Ruth Hicks: Good afternoon, everyone and welcome to this ICD 10 webinar brought to you by the Centers for Medicare and Medicaid Services, or CMS. My name is Ruth Parker Hicks, and I am a nurse and also a health insurance specialist in the Kansas City CMS Regional office, and I’ve been with CMS 17 years, and prior to that, I was working out in the field with many of you for about 20 years. So, I do have a little bit of a sense about some of the challenges that you’re experiencing. Today I’ll be presenting the update on ICD 10, and at the end of the presentation, as Kyle mentioned, there will be a Q-and-A session, where you’re going to have an opportunity to ask questions. And we’re very fortunate to have representatives from the CMS Regional Office — Central Office, I’m sorry, with us on the line that are going to be able to help us answer some questions as well. After the Q-and-A session, you’ll also have an opportunity to download the slides from today’s webinar. So, let’s get started. First, I want to really thank you for the opportunity to speak with you today and to provide you with an overview of the ICD 10 impact and progress that’s been made to date, and discuss resources that are available to assist you and to help prepare you for ICD 10. First, I want to talk about some of the ICD 10 basics. The first is: What is ICD 10? Why ICD 10 matters, and thirdly, what are the opportunities of compliance with ICD 10 and risks of noncompliance? ICD 10 replaces the ICD 9 code set, and it includes updated medical terminology and classification of diseases. ICD 10 refers to the diagnosis and procedure code set and consists of two parts: the CM and the PCS. ICD 10 CM, or clinical modification, is for use in all U.S. health care settings. Whereas ICD PCS, or the procedure coding system is for use in-patient hospital settings only. All organization covered by HIPAA must use ICD 10 to code health care services provided on or after October the 1st, 2014. And you see that’s bolded on the slide, because the compliance date is firm, and we’re moving ahead to prepare for the transition. So what is ICD 10? The World Health Organization originally developed the ICD 9 code set. The National Center for Health Statistics, or NCHS, developed the ICD 9 CM, or clinical modification, in the United States in the 1970s to assign codes attributed to in-patient, outpatient and physician care. ICD 10 CM is a diagnosis code set that will be replacing ICD 9 CM volumes one and two. ICD 10 CM will be used to report diagnoses in all clinical settings. ICD 10 PCS, or the procedure coding system, will be used to report hospital in-patient procedures only. The current procedure coding — procedural technology, or CPT, and health care common procedure coding system, HCPCS or “Hic Pics” as we call it, will continue to be used to report services and procedures in out-patient and office settings. 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 as a HIPAA code set is a requirement. All HIPAA covered entities must use ICD 10 codes for information they transmit electronically. As mentioned earlier, the compliance date of October 1st, 2014 is firm. So why does ICD 10 matter anyway? Because ICD 10 is essential to health care reform and is part of the overall goal to achieve better care, better health at a 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 including new technologies and diagnoses. The ICD 9 code set is over 30 years old now, and it’s become outdated and it’s no longer considered usable for today’s treatments, reporting, and payment processes. Additionally, it doesn’t 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 diagnoses codes for public health research, reporting, and surveillance. This slide demonstrates the opportunities and the risks related to ICD 10 compliance. ICD 10 offers significant opportunities to improve payment and claims processing, and, as mentioned earlier, ICD 10 is foundational to health care reform and the achievement of better care, better health and lower costs. The risks of noncompliance with ICD 10 include incorrect or slow claims payments, penalties, and disruption in analytics and research. 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. Medicare and Medicaid state agencies are on track for the October 1st, 2014 ICD 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 towards ICD 10 implementation. Large practices, clearinghouses, and many agencies are on track for ICD 10. However, some small physician practices need additional technical assistance. Therefore, CMS is working with them to offer education and technical support to help them prepare for the ICD 10 implementation. CMS is also engaging in conversations with vendors and discussing next steps and how vendors can work together with their customers to get ready for ICD 10. CMS has an ICD 10 Project Management Office, or PMO approach, which is a comprehensive implementation approach based on an impact analysis, solution concept, implementation, and monitoring plans and project schedule. The ICD 10 implementation is guided by an e-health steering committee made up of CMS executives, policy, technical and systems staff. Nineteen key project areas were identified with 52 projects supporting the larger project area and monitoring of the system. There’s bi-weekly governance board and weekly monitoring and planning needs as well. Project input is obtained every two weeks, and the project dashboards are updated to incorporate this new input and to track and communicate risks to the PMO, or Project Management Office. The PMO 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 