Tip:
Highlight text to annotate it
X
Renee Richard: Thank you. Good morning everyone, and welcome to the
ICD-10 Webinar. This is being brought to you by the Centers for
Medicare and Medicaid Services. My name is Renee Richard, and I am a
Health Insurance Specialist in the CMS Boston Regional Office, and today
I will be presenting the update on ICD-10. At the end of the
presentation, there will be a Q and A session where you will have the
opportunity to ask questions. Representatives from the CMS Central
Office will be on the line to help answer any questions that we have.
After the Q and A session, you will also have an opportunity to download
the slides from today's webinar.
So, we will get started. We will begin on Slide 1. We would like to
provide you with an overview of the ICD-10 impact and progress made to
date and discuss resources that are available to assist you as you
prepare for ICD-10. First I will talk about some of the ICD-10 basics,
what is ICD-10, why ICD-10 matters, and what are the opportunities of
compliance with ICD-10 and the risks of noncompliance.
ICD-10 replaces the ICD-9 code sets and includes updated medical
terminology and classification of diseases. ICD-10 refers to the
Diagnosis and Procedure Code Sets and consists of two parts, the CM and
the PCS. ICD-10-CM is for use in all U.S. healthcare settings. The
ICD-10 Procedure Code Set is for use in U.S. inpatient hospital settings
only. All organizations covered by HIPPA must use ICD-10 to code health
care services provided on or afterOctober 1, 2014. The compliance date
is firm, and we are moving ahead to prepare for the transition.
What is ICD-10? The World Health Organization originally developed the
ICD-9 code set. The National Center for Health Statistics developed the
ICD-9 Clinical Modification codes for the United States in the 1970s to
assign codes attributed to inpatient, outpatient, and physician care.
ICD-10-CM is the diagnosis code set that will be replacing ICD-9-CM
Volumes I and II. ICD-10-CM will be used to report diagnoses in all
clinical settings. ICD-10 Procedure Code Sets will be used to report
hospital inpatient procedures only. The Current Procedural Terminology,
or CPTs, and Healthcare Common Procedure Coding Systems, or HCPCS, will
continue to be used to report services in outpatient and office.
ICD-10 provides much more granular information and will enhance the
ability to better manage care, track health outcomes, enhance quality of
care, and robust data analytics. The conversion to ICD-10 is a HIPPA
code set requirement. All HIPPA covered entities must use ICD-10 codes
for information they transmit electronically. As mentioned earlier the
compliance date ofOctober 1, 2014is firm.
Why ICD-10 matters.
ICD-10 is essential to health care reform and it is part of the overall
goal to achieve better care, better health, at lower cost. The ICD-10
code set reflects advances in medicine and uses current medical
terminology. The code format is expanded, which means that it has the
ability to include greater detail within the code. The greater detail
means that the code can provide more specific information about the
diagnosis. The ICD-10 Code Set is also more flexible for expansion and
includes new technologies and diagnoses.
The ICD-9 code set is over 30 years old and has become outdated. It is
no longer considered usable for today's treatment, reporting, and
payment processes. It does not reflect advances in medical technology
and knowledge. ICD-10 is more effective at capturing public health
diseases due to its greater specificity. Federal, state, and local
officials, including researchers, will use ICD-10 diagnosis codes for
public health research, reporting, and surveillance.
I am now on a slide that is entitled "ICD-10 Compliance," and what we
have is two message boxes giving you information regarding the
opportunities for compliance and the risks of noncompliance. ICD-10
offers significant opportunities to improve payment and claims
processing, and ICD-10 is foundational to healthcare reform and the
achievement of better care, better health, and lower cost. It also
enhances fraud, waste, abuse prevention, and detection. The risks of
noncompliance with ICD-10 include incorrect or slow claims payment,
penalties, and disruption in analytics and research; and we actually, as
I say, will provide a little more detail regarding that information on
the slide.
Next I want to provide you with an industry update on progress toward
ICD-10 implementation and focus on approaches that can assist you in
successfully implementing ICD-10.
The next slide is entitled "CMS ICD-10 Implementation Today." Medicare
and state Medicaid agencies are on track for the October 1, 2014ICD-10
implementation date. Medicare programs are approximately 68 percent
complete, and the system updates are approximately 75 percent complete.
CMS is conducting quarterly assessments with the state Medicaid agencies
to track their progress toward ICD-10 implementation. Large practices,
clearing houses, and many payors are on track for ICD-10. The small
physician practices need additional technical assistance. CMS is also
working with the small physician practices to offer education and
technical support to help them prepare for the ICD-10 implementation.
