ICD-10: Beyond Awareness Now is the time for action! Regulatory, Industry and Health Plan Perspectives and Challenge

1. ICD-10: Beyond Awareness Now is the time for action! Regulatory, Industry and Health Plan Perspectives and Challenges George Vancore Florida Blue Sr. Manager, Delivery Systems Compliance Portfolio AAHAM South Florida & Greater Florida Buccaneer Chapters August 14, 2013 900-3139-0812

2. ICD-10: Beyond Awareness Now is the time for action! Session Objectives To increase your awareness and understanding of the challenges that ICD-10 brings to Providers; Payers and others in the Health Care industry. To increase your understanding of the current state of ICD-10; recent regulatory decisions and industry perspectives. To share insights into why collaboration between providers, payers and others in health care is critical to a successful ICD-10 implementation. To provide you with some tools, techniques and helpful hints that could be used as you begin and continue your ICD-10 journey.

3. ICD-10: Beyond Awareness Now is the time for action! • Regulatory and Health Care Industry Update • The ICD-10 regulatory compliance date of October 1, 2014 remains in effect. • NUCC has formally announced changes to the CMS 1500 professional paper claim form to accommodate ICD-10 (www.nucc.org); a recommended transition timeline follows: • January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12). • January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05). • April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12). • CMS has re-launched their ICD-10 teleconferences and industry-wide communications across provider and electronic trading partner channels (www.cms.gov/ICD10). • Industry workgroups (I.e. WEDI) and health care industry trade associations (I.e. AHA: HBMA; PAHCOM; HIMSS) are accelerating their outreach to their constituents on ICD-10.

4. ICD-10: Beyond Awareness Now is the time for action! • Regulatory and Health Care Industry Update (continued) • New state and national ICD-10 collaborative’s are forming with a focus on shared learning's, outreach and engagement with providers and electronic trading partners. • AMA’s position on ICD-10 focuses on an indefinite delay and the opportunities and challenges associated with leap-frogging ICD-10 for ICD-11. • The AHA and the BCBSA issued a joint letter to the House and Senate on their continued support of implementing ICD-10 on October 1, 2014. • CMS announced an ICD-9 and ICD-10 code set freeze. • Small to mid-sized providers continue to show slow adoption/action toward engagement. • Provider “end-to-end” testing continues to be a significant industry challenge. • ICD-10 readiness survey’s between providers, health plans, electronic trading partners and business associates are accelerating; these surveys are indicators as to the various levels understanding and awareness of the ICD-10 challenge ahead.

5. ICD-10: Beyond Awareness Now is the time for action! • Regulatory Fundamentals (What do we remember?) • The ICD-10 CM (Clinical Modifications) and ICD-10 PCS (Procedure Coding Structure) are the new medical diagnosis and procedure code sets under HIPAA-AS. • The new ICD-10 code sets represent a fundamental overhaul to the current ICD-9 coding system; they will replace outdated codes that do not reflect recent advances in medical technologies nor are they descriptive enough. • ICD codes are used to codify medical diagnoses and procedures, calculate &d adjudicate coverage, compile medical statistics, assess quality of care and help manage clinical quality outcomes for patients. • As highlighted in the final rule, the new ICD-10 CM and PCS code sets are intended to: • Provide greater flexibility to enable future capabilities. • Provide more descriptive and robust categories for precise coding. • Enable streamlined reimbursement processes. • Provide richer medical data with higher degrees of details and quality for further analysis; help enrich clinical care profiles and patient outcomes. • Maximize the value of clinical data and the business value of interoperability of e-health initiatives and the Electronic Health Record (EHR).

6. ICD-10: Beyond Awareness Now is the time for action! • Regulatory Fundamentals (What do we remember?) • CD-10 CM is the new medical code sets under HIPAA-AS for diagnosis reporting and replaces ICD-9 CM in all U.S. health care settings.

7. ICD-10: Beyond Awareness Now is the time for action! • Regulatory Fundamentals (What do we remember?) • ICD-10 PCS identifies medical procedures for use in U.S. inpatient hospital settings only; does not replace CPT/HCPCS codes for outpatient services.

8. ICD-10: Beyond Awareness Now is the time for action! • Regulatory Fundamentals (What do we remember?) • In addition to structural and content changes to the code sets, there are several medical terminology changes that are also being implemented. A few examples follow:

9. ICD-10: Beyond Awareness Now is the time for action! • Regulatory Fundamentals (What do we remember?) October 1, 2014 The implementation of ICD-10 is “Service Date” driven for outpatient services and “Discharge Date” driven for inpatient services!! So, how does this impact you? Do you need to co-exist between ICD-9 and ICD-10 after the mandated compliance date? What happens if a pre-authorization is issued under ICD-9 but the Service is not performed until after ICD-10 is implemented?