progress. Now, I want to review with you the impact that ICD 10 has on the provider community as well as the health care industry as a whole. I’ll also review some practical step-by-step actions that providers can take to prepare for ICD 10. I know this looks like a busy slide, but it really kind of gives us an idea about the impact across the industry. The ICD 10 impact affects many areas and organizations across health care and financial sectors. For instance, with payers, ICD 10 impacts health plans because the claims may alter coverage and reimbursement. It 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 payer system. And sometimes payers are subject to claim process reviews. Payers are responsible for notifying external parties of when and how the payer is converting from ICD 9 to ICD 10. So now let’s talk a little bit about how this affects health care payers and clearinghouses. The shift to ICD 10 will also require is software modifications in both the insurance coverage and billing sections of practice management systems. Billing services in clearinghouse vendors will also have to comply with the new system. Providers are certainly impacted as well. Providers use ICD 10 code to code, submit, and process claims accurately at clearinghouses. And, of course, this is also going to impact the patient member beneficiary in that co-payments are tied to codes that determine the nature of the service. Treasury and banks are also identified. However, there is no direct impact on them, although financial information is necessary to report to the Treasury Department in relationship to banks, premium dollars received from employer group and the government to cover the cost of care, are deposited into the bank. CMS created timelines for different provider groups and payers to provide a visual guide of the key transition activities by phase and the estimated time frame for each activity. These time frames are available on the CMS ICD 10 website at www.cms.gov/ICD10. 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 and another and with other business trading partners, and this testing should occur between October 2013 and October 2014. ICD 10 will impact all aspects of your practice, from the front desk, to the nursing documentation, to the clinical areas of physician office and physician documentation, to the manager’s office to billing and coding as well. As you can see on this slide, ICD 10 has an impact on people, process and technology. So, preparation. What should we do? As applicable, ask if necessary software updates will be installed with your upgrade for the version 5010 HIPAA transaction. If you don’t use HIPAA transaction, determine when they will have your software updates available and when they’ll be installed in your system. Next, determine when clearinghouse’s billing service payers will have their ICD 10 upgrades completed and when you can begin testing with them. Then you need to identify changes needed to convert to ICD 10 code set, such as with your diagnosis coding tool, your super bill and public health reporting tools, et cetera. Then, be sure to attend implantation training. CMS and its regional offices as well at EHR regional extension centers will be offering several training session on ICD 10 implementation. Internal testing and training to be conducted between April to December 2013 and external should be conducted October 2013 to September 30th, 2014. Make a note that the links at the bottom of the page are going to take you to the Health Information and Management Systems Society, or HIMSS, ICD 10 playbook and a list ofvendor questions. Next, what I want to do is provide you with information on a variety of resources that are available to you to support your ICD 10 implementation. The Medscape modules are a great resource. CMS is working with Medscape, and has developed several modules and materials 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’s offered to everyone, in fact, physicians can earn CME credits for taking the training. Already about 16,000 people are taking this training each quarter, and we really encourage you to sign up for this as well. CMS has a page on its website that is totally dedicated to ICD 10. The address is www.cms.gov/ICD10. That’s the number 10. This is a 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, payers, and vendors just to name a few. And you can also sign up to receive ICD 10 email updates as well as alerts when new information is posted on the latest news page. In addition, information on the general equivalence mapping, or GEM on the ICD 9 coordination and maintenance committee can be found there. There’s over 108,000 people who have signed up for the email updates, so we really encourage you to please use these resources as well. Also available on our CMS website are implementation guides. And CMS is — I don’t see the slide advancing, so I’m wondering — oh, there it is. Okay, great. We had trouble earlier with the advancement of the slides, so if that happens we’ll bear with it, but we’re doing good so far today. Also available on our CMS website are these implementation guides that have been developed and are tailored to various audiences, including small and large providers and small hospitals and payers as well. The implementation guides include planning, communication, assessment, implementation, testing, and transitioning recommendation. So these are a great resource for you. In addition to the hard copy implementation guide, the implementation guides are being developed for online use. The online implementation guides will provide