CMS is engaging in conversations with vendors and discussing next steps
on how vendors can work together with their customers to get ready for
ICD-10. And on this slide, we give an update regarding Medicare
implementation, state Medicaid agencies, providers, as well as vendors.
Our next slide is entitled "CMS ICD-10 Project Management Office
Approach."On this slide, CMShas a comprehensive implementation
approach based on an impact analysis, solution concept, implementation
and monitoring plans, and project schedules. The ICD-10 implementation
is guided by an e-health steering committee made up of CMS executives,
policy, technical, and systems staff. 19 key project areas were
identified, with 52 projects supporting the larger project areas and
monitoring of systems. There is also a biweekly governance board and a
weekly monitoring and planning meeting.
The next slide is regarding CMS ICD-10 Reporting Structure. Project
input is obtained every two weeks, and the project dashboards are
updated to incorporate this new input to track and communicate risks to
the Project Management Office. The Project Management Office takes that
information and updates the master schedule and creates program
dashboards that are used to inform the steering committee about the
ICD-10 implementation project's progress. This slide highlights that
process that we are using internally at CMS.
Next, I would like to review with you the impact that ICD-10 has on the
provider community, as well as the healthcare industry as a whole. I
also will review some practical step-by-step actions that providers can
take to prepare for ICD-10.
Our next slide is entitled "ICD-10 Impact Across the Industry," and
shown on this screen is a focus and a diagram of how each area in a
practice or hospital will be affected. The ICD-10 impact affects many
areas and organizations across healthcare and financial sectors. For
instance, with payors, ICD-10 impacts health plans because the claims
may alter coverage and reimbursement. ICD-10 expands the number of
available codes requiring organizations to evaluate codes and determine
what the organization will pay for certain benefits. Codes are used to
determine whether services are covered, for benefit accumulation, and
trigger business rules within the payor systems. Sometimes payors are
subject to claim process reviews. Payors are responsible for notifying
external parties of when and how the payer is converting from ICD-9 to
ICD-10.
Let's talk a bit about how this affects payors and clearing houses. The
shift to ICD-10 will also require software modifications in both the
insurance coverage and billing sections of practice management systems.
Billing services and clearing house vendors will also have to comply
with the new system.
Providers. Providers use ICD-10 codes to code, submit, and process
claims accurately at clearing houses.
Patient member beneficiary. Co-payments are tied to codes that
determine the nature of the service.
I am now -- if we get our system back, I am now on slide 13, "ICD-10
Timeline for Providers and Payers." CMS has created timelines for
different provider groups and payers to provide a visual guide of the
key transition activities by faith [spelled phonetically] in the
estimated time frames for each activity. These timelines are available
on the CMS ICD-10 website, which iswww.cms.gov/ICD-10. April through
December 2013, providers and payers should conduct ICD-10 internal
testing within their organizations. Providers and payers should allow a
full year for testing with one another and with other business trading
partners, and this testing should occur between October 2013 to October
2014.
Our next slide is entitled "ICD-10 and Physician Practices." Again,
here we give a diagram of each of the areas that will be affected by
this implementation. We highlight it with how it will affect nurses,
physicians, clinical staff, managers, front desk folks, coding, billing,
as well as our labs. ICD-10 will impact all aspects of your practice
from the front desk to nursing documentation to the clinical areas and
physician office to the manager's office to billing and coding. As you
can see, it will affect all areas of business. ICD-10 has an impact on
people, process, and technology.
Slide 15: "What Should You Do To Prepare?" As applicable, ask if the
necessary software updates will be installed with your upgrades for the
Version 5010 HIPPA transaction. If you do not use the HIPPA
transaction, determine when they will have your software updates
available and then when they will be installed in your system.
Determine when clearing houses, billing services, and payors will have
their ICD-10 upgrades completed and when you can begin testing with
them. Identify changes needed to convert to ICD-10 code sets, such as
with your diagnosis coding tools or super bills or public health
reporting tools, et cetera.
Attend implementation training. CMS in its regional office as well as
the EHR Regional Extension Centers will be offering several training
sessions on ICD-10 implementation. External testing should be conducted
October 2013 throughSeptember 30, 2014. We have some links available
on the slides that will take you to the HIMSSS ICD-10 playbook and a
list of vendor questions.
Next we are going to talk about resources. I want to provide you with
information on a variety of resources that are available to you to
support your ICD-10 implementation.
