MAC J5 and J8 EDI ACT (December 12, 2013)

1. MAC J5 and J8 EDI ACT (December 12, 2013)

2. Purpose of Power Point • Current issues • MSP Claims 5010 • ICD-10 Preparedness & Test Days • Monitor Your Business • Go Green • Upcoming EDI ACT 2014 • Contacting EDI

3. Current Med A Issues – • PCPrint  - DLL error for Windows 8 users (version 4.2.4) Has been reported to Shared System Maintainer. No ETA at this time. • 999 and 277CA not received.

4. Current Med B Issues • Canadian Beneficiary Address • Sporadic delays in sending responses (999, 277CAs or 835s) • Incorrect Common Edit Module 277CA rejections for various reference files. • 999 and 277CA resends for Medicare EDI Gateway (MEG) users. • MREP issues for Windows 7 or 8 users

5. MSP Claims - 5010 • MSP claims are not an ASCA (Administrative Simplification Compliance Act) exception and must be sent electronically. • Avoid front end rejections, delays and Unprocessable rejections: • When determining the beneficiary’s insurance coverage, it is important to determine the correct insurance type code. • Always give the MSP insurance type code. • Other Insured's Adjustment Quantity; 2430/CAS must not be equal to zero. • Primary paid amount should not exceed the billed amount. • Primary paid amounts at the claim level should agree with the amounts submitted at the line level. • Instructions: http://www.wpsic.com/edi/files/msp5010A1.pdf

6. ICD-10 Impact • ICD-10 is the biggest change in standard healthcare coding systems in decades. • ICD-10 will impact every system, process and transaction that contains or uses a diagnosis code.

7. Are you prepared for ICD-10? • Start now • Ask your vendor and/or clearinghouse about their plans and timeframes implementing ICD-10 • ICD-9 to ICD-10 analysis – identify: • New, deleted and modified content • Impact to business needs • Training -Staff training • 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. • Identify contingencies • It is your responsibility to be compliant. • If you fail to prepare, it will be your business and cash flow that will be affected!

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, 2014 • 837I - ICD-10 on institutional claims with a discharge date, of October 1, 2014 or later • 837P - ICD-10 codes on professional claims with a date of service October 1, 2014 or later

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. ICD-10 • ICD-10-CM will be used in all healthcare settings • ICD-10-PCS will be used for facility reporting of hospital inpatient services

11. Implementation Phases • Phase 1 – Impact Assessment • Phase 2 – Preparing for Implementation • Phase 3 – Go-Live Preparation • Phase 4 – Post-implementation

12. 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-10CM 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 -ICD-9 vs ICD-10CM

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

14. ICD-10 FAQs • http://www.wpsmedicare.com/j5macparta/claims/icd-10/index.shtml • http://www.wpsmedicare.com/j5macpartb/claims/icd-10/index.shtml • http://www.wpsmedicare.com/j8macparta/claims/icd-10/index.shtml • http://www.wpsmedicare.com/j8macpartb/claims/icd-10/index.shtml

15. Are you ready for ICD-10? • ICD-10 codes are 3-7 characters long. Have you contacted your vendor to ensure that your billing software will accommodate ICD-10 codes? • When will you be ready to send a ICD-10 test to your payer or clearinghouse? • Have your staff been trained on ICD-10? • Do you know when your payer will ready to test ICD-10? • Do you know when your payer will be ready to receive production ICD-10 claims? • What phase of implementation are you in? • Paper billing - If you ever print your claim forms, does your billing software accommodate the new form? Do your printer settings need to be modified? If you are using an ICD-10 codes on a paper claim, do you use the appropriate alpha diagnosis code pointers in item 24E?