stakeholders with a quick, easy way to access the implementation materials. Stakeholders can click through the information to find the most relevant information. The online implementation table of contents will highlight the key ICD 10 implementation steps and activities, including planning, communication and awareness assessment, implementation, testing, and transition. There’s 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 that we generate from the Medicare learning network. Also, something that we learned: several folks had questions with regard to the updates and if you’re interested in e-versions of the coding there’s an index, a tabular section, both that can be found on our ICD 10 website. And let me give you that link as well. It’s cms.gov/medicare/coding/icd10/index.html. And we update these files annually in June and vendors use these files to actually produce the paper version of the codebooks or the electronic end codes, so that might be some benefit to you as well. Now we’re going to talk a little bit about the state Medicaid agencies and 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. CMS is working very closely with the state Medicaid agencies and they’ve engaged in a variety of activities, including providing online and live educational information and establishing a forum for collaboration. The state Medicaid agencies’ ICD 10 implementation handbook and site visits have been well received by the states. Of the nine policy briefs that are mentioned on this slide, the first four have been shared with the state Medicaid agencies, and the other five policy briefs are currently being developed. Each policy brief provides an in depth look at a specific condition or topic and examines how the change in ICD coding will impact state Medicaid agency programs for that condition. The policy briefs tie in other health care initiative that the states will need to address in addition to ICD 10. Health condition mapping is being finalized later this year, which is highlighted in more detail in the next slide. The top 30 health conditions listed on this slide that are key to state Medicaid agency business and analysis were identified. The state Medicaid agencies, through a multidisciplinary team, define each health condition. So there was clarity of intent of what is or isn’t to be included in the category. The ICD 9 codes and the 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. And after validation, all category depth admissions and mappings will be made available on the state Medicaid agencies ICD 10 collaboration site. The state Medicaid agency ICD 10 collaboration site provides the state with a single reference point where relevant information is available and where they can share information with their counterparts. So I’ll just note that it is something that the states share with each other and it’s not accessible to just the general public. So we can’t all access it, but it is something that they use routinely. The collaboration site for them includes updates on important state Medicaid agencies events, educational support materials and resources, and a community for state Medicaid agencies to share best practices and lessons learned. This map shows the onsite training session that our Center for Medicaid and CHIP Services, or CMCS, has provided for the states. CMS has visited 36 states to provide technical assistance, and has conducted 11 policy remediation workshops. CMCS has two additional training sessions that are scheduled as well. CMS has conducted regional office workshop visits as well as the 36 state site visits and 11 policy remediation site visits. The state Medicaid agencies training modules include ICD 10 overview, code structure definition, information on GEM, or the general equivalence mapping, and translation and dual processing, claims management, managed care, analytics, and reporting, program integrity and provider communication. And here you’ll see two of the 250-plus slides that make up the ICD 10 state Medicaid site visit training content. And the two example slides — one that concentrates on the key business reasons why the 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 core business functions. The ICD 10 state Medicaid agencies implementation handbook is strictly developed for state Medicaid agencies, and it provides a core background information of the rationale of moving from ICD 9 to ICD 10. The key milestone activities related to are five ICD 10 implementation phases and the activities that must be completed in order to be compliant with ICD 10 by October the 1st, 2014. As mentioned earlier, there are nine policy briefs that show how ICD 10 supports health care transformation, and the first four listed here are complete and have been shared with the state Medicaid agencies. 