We will first talk about state Medicaid agencies and the ICD-10
implementation. The state Medicaid agencies have a number of ongoing
activities to monitor progress toward ICD-10 implementation and to
provide training and support to the states.
Our next slide is entitled "Working With the State Medicaid Agencies,"
and we have highlighted a number of topics that CMS is working with
state Medicaid agencies. The state Medicaid agencies have engaged in a
variety of activities,including providing online and live educational
information in establishing a forum for collaboration. The state
Medicaid agencies, ICD-10 Implementation Handbook, and site visits have
been well received by the states. As I mentioned, the ICD-10
Implementation Handbook is an online tool providing SMA specific
information to assist in ICD-10 implementation.
We also have Health Condition Categories, a foundation for SMAs to
define health conditions in alignment with the needs of their specific
agency. There are quarterly online ICD-10 self-assessments, as well as
a state ICD-10 collaboration site, which we'll highlight in a second.
There are also policy briefs. The first four policy briefs that are
shown on this slide are complete and have been shared with the state
Medicaid agencies. There are also five other policy briefs that are
being developed. Each policy brief provides an in-depth look at a
specific condition or topic and examines how the change to ICD-10 coding
will impact state Medicaid agency programs for that condition. The
policy brief ties in in other health care initiatives that the states
will need to address in addition to ICD-10. Health condition mapping
will be finalized later this year, and we willhighlight a little bit
more of this detail on our next slide, which again I apologize that you
can't see.
The next slide is entitled "Medscape Modules on ICD-10." CMS is working
with Medscape and has developed several modules and articles around
ICD-10 implementation. These materials provide useful tips on how to
get started and move through the various ICD-10 implementation stages.
The training is offered to everyone. In fact, physicians can earn CME
credits for taking the training. About 16,000 people are taking the
training each quarter, and we encourage you to sign up.
The next slide is entitled "CMS ICD-10 Website," and we have a picture
of that screen, and we have highlighted on the left hand side the
different pieces of information that you can easily access by clicking
on the link. This website is dedicated to ICD-10. The address
iswww.cms.gov/ICD-10. This is the central location of all CMS
materials concerning ICD-10.
The links on the left side of the screen are broken into different
categories of information, such as provider, payors, and vendors to name
a few. You can also sign up to receive ICD-10 e-mail updates as well as
Alerts when new information is posted on the Latest News page. In a
difference, there isinformation on the General Equivalency Mapping, and
the ICD-9 Coordination and Maintenance Committee can be found here.
Over 108,000 people have signed up for the e-mail updates, so we
encourage you to please use this resource that is available.
Also available on our CMS ICD-10 website are implementation guides. CMS
has developed implementation guides that are tailored to the various
audiences, including small and large providers, small hospitals, and
payors. The implementation guides include planning, communication,
assessment, implementation, testing, and transition recommendations.
We are also developing an online ICD-10 implementation guide. The
online implementation guides will provide stakeholders with a quick,
easy way to access the implementation materials. Stakeholders can click
to the information to find the most relevant information. The online
implementation guide Table of Contents will highlight the key ICD-10
implementation steps and activities including planning, communication
and awareness, assessment, implementation, testing, and transition.
The next couple of slides we talk about the ICD-10 resources, and we
provide links to each piece of those, each resource that we have
listed. There is a wealth of ICD-10 resources available to the public,
and new information is being updated and added on a regular basis. The
CMS ICD-10 website contains materials to help industry with
implementation as well as ICD-9 to ICD-10 mapping information.
Other resources include materials that are shared in various formats,
including national provider calls, information on national coverage
determination, and the education information generated from the Medicare
Learning Network.
Our next slide is entitled "Health Condition Categories." The top 30
health conditions that are key to state Medicaid agency business and
analysts are identified on this slide. The state Medicaid agencies,
through a multidisciplinary team, defined each health condition so that
there was clarity on the intent of what is or what is not to be included
in the category. ICD-9 codes and ICD-10 codes were mapped to each
category based on this definition.
CMS is also reaching out to industry groups to share and request a
review of the health conditions. After validation, all category
definitions and mappings will be made available on the state Medicaid
agencies' ICD-10 collaboration site.
The next slide speaks about the state Medicaid agency's ICD-10
collaboration site. The state Medicaid agency ICD-10 collaboration site
provides the states with a single reference point where relevant
information is available and where they can share information with their
counterparts. The collaboration site includes updates on important
state Medicaid agency events, educational and support materials and
resources, and a community for state Medicaid agencies to share best
practices and lessons learned.