16. CMS Announces Testing Days • CR8465 • Allowtrading partners access to MACs for testing with real-time help desk support. • Front End (999/277CA) testing only. • Submit ICD-10 codes on claims with Dates of Service 10/1/2014 or later. • Register in advance via site or email. • March 3-7, 2014

17. Register Now For ICD-10 Front End Testing Days… • http://www.wpsmedicare.com/j5macparta/departments/edi_/icd10-testing-day.shtml • http://www.wpsmedicare.com/j5macpartb/departments/edi_/icd10-testing-day.shtml • http://www.wpsmedicare.com/j8macparta/departments/edi_/icd10-testing-day.shtml • http://www.wpsmedicare.com/j8macpartb/departments/edi_/icd10-testing-day.shtml

18. Contingency Plans • Approved vendor, billing services, clearinghouse and Network Service Vendor (NSV) lists: http://www.wpsic.com/edi/files/medicare_connection.pdf • PC-Ace Pro32 • Clearinghouse options? • What are your contractual arrangements with vendor and/or clearinghouse? • Paper claim submission is not a contingency option • Other?

19. PC-Ace Pro32 • Providers may download PC-Ace Pro-32 software at the link below to submit 5010 file formats: http://www.wpsic.com/edi/pcacepro32.shtml • This free 5010 errata software with instruction regarding set up posted on web site. • New PC-Ace users must test. • Existing PC-Ace users are not required to test. • Import 277CA or 835 into readable reports. • A common piece of providers’ contingency plans! • Current version 2.48

20. Monitor Your Business!!! • Use the tools available to you to monitor your business • Identify contingencies • Read your 999 responses • Read your 277CA responses • Review your remittances • Monitor your cash flow • Identify and correct in a timely manner any issues identified. • Use these tools to monitor your business so when you call, you’ll already have an idea what the issue may be.

21. Help Us Help You… • When you call, have information available which will help us identify your file and research your issue: • Submitter ID • NPI • ISA Control Number that was sent to WPS Medicare (this is especially important for clearinghouse customers. ISA13 is NOT Protected Health Information) • Claims Count • Date of Submission • Dollar Amount of submission • Other ways to contact EDI… EDIMedicareA@WPSIC.com, EDIMedicareB@WPSIC.com

22. WPS Connectivity Options • Dial Up Bulletin Board System (BBS) • Network Service Vendor (NSV) into Medicare EDI Gateway (MEG)

23. Go Green!!! • Go Green!!! • Even if you don’t post electronically you can take advantage of 835. • Over 78% of all remittances are sent electronically in 5010-835 format. • PcPrint and MREP are free and easy to use. • You can download MREP and PcPrint from: http://www.wpsic.com/edi/tools.shtml

24. MREP for Part B; PC Print for Part A Will enable physicians and suppliers to view and locally print a Medicare Part B / DMERC HIPAA compliant 835 file in a format that mirrors the Medicare Standard Paper Remittance Advice (SPR). Eliminates physical filing and storage space needs. Print remit same day as 835 is available. Print and forward claims for other payers. Quick and easy access to claim information. No waiting for mail. Several useful reports. Save time and money. It’s FREE! Medicare Remit Easy Print (MREP) and PcPrint Software

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26. Future EDI ACTs 2014 • 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. • 2014 calls (all times 1-2:30 pm cst): Date • February 13, 2014 • April 10, 2014 • June 12, 2014 • August 14, 2014 • October 9, 2014 • December 11, 2014

27. Questions and Answers • We want to hear from you… • If you have additional questions, you can also send an email to: EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com • Also visit our EDI site for additional information: http://www.wpsic.com/edi/

28. EDI Addresses & Numbers EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com MAC J5, J8 Part A & B (Iowa, Kansas, Missouri, Nebraska and J5 National) (Indiana, Michigan) WPS Medicare EDI 1717 West Broadway Madison, WI. 53713 Fax: (608) 223-3824 J5 J8 Hotline: (866) 503-9670

29. Important Dates February 12, 2014 EDI ACT March 3-7, 2014 ICD-10 Nat’l Test Week

30. Resources • CMS 5010 and D.0 Webpage http://www.cms.gov/version5010andD0 • Educational Resources: http://www.cms.gov/Versions5010andD0/70_Medicare_Fee-For-Service_Stems.aspys • 5010 Technical Review Type 3 guides: • X12: www.X12.org • Washington Publishing www.WPC-EDI.com • WPS Medicare: http://www.wpsic.com/edi/med_index.shtml • WPS 5010: http://www.wpsic.com/edi/5010-Readiness.shtml