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 to change in ICD 10 coding will impact state Medicaid agency programs for that particular condition. The policy briefs tie in other health care initiative that the states will need to address in addition to ICD 10. That actually conclude our general presentation, and this slide contains my contact information, and if you don’t have a regional office contact of your own, feel most free to contact me. My name is Ruth Hicks, and my email is [email protected] And then, in this last slide is a mailbox for additional questions. If we don’t get to everyone’s question today after the session, then feel free to submit your questions to this mailbox: [email protected] That concludes the presentation portion of the webinar and now I’m going to open it up to questions from the audience. So, Kyle, could you please open the lines up for questions? Male Speaker: As a reminder, ladies and gentlemen, if you’d like to ask your question, please press star, then the number one on your telephone keypad. If you’d like to withdraw your question, press the pound key. Please limit your question to one question and one follow up to allow other participants time for questions. If you require any further follow up, you may press star one again to rejoin the queue. Your first question comes from the line of Heidi McIntosh [spelled] phonetically]. The line is open. Heidi McIntosh: Hi, Ruth. Thank you for the presentation. My question is in regards to the in-patient codes. Are we going to have to change the HCPCS codes to something different when it is a provider seeing a patient inside the hospital as a hospital visit? Female Speaker: Yes, hi. This is Denishia [spelled phonetically] and for ICD 10 to HCPCS and CPT codes don’t change. Heidi McIntosh: Okay, thank you. Female Speaker: You’re welcome. Thank you. Ruth Hicks: Thank you, Denishia. Female Speaker: Sure. Male Speaker: Your next question comes from a participant whose information was not gathered. If you could press star one. Please announce your first and last name. You are from Providence Health Care. Your line is open. August Len: Hi Ruth. My name is August Len and I am wondering if you have more information on around when the superbill will be released by CMS for the national PACE association — Ruth Hicks: I’ll turn that over to Denishia as well. I’m not aware of our preparing a superbill, so… Female Speaker: Yeah. Could you give me a little bit more on that. Are you talking about the cross walk for ICD 9 to ICD 10, or ? August Len: Yes, actually — Female Speaker: Okay August Len: How do the 9s move up to the 10s, and actually for the HTCs as well? Female Speaker: Sure. So we have what we’re calling the GEM, which is a mapping tool, and it is a start. It doesn’t have everything, but it is a good tool to use in your organization. We have that out on our website, and I believe it is listed in the slide as a link there. August Len: So this is a little more specific to the PACE program, the Program for the All-Inclusive Care for the Elderly. I believe it’s Medicare Advantage Part A, and there is a superbill that has ICD 9 codes associated with, I believe, certain conditions. And then, within those 9 codes, there are a set of codes called hierarchical condition categories, or HTCs and those are currently mapped to ICD 9 codes. And I believe those are typically released once a year, and they weren’t released last year. And so, we’re waiting for CMS to release those codes for the PACE program where they’ll be mapped to ICD 10. Female Speaker: Okay. Then they would definitely be out on the same site. I don’t have a date on that if you’re not referring to the GEMs itself. I don’t know if you’ve been out to our site to take a look there, but we have a lot of information on mapping to 9 to 10. I would point you there for now until we can get some additional information for you as to when that specific information will be on the website. August Len: That’s why I e-mailed [email protected] to maybe get some more specific information. I’ll look on the website. I haven’t been able to find anything so far but — Female Speaker: Yeah, we have a coding area for the website. I know we just released some additional information on the GEMs so it may be something that is already out there but if you send in your information we can send you a link there. Take a look; otherwise we’ll follow up with you. August Len: All right. Thank you. Female Speaker: Thank you. Male Speaker: Your next question comes from the line of Travis Komodo [spelled phonetically] from Providence Holden Medical Care. Your line is open. Travis Komodo: Yes, I have a question about the 1500 claim form. Will there be a new version for the ICD-10? If yes, when will that be released? Female Speaker: The answer is yes and we are — it’s in clearance right now and so we don’t have a target date just yet. But it is in clearance and yes it is being updated to reflect ICD-10. We can certainly get back to you when we have additional information. Travis Komodo: Perfect. Thank you. Female Speaker: Thank you. Male Speaker: Your next question comes from the line of Janine Kodama from CalOptima. Your line is open. Janine Kodama: Hi. I actually have two questions for you. The first one is, is when is CMS going to do the remapping of MSDRGs to ICD-10 code? And also, in regards to the earlier caller, I think she was speaking to the risk adjustment, for the Medicare advantage plans, the hierarchical code category drive our reimbursements. So, to our concern also, is when would the mapping be ready for that? Female Speaker: Okay. So the Medicare advantage plan, they’re actually working through that. That’s one of the projects that they’re working on right now to do the mapping on that. I don’t have a target date as to when that would be ready. Thanks for clarifying the question. Janine Kodama: And then do you have any target date of when CMS will have the mappings for the MSDRG, and I-10 versus I-9? Female Speaker: I believe those will be done — I want to say August. They’re done towards the end of the year so I think its August that we’ll have something this year then it will be updated next year in August. Janine Kodama: One last question. I’m sorry. I think we all have concerns about the states being ready with ICD-10. Is CMS going to enforce and ensure that the states are ready to accept ICD-10 so that providers are not