10. ICD-10: Beyond Awareness Now is the time for action! • Regulatory Fundamentals (What do we remember?)

11. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue Fundamentals (What do we remember?) • How is Florida Blue Addressing the ICD-10 Challenge? • In early 2010, Florida Blue established an ICD-10 enterprise-wide program with a formal governance structure and Program Management Office (PMO). • Florida Blue’s ICD-10 Program is chartered under an ICD-10 Steering Committee with appropriate senior leadership and membership across the enterprise. • Florida Blue’s ICD-10 Program has established three primary objectives: • Meet the ICD-10 compliance requirements (Functionally Compliant). • Mitigate any medical cost impacts that may result from the implementation of ICD-10 (Financial Risk). • Achieve administrative efficiencies (Operationally Efficient).

12. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue Fundamentals (What do we remember?) • How is Florida Blue Addressing the ICD-10 Challenge? (continued) • Florida Blue’s ICD-10 Program has organized the work across the following 14 elements with each element having its own project scope that is aligned with the overall ICD-10 program:

13. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue Fundamentals (What do we remember?) • How is Florida Blue Collaborating with Providers for ICD-10? • Florida Blue’s Provider Communication, Collaboration and Education (PCCE) element is focused on collaborating with providers to support a successful ICD-10 implementation; • The following tactics are currently being executed to increase provider understanding, engagement and collaboration on ICD-10: • Utilize corporate communication channels (BlueLine; Provider Bulletins; Florida Blue website): • Deliver ICD-10 related articles of interest that will increase ICD-10 awareness, understanding and engagement with an emphasis and how Florida Blue is meeting the ICD-10 challenge. • Partner with Medical Associations and Societies (FHA; FMA; FOMA; HFMA; FAFP; HBMA; WEDI; AAHAM; Florida Collaborative; N Florida MGMA; Palm Beach and Duval County Medical Societies): • Publish Florida Blue ICD-10 related articles in their membership newsletters. • Attend local, regional and state-wide seminars and meetings to present and discuss ICD-10 and its implementation challenges.

14. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue Fundamentals (What do we remember?) • How is Florida Blue Collaborating with Providers for ICD-10? (continued) • Partner with the BCBSAPCCE Workgroup to share practical experiences, learning’s and best practices. • Partner with Availity: • Florida Blue has partnered with Availity to jointly sponsor ICD-10 Webinars in 2012 and will continue into the latter part of 2013; these free seminars have been/will be focused on what providers need to do to successfully transition to ICD-10 and are available for free download from the Availity website. • Florida Blue’s ICD-10 Open-Line Friday: • Since May 2012, Florida Blue launched a monthly ICD-10 Open-Line Friday teleconferences for providers and electronic trading partners that cover a variety of ICD-10 related topics. • Florida Blue collaborates with several providers and electronic trading partners to jointly present topics of common interest and share best practices (Tampa General; Mayo Clinic; Baptist Health South Florida; Availity; The SSI Group; SecureEDI, etc.). 14

15. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue’s Provider Testing Approach • Florida Blue has developed an overarching 3-phased strategy and approach for ICD-10 Provider Testing: • Phase I: Code Validation • The primary objective of this phase is to help determine providers ICD-10 coding behaviors through the sharing and reconciliation of common clinical scenarios and their associated ICD-10 diagnosis and procedure codes. • Note: • This phase will utilize a series of clinical scenarios that have been developed by Florida Blue and will include any reasonable number of clinical scenarios that providers generate. • Providers will be asked to provide both ICD-9 and ICD-10 codes for their specialty against these clinical scenarios. • If you are interested in ICD-10 testing with Florida Blue, please send an e-mail with your contact information to FloridaBlueOpenLineFriday@FloridaBlue.com. • Value: • Helps introduce the complexity of coding ICD-10 using ICD-9 as a baseline against clinical scenarios that are provider specialty-based. • Supports a collaborative learning approach that will help to validate and verify coding behaviors and expectations between Florida Blue and providers.

16. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue’s Provider Testing Approach (continued) • Phase II: Internal End-to-End • The primary objective of this phase is to validate and verify Florida Blue’s internal system readiness to successfully process an ICD-10 coded electronic transaction originating from the provider using a test environment with time-stamped production data. • Note: • This phase will utilize previously processed ICD-9 transactions that have been modified by the provider to their ICD-10 “equivalent”. • These ICD-10 enabled transactions will be sent to Florida Blue using existing electronic transaction pipelines and protocols. • The provider will NOT receive any electronic or reporting results in this phase. However, communication channels between Florida Blue and the provider will be maintained. • Value: • We will be able to establish a comparative baseline by using previously processed and adjudicated ICD-9 transactions that have been ICD-10 enabled by the provider. • This phase will help validate and verify Florida Blue’s internal system ICD-10 readiness without disrupting provider environments. • Using production data will not require data synchronization between electronic transaction value-chain partners.