"Technical Assistance and Training." On this slide, we have a CMS
ICD-10 Technical Assistance Estate], so it is a map of the U.S. with a
key code and highlights. The map shows the on-site training sessions
that the Center for Medicaid, CHIP and Survey and Certifications
Department has provided for the states. CMS has visited 36 states to
provide technical assistance and has conducted 11 Policy Remediation
workshops. The Center for Medicaid, CHIP and Survey and Certifications
has two additional training certifications that are scheduled for the
future.
The next slide is entitled "SMA ICD-10 Technical Assistance and
Training." CMS has conducted regional office workshop visits as well as
36 stateside visits and 11 Policy Remediation site visits. The state
Medicaid agencies' training modules include ICD-10 Overview, Code
Structure and Definition, Information on GEMS in Translation and Dual
Processing, Claims Management, Managed Care, Analytics and Reporting,
Program Integrity, and Provider Communication.
The state Medicaid agency site also has training content. On this slide
we show are two of the 250 slides that make up the ICD-10 state Medicaid
agency site visit training content. In the two examples that we provide
in the presentation, one concentrates on the key business reasons why
state Medicaid agencies need to focus and prepare for ICD-10, and the
other highlights the related impact ICD-10 will have on the state
Medicaid agency's core business functions. Again, both of those slides
are presented on the slide in the presentation.
The ICD-10 state Medicaid agency also has an Implementation Handbook.
The ICD-10 state Medicaid agency's Implementation Handbook is strictly
developed for state Medicaid agencies and provides core background
information on the rationale of moving from ICD-9 to ICD-10, the key
milestone activities related to ICD-10 implementation phases, and the
activities that must be completed in order to be compliant with ICD-10
byOctober 1, 2014.
Our next slide is entitled, "9 Policy Briefs Show How ICD-10 Supports
Healthcare Transformation." The first four policy briefs listed here
are complete and have been shared with the state Medicaid agencies, and
there is a picture of each of those policies. The other five policy
briefs are being developed. Each policy brief provides an in-depth look
at a specific condition or topic, and it examines how the changed ICD-10
coding will impact state Medicaid agency programs for that condition.
The policy brief ties in other healthcare initiatives that the state
will need to address in addition to ICD-10.
On the last slide, it includes a CMS point of contact, and for this
presentation it is myself, Renee Richard, and my email is
renee.richard@cms.hhs.gov.
Also, before we start with questions, the last slide of the presentation
provides an ICD-10 Questions Mailbox, and providers and those on the
call should feel free to use this if we are not able to get to your
question today, or if perhaps you think of a question in the future.
That email link isICD-10questions@noblis.org, and again that link
isICD-10questions@noblis.org.
That concludes the presentation portion of the webinar. Again, I
apologize for the technical difficulties we had in our office. We will
now open it up forquestions from the audience. Sally, would you be
able to begin that process?
Female Speaker: As a reminder, Ladies and Gentleman, if you would like
to ask a question, please press "*" then "1" on your telephone keypad.
If you would like to withdraw your question, press the "#" key. Please
limit your questions to one question and one follow up to allow other
participants time for questions. If you require any further follow up,
you may press "*1" again to rejoin the queue.
Your first question comes from the line of Barbara Horagan [spelled]
phonetically] with Dr. Peter von Cor's [spelled phonetically] office.
Your line is now open.
Barbara Horagan: Hi. Thank you, Renee. I would like to know, is this
course going to be given again, and how do we get the different slides
that we were not able to see? I think I would have gotten more out of
this if I was able to see the slide [laughs].
Renee Richard: Hi. I absolutely agree and I apologize. There is a file
share box. Are you able to see that? Where you can download the
presentation?
Barbara Horagan: I see it, and I have hit "Save to My Computer" and
nothing happens.
Renee Richard: OK. What you can do if you want, let me give you my
email address again. You can contact me and I can send you the
presentation. We do have two other webinars that we are giving today.
They may be full, but I will definitely take this into consideration and
talk to the other folks about perhaps presenting it again, since we did
have technical difficulties.
Barbara Horagan: Okay, and your email?
Renee Richard: My email is Renee, R-E-N-E-E, dot Richard, R-I-C-H-A-R-D,
at C-M-S dot H-H-S dot G-O-V.
Barbara Horagan: Okay.
Denicia Green: Hello. This is also Denicia Green [spelled phonetically]
with CMS, and one of the things we can think about doing is posting the
PowerPoint presentation to our website as well, if that will be helpful.
Renee Richard: Sounds good [laughs]
Denicia Green: Thank you.
Barbara Horagan: Thank you.