having to send to payers in 9 — I mean 10, and to the state in 9? Female Speaker: Yes. Well one of the things that we’re doing is we’re having constant communication with the states. We are making sure that the states are aware of this and that they’re fully ready to go. This is a large-scale implementation, so this is not just happening within Medicare and Medicaid but across the industry. So we’re asking everyone to understand that there will be some learning curve across the board. But yes, we are talking to the states, we’re training the states, we’re providing technical assistance to the states, and we’re monitoring them on a quarterly basis as to where they are in their progress, but where they are in their phases. So we’re really getting into the weeds a bit as to where they are. And for those groups that are struggling a bit, we are offering some additional onsite remediation. So this is something that’s very serious to CMS to ensure that the states are up and running. We know that there have been other sort of large-scale implementations where you had a few states fall behind and so what we’re doing is really focusing on those states that have had those types of issues in the past and we’re also using, you know, the 5010 upgrade as a, sort of a lessons learned and, you know, working across the board with partner groups, stakeholder groups, some of the larger industry leaders. We’ve also pulled in some of the small physician practices to really engage states. We also have heard that some of the states are reaching out to providers to find out if they’re ready. So we’re encouraging, sort of, this national dialog, if you will, and hoping that that conversation continues at the local level so that people are reaching out to their business partners, their trading partners, states, payers, clearinghouses, vendors, if applicable. So yes, states are fully aware of the compliance state that has been made clear by our leadership and we’re doing everything we can do to move them along and move them closer to compliance. Janine Kodama: Thank you. And just to go back to a previous caller on the 1500 claim form, because unfortunately we have providers who use paper claims. I understand it’s been with the OMB for quite some time, but we’re asking providers to make changes to their systems to accommodate ICD-10. There are substantial changes with the new 1500 forms. I’m hoping sooner rather than later we would get those forms out so the providers don’t balk again at another change coming out after the fact in regards to ICD-10 after they’ve already made system changes. Female Speaker: Understood, and we’re doing everything that we can do on our end. We’re following up on, you know, the 1500 form very often, to ensure that, you know, this is something that’s moving along in the clearance process, so we’re aware as to where it is. We’ve been in constant communication with OMB and again, we expect to have those forms ready pretty soon. I can’t give you a target date, again it’s going through clearance. Janine Kodama: Thank you. Female Speaker: Thank you. Male Speaker: Your next question comes from the line of Tammy Keys [spelled phonetically] from Rocky Mountain Family. Your line is open. Tammy Keys: Just to clarify the in-patient billing, our family practice doctors do rounds to see our patients in an in-patient setting so if a patient is admitted, say September 29th and discharged on October 3rd, that whole set of visits is coded in ICD-9 or ICD-10 or split? Female Speaker: What we’re hearing is that it’s just a general split claim, because you have part of it that’s going to take place beforehand and part of its going to take place afterwards. So it sounds like you have a split claim situation there. But you said the date of discharge is when exactly? Tammy Keys: It would be, for example, October 3rd. Female Speaker: Oh, okay. So the date of discharge is October 3rd so it would be an ICD-10 code. Tammy Keys: Okay. Female Speaker: I’m sorry. I misunderstood the question. Tammy Keys: Yes, but the admission is still, say September 28th. Female Speaker: Yeah, it would be based under the date of discharge. Tammy Keys: Okay. Female Speaker: This is Barb. Can I interrupt and ask a question? Are you talking about the professional claim though, that’s coming in the door, the Part B bill? Tammy Keys: Correct. Female Speaker: So it wouldn’t be the Part A bill, Denishia, they would have individual line-item dates of service that would be pre-10/1 and post. Female Speaker: Oh, okay. So then, in that case it could be a split claim situation. Tammy Keys: Okay. Female Speaker: You could have some 9s and some 10s. Tammy Keys: Okay. So in that case it would be — since it’s a Part B claim it would be date of service, not date of discharge? Female Speaker: That’s right. Tammy Keys: Okay. And just a quick second question, do you know when the final release of ICD-10 codebook is going to be? Is that going to be this year or next year? Female Speaker: We’re hearing a lot about that and I want to ensure that I understand. Are you talking about the GEMs that we have where we’re mapping ICD-9 to ICD-10? Tammy Keys: No, not the GEMs, the actual, you know, ICD codebooks that we use to look up our codes. Female Speaker: Okay. What — we’ll have to check into that for you. Ruth Hicks: I think — this is Ruth — I know Pat Brooks had followed up with an email, and she — I can give you this information that she provided, and see if it relates. She confirmed that the files on our website that are used in development of those books, are out there, that link that I gave you. The ICD-