments in the event that a provider is subsequently “decertified” for enhanced payments as result of subsequent audits or other changes to providers Reaching across Arizona to provide comprehensive quality health care for those in need

  20. PCP Rate Parity (cont.) • “Catch-up” cost-settlement report for qualified encounters adjudicated/approved between 8/1/2013 and 12/31/2013 a well as the first 1/4ly report for the January through March time period were run and distributed to Contractors; late last week an issue was noted with the reporting and re-runs of both reports for redistribution to Contractors is in progress Reaching across Arizona to provide comprehensive quality health care for those in need

  21. Security Audit • Reminder - First audit due no later than June 1, 2014; any issues or concerns with this timeframe please let us know ASAP • Minor clarifications made to published policy in response to additional Contractor feedback made and distributed in January • Timeframe for our internal review not yet determined but will be communicated shortly Reaching across Arizona to provide comprehensive quality health care for those in need

  22. AHCCCS >99 Encounter Lines • AHCCCS 999 UB Lines HIPAA compliance changes proposed for mid 2015 • Will fully remediate the PMMIS system to expand the CRN by 1 additional digit • Will impact and require testing with Contractors • Detailed timelines in development Reaching across Arizona to provide comprehensive quality health care for those in need

  23. RBHA Encounter Data • Beginning in January of this year AHCCCS began directly processing RBHA (including the Integrated RHBA) encounters for both TXIX/TXXI and State Only populations/services • Includes processes to capture and support State Only member records in PMMIS • ADHS/BHS receives copies of process related reporting Reaching across Arizona to provide comprehensive quality health care for those in need

  24. Other • Next Technical Consortium scheduling in progress for sometime in June • Technical Workgroup focused on TPL data and related processes scheduled for Tuesday, June 10th; Will include participants from HMS Reaching across Arizona to provide comprehensive quality health care for those in need

  25. Questions? Reaching across Arizona to provide comprehensive quality health care for those in need

  26. Thank You. Reaching across Arizona to provide comprehensive quality health care for those in need

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