Female Speaker: Your next question comes from the line of Eleanor Miller
[spelled phonetically] with the Center for Orthopedics. Your line is
now open.
Eleanor Miller: Oh, no. I was going to ask for that as well as the last
person since I could not download that either, but if it is going to be
up on the website that will be fine.
Renee Richard: Okay, and just in addition to that, today's webinar will
be recorded and both the audio version and slides will be made
available.
Eleanor Miller: [affirmative]
Renee Richard: I think it is, I am not exactly sure of the date, but
please be looking for that as well on the ICD-10 website.
Eleanor Miller: Okay.
Female Speaker: Your next question comes from the line of Carol Shift
[spelled phonetically]. Please state your organization. Your line is
now open.
Carol Shift: Dr. Norman Turowski [spelled phonetically]. Now you said
it is going to be on the website. Is it going to be on the main page,
because now I cannot download these things either? And how big is the
ICD-10 book going to be compared to the ICD-9?
Denicia Green: Yes, hi. This is Denicia and I -- some clarification on
that, are you talking about the guide, the implementation guides?
Carol Shift: Well, what we missed --
Denicia Green: Or were you talking about the code book?
Carol Shift: Well both. The code books. I mean, compared to the ICD-9
book that we have now. I mean because of all the -- there's are going
to be lot more codes. Now is this --
Denicia Green: Sure.
Carol Shift: -- going to be like a huge book?
Denicia Green: [affirmative]
Renee Richard: So what we were talking about, in the presentation and
apologies that there were some difficulties, is we have a guide book
that helps providers, hospitals and others to navigate ICD-10
implementation,and so it is an A through Z guide on sort of the how-to,
how to get started, so to catch up if you are behind, what are the major
steps in and milestones that you need to take and achieve as you move
towards compliance.
Carol Shift: Right.
Renee Richard: And so what we'll do, we will work on getting these
slides up for you all so that you all can have access to it, and I would
imagine that you would have additional questions after having an
opportunity to review it in addition to what she mentioned. The audio
will be also included with the slides so that you can walk through and
get a sense of the presentation today.
Carol Shift: Now has the ICD-10 book been published yet?
Renee Richard: Yes, there is an ICD-10 book.
CarolShift: Okay.
Renee Richard: [affirmative]
Carol Shift: Compared to the ICD-9, I mean is it like twice the size?
Because there are so many more codes?
Renee Richard: It is more codes. It is a book that you would need to
purchase. CMS does not develop that book, but we absolutely have the
guide book available for everyone, it's an online tool. We're also
finding that many providers are wanting to have something more useful,
and so it's hands-on. Our guides right now range from about 60 pages,
and so it is a very helpful guide for getting you there, and you may
just want to pull pieces out of it depending on which step of
implementation that you are in. So what we're doing right now is
pulling key pieces of that document and creating some checklists and
fact sheets.
Carol Shift: Great.
Renee Richard: It would be a helpful aid that you can have right there
at your desk or location to kind of help you walk through and talk to
others at your office.
Carol Shift: Thank you very much.
Renee Richard: Thank you, and if it would be helpful for us to share
some of those sort of key links, I know that many of them are in the
presentation, but we could certainly share them while we are putting
that up on the website.
Female Speaker: Your next question comes from the line of Eleah Ann
Machezi [phonetically spelled] with the Suffolk Anesthesiology
Associates. Your line is now open.
Eleah Machezi: Hi. Thank you. I might have missed these links. I was
able to download the presentation so I did follow along, but I am
looking for the web address for the state Medicaid agency's ICD-10
collaboration site. Was that in one of your slides?
Renee Richard: Well, we shared the information about the state's
collaboration site. We did not share the link itself because it is
specific to state Medicaid agencies and we --
Eleah Machezi: Right, okay. That's the one [unintelligible].
Renee Richard: Yes, and we do have a form for them, and the intent there
is to get some best practices and lessons learned being shared across
the state Medicaid agencies.
Eleah Machezi: [affirmative]
Renee Richard: And so it is a definite form for them, but what we are
doing is we are looking at what are some of the key things that they are
finding, what are some of the lessons learned, and we're pulling that
information out and planning to share that more broadly.
Eleah Machezi: You will in the future?
Renee Richard: Yes, absolutely.
Eleah Machezi: Okay.
Renee Richard: Yeah, we're looking for those key themes that we can
share across the industry.
Eleah Machezi: Okay. That's great. On the Technical Assistance and
Training Map, I notice --we're in New York -- I noticed there is no
training, no technical assistance sites available. Is that going to
change?