17. ICD-10: Beyond Awareness Now is the time for action! • Florida Blue’s Provider Testing Approach (continued) • Phase III: Round Trip • The primary objective is to enable an electronic “round-trip” test between the provider and Florida Blue of previously processed ICD-9 coded electronic transactions that have been ICD-10 coded by the provider. • Note: • As noted in phase II, this phase will again utilize previously processed ICD-9 transactions that have been modified by the provider to their ICD-10 “equivalent”. • These ICD-10 enabled transactions will be sent to Florida Blue where they will processed and returned to the provider using existing electronic transaction pipelines and protocols. • The provider will receive all relevant electronic transaction and reporting results. • Communication channels between Florida Blue and the provider will be maintained. • Value: • Florida Blue and the provider will be able validate and verify the full round-trip processing of electronic transactions between the clinical to the administrative environments. • This phase will help validate and verify the ICD-10 readiness of valued electronic trading partners, vendors and business associates.

18. ICD-10: Beyond Awareness Now is the time for action! • What Can Providers/Practices Do Now to Prepare? • The CMS ICD-10 website (www.cms.gov/ICD10) has official “source-of-truth” resources to help you prepare for ICD-10. • The CMS ICD-10 Implementation Guides are available by provider type (I.e. Small to Medium Sized Practices; Large Practices; Small Hospitals);these guides provide starting points, milestone planning and are broken into six phases: • Planning (Start now; designate an ICD-10 champion; learn what you can). • Communication and Awareness (Raise awareness & understanding to gain commitment). • Assessment (Identify where you use, access, create, update, or delete diagnosis and procedure codes today; don’t forget about your vendors and electronic trading partners; what about medical documentation?). • Implementation (What changes do you need to make in your business processes and supporting systems to accommodate ICD-10? How will these changes happen? Who is going to make those changes and how will you implement?) • Testing (How will you test that the changes you are making work correctly and as anticipated?) • Transition (How will you migrate current operations to the new ICD-10 code sets?)

19. ICD-10: Beyond Awareness Now is the time for action! • What Can Providers/Practices Do Now to Prepare? (continued) • Some additional helpful hints from what others are doing now to prepare: • Outreach to your billing service; clearinghouse or practice management software vendors about their ICD-10 compliance plans. • Your assessment of internal and external impacts will help create a work plan, timeline, budget and staffing needed for ICD-10 preparations. • Plan for significant impacts to medical coding and to your clinical documentation. • Communication, education and training programs are on the critical path. • Establish regular ICD-10 project team meetings. • Use your peer group, medical societies and associations, software vendors and payers to see how they are addressing the ICD-10 challenge and where you can get help. • Collaboration will be the key to a successful ICD-10 implementation!

20. ICD-10: Beyond Awareness Now is the time for action! • Some Next Steps • Visit Availity®1and access their ICD-10 Webinar Series: • The Availity Health Information Network has archived a four-part “ICD-10 Webinar Series” that is available for download. For more information, simply visit www.availity.com/learningcenter. • Access and review Florida Blue’s ICD-10 Provider Toolkit: • Please visit www.floridablue.com and review our ICD-10 Provider Toolkit. Feedback is always appreciated and valued and can be submitted to FloridaBlueOpenLineFriday@FloridaBlue.com with the subject line Provider Toolkit. • Attend Florida Blue’s ICD-10 Open Line Friday teleconferences: • These one-hour monthly sessions provide an opportunity to hear how providers, health plans and electronic trading partners are preparing for ICD-10; the next scheduled session is Aug 16, 2013 beginning at 9:30am; visit www.floridablue.com/icd-10 for more information. • If you are interested in ICD-10 testing with Florida Blue: • Please send an e-mail with contact information to FloridaBlueOpenLineFriday@FloridaBlue.com. • For important ICD-10 information from Florida Blue (BlueMail): • Please submit your ICD-10 key contact e-mail address to FloridaBlueOpenLineFriday@FloridaBlue.com. • 1Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit Availity’s website at www.availity.com

21. ICD-10: Beyond Awareness Now is the time for action! • Appendix: Some Helpful Tools • There are several publicly available websites that can help increase general awareness and understanding of the ICD-10 mandate and its impact to the health care industry; some recommendations include: • www.cms.gov/ICD10 • www.wedi.org • www.ama-assn.org • www.ahima.org/icd10 • www.cdc.gov/nchs/icd/icd10.htm • www.fmaonline.org/HomePage.aspx • www.fha.org • www.FloridaBlue.com/ICD-10 • www.Availity.com

22. ICD-10: Beyond Awareness Now is the time for action! Questions and Discussion Thank You