Renee Richard: As a matter of fact, we have reached out onto New York a
couple of times to get training scheduled and are very much interested
in doing that, so that's for the state Medicaid agency itself, but we
are also offering some additional technical assistance and training,
just more focused around the provider.
Eleah Machezi: How will the provider be made aware of these sites?
Because this is the first time I am hearing of this, these physician
sites.
Renee Richard: Sure, sure. So what we are doing is we are working with
stakeholder organizations to work with them, to share that with their
membership. If there's interest in something like that, we can
certainly partner you up and pair you with a group that will be giving
that free trainingand technical assistance, too.
Eleah Machezi: Okay.
Renee Richard: So if you are interested in that, please send that
information into our ICD-10 questions mailbox and we can certainly
follow up with you on that.
Eleah Ann Machezi: Okay. Very good. Okay, thank you so much.
Renee Richard: Thank you.
Female Speaker: Your next question comes from the line of Terry Kelly
with Ocean Medical Center. Your line is now open.
Terry Kelly: Hi. Thanks for taking my call. I was able to download the
presentation before you started having issues. I'm just not seeing the
slide numbers anywhere on the presentation. Am I just missing them?
When you were mentioning, you know, "refer to slide so-and-so," I really
could not follow, because I am not seeing the numbers on here. Hello?
Renee Richard: Hi. This is Renee. I apologize for that. I realize
that is the case. I guess I saw them because when I typically, when I
have a presentation I haveprinted it out as view the notes.
Terry Kelly: Okay.
Renee Richard: So the numbers were in there, but we will definitely
update the presentation to include the slide numbers, and we apologize
for that.
Terry Kelly: And then my other question is, you had mentioned that
physicians can earn CME credits for taking the training? Is that
somewhere in this presentation? Because I want to bring that back to
our physician liaisons so they can go out and start, like kind of
promoting this.
Renee Richard: Absolutely. If you go to our ICD-10 website, you can
actually pick up the information about training there, and that is
detailed on the website, and we are encouraging everyone to use it. It
has been very popular, and so anyone can take the training, the nurses,
staff, you name it. But only physicians will earn the CMEs, and we're
also looking into exploring offering CME credits as well down the line.
Terry Kelly: And is there going to be any notification going out to
providers that participate with Medicare that this is available to them,
or are you relying on us as the hospital to let them know that? [laughs]
Renee Richard: [laughs] Well, you know this is really an implementation
where we are going to have to come together, so absolutely share that
information with your providers. We are and have been sharing that
broadly. Right now we have about 16,000 people taking the training each
quarter. We'd like to increase that number, so absolutely please share
that information. It would be wonderful.
Terry Kelly: And it iswww.cms.gov/ICD10and then there is something for
training that I click on?
Renee Richard: Yeah, so you would go under provider resources.
Terry Kelly: Okay.
Renee Richard: And it's right in there. As a matter of fact, there's a
great number of fact sheets, resources, and that's the one thing about
our website that I do like is that you can identify, you know, if I am a
payor, if I am a provider, where do I go? And it is a section, and it
gives you everything you need if you are a provider, everything if you
are a payor.
Terry Kelly: Very good. Thank you so much.
Renee Richard: Thank you.
Terry Kelly: Okay.
Sally: Your next question comes from Anthony Carbone [spelled]
phonetically]. Please state your organization. Your line is now open.
Anthony Carbone: Thank you. I am with National Government Services. Hi
Denicia and Renee. I understand your issues with the presentation. I
do presentations as well, and it does happen. My question is -- I'm
still downloading this presentation. I know you gave me your address to
email to get that, but my question is with ICD-10 and 5010
implementation for electronic billing, I am sure you guys are going to
be doing also electronic ICD-10 sessions in the future?
Renee Richard: Yes. You know we are really looking for innovative ways
to get this message out and would like to get some input and feedback to
that. We have heard that many physicians and other professionals are
extremely busy during the day, and having those modules online sometimes
works best. So we're trying to give the training and the information in
a couple of different formats, but yes, please send those suggestions
in.
Anthony Carbone: Okay, and as far as the ICD-10 booklet, one of the
people on the call was asking about the book being tremendously big. I
would assume that this would also be on a CD-ROM. The ICD-10 booklet
can be purchased, I would think, for an ICD-ROM, and then they could
print out what they need off the CD because of the volume of the
booklet.
Renee Richard: Well, yeah, well it's not in CD-ROM right now. I will
say that you can go in right now and print a portion of the book as you
needed it. It is separated out into specific areas and specific
sections, so it's not like you hit a print and it prints out all 60
pages. You can actually go to the section that you are most interested
in right now and print out that section.
Anthony Carbone: All right. I want to thank you --
Renee Richard: And we are -- sure, and I just wanted to add another
comment to that. We are taking the booklet itself and developing an
online tool to break it down even further, so. Thank you.
Anthony Carbone: No, thank you.
Sally: Your next question comes from the line of Robert Ratchett
[spelled phonetically] with Middleborough Chiropractic [spelled]
phonetically]. Your line is now open.
Robert Ratchett: Hi ladies. How are you today?
Renee Richard: Wonderful. How are you?
Robert Ratchett: Great. Actually, most of my questions have been
answered. I tried to get the question to come off, but I guess I was
still in the queue. My biggest question was the download.
Renee Richard: No problem, and again we apologize for the technical
difficulties today, but it was our intent to really have a conversation
with you all to make sure that you had some of the key pieces in
implementing ICD-10. We will ensure that this Power Point presentation
is made available to each and every one of you, and we would just want
to thank you for taking the time out today.
Robert Ratchett: Fantastic. Thank you very much.
Renee Richard: Thank you.
Female Speaker: Your next question comes from the line of Robert. If
you could state your full name and organization. Your line is now
open.] Robert, your line is now open if you have queued up for a
question. Your next question comes from the line of Holly Brocko
[spelled phonetically] with the Jewish Physician Group. Your line is
now open.
Holly Brocko: Yeah. Hi. We were just wondering how this will impact
work comp and, say, auto claims?
Renee Richard: Sure. Those organizations are not considered covered
entities, and so -- the ICD-10 requirement is for covered entities, and
so we've been talking a lot with other payers and plans, and it really
is a business decision as to how each plan or payor would like to
receive claims from those organizations. For Medicare, or for CMS,
we're requiring it to be in ICD-10 format, depending on, you know, date
of service, date of discharge. But, you know, it is a question of how
plans are planning to take that information in. We have had some
preliminary calls with some plans, and many are doing the same thing,
requiring an ICD-10, but please check in with your payor and health
plans.
Holly Brocko: Okay. So it's up to the physician practice then to reach
out to the payors and their reason to determine --
Renee Richard: Yes.
Holly Brocko: -- what they are going to be accepting?
Renee Richard: Yes.
Holly Brocko: OK, so this, I guess I, you know with ICD-10 kind of being
such a big deal, and I had -- I know that this is something CMS is
doing, but I guess I had the impression that this was something that was
required. So you are saying that payors have an option? So Anthem
could say, "Well, we do not want to do ICD-10 so we are going to stick
with ICD-9,"is that what you are saying?
Renee Richard: Oh. No. So let me clarify that. So there are a couple
of entities, and very limited, that are non-covered entities.
Holly Brocko: Okay.
Renee Richard: ICD-10 affects payors, providers, clearing houses. You
name it, so it's ICD-10 moving forward. However, there are small,
limited amount of groups and types of claims like workers' compensation,
auto, property and casualty, and other types of unique cases that are
not covered entities, and so those organizations do not have to provide
an ICD-10 claim. However, we are hearing from many providers and many
payors that because of their business rules, they will require that as
part of reimbursement. So, it is a question of if you fall into that
very limited, very unique case, then you would need to check in with
your payor to see how they plan to process that payment. For CMS, and
we are requiring an ICD-10 code to come through, and that would be based
on the date of service or date of discharge.
Holly Brocko: Okay, and I understand that. I guess I was a little
confused when you said that there are payors who could determine if they
were going to accept it or not. So you're just saying that there are
certain limited classes such as workers' compensation, auto and maybe --
Renee Richard: Yes.
Holly Brocko: -- small payors. I do not know really what you mean by
that, but is there -- there's not really a list of any classifications
per se that we can look up somewhere as a reference, you know, that
these are not necessarily required to comply with ICD-10, because it --
Renee Richard: It's auto claims, it's workers' comp claims, those sorts
of things, but you know, it sounds like this may be a good topic for
maybe some additional clarification around that.
Holly Brocko: So because it makes a big difference, you know, from an
operational perspective. And if you take orthopedics for example, you
know you have a physician in a practice that sees a lot of work comp
likely, and then they probably see a lot of Medicare, too, or non-work
comp cases, so it is kind of like, from an operational sense there has
got to be a work flow put into place for, "Okay now I am in ICD-9 mode,
and now I am in ICD-10 mode." It can be very confusing.
Renee Richard: Sure. Let me add a little to that, if this would be
helpful. So, ICD-9 versus ICD-10, Medicare has issued guidelines on
payment and how those things should be billed, and so you will see that
on our CMS website and we can certainly share some additional
information around that. I know much information has gone out over the
last few weeks to ensure that the message is really getting out across
the industry. But whether you use an ICD-9 or ICD-10, it's still based
on the date of service or date of discharge. So in this case, if the
group is supposed to be using a nine, and that would be a nine code, and
that would be prior toOctober 1, 2014, then that is fine, and that
applies to everyone. If it's a claim that is -- if it's is a date of
service that is afterOctober 1, 2014then it should be an ICD-10 code.
In the unique case here, you have a non-covered claim and so, for
example, you have auto workers, they are not required to use ICD-10 in
that case. However, in order to get paid for that claim, the payor may
require them to submit it in that format and that can be the case. And
so, absolutely, they should check in with their payors or health plans
to see how they are going to process that individual claim. For
Medicare I think we have been clear as to how we would process those,
and it again would be based on that date of service, the date of
discharge. And if it is beforeOctober 1, 2014it is going to be a nine
and if it is afterwards, if it is going to be on or after, it is going
to be an ICD-10 code.
Holly Brocko: Okay. Okay, great. Thank you.
Renee Richard: Sure. Does that help to clarify somewhat --
Holly Brock: Yeah, I think we know --
Renee Richard: -- and is there a need for any additional --
Holly Brocko: But it was just the whole, you know, the ones that I guess
are not following ICD-10, so we will have to just kind of drill down and
get --
Renee Richard: Sure.
Holly Brocko: -- those individual work comp carriers, I guess, and
figure out what we need to do. So, thank you very much.
Renee Richard: Sure. Thank you.
Female Speaker: Your next question comes from the line ofChristy
Stillion [spelled phonetically] with Westfield Fire Department. Your
line is now open.
Christy Stillion: Good morning. I do have a question, but I also have a
comment for the people who are having issues saving the presentation to
the computer. I did at first in that File Share box. I do not know if
anyone has tried. You have to select on the document, stating "Eastern
Event R O ICD-10 Presentation," then hit "Save" to your computer. Once
I did that, there was no problems. It did take a very long time to
download, though, however. It took a good five, 10 minutes to get it to
work, okay? My question --
Renee Richard: Thank you for that.
Christy Stillion: You're welcome. I do not know if -- once you hit on
the "Eastern Event" it turns to yellow and then the "Save to my
computer" box highlights, or goes into bold and then you are able to
save it. So I do not know if that is part of the issues that some of
the people were having. My question regarding ICD-10 comes on the basis
of providing ambulance transports. What does the EMT documentation --
does there need to be any changes as to how they document in order to
process claims to the insurance carriers. How does ICD-10 affect
ambulance?
Renee Richard: Well, the general answer to that is, and I guess this
would go across the board, is your documentation should be able to
support the ICD-10 code that you have chosen. With the greater
specificity in the code there will be a need to ensure that your
documentation is reflective of that.
Christy Stillion: So they have to be specific as in if we pick someone
up for leg pain, it needs to be left leg versus right leg, and going
through past Medicare webinars and conferences, they also talk about
first event, second event, you know, past history. Our EMTs have to
document all that?
Renee Richard: Well, any claim that is coming through would, of course,
require the documentation that would be needed to support your diagnosis
code. For ICD-9 you're doing that now. You're supporting your
diagnosis code, and that would be the same for ICD-10, that you would
need the documentation available to support your diagnosis for ICD-10 as
well.
Christy Stillion: Okay. Because I know like there is general, there is,
you know, leg pain in ICD-9, but of my understanding in the ICD-10 that
they are more specific as to what leg, and upper leg, lower leg. It's,
like very specific. On the ICD-10 CMS website, is there any area
specifically that I can go for help regarding with ambulance that I
canbring to the EMTs?
Renee Richard: We'll certainly take a look and see if we have anything
to address that issue. What I will ask you to do is send in your
question to the ICD-10 questions mailbox and we will follow up with you
offline.
Christy Richard: Okay. All right. Thank you.
Renee Richard: Hi. This is Renee again. It seems we have come to the
end of our presentation. We'd like to thank you all for participating
in the ICD-10 Webinar today. Hopefully everybody can access the
presentation slides that are available in the file share. If not, as we
said, we will be posting them on our website as well as providing a
recording and audio of this presentation. So again, we would like to
thank everyone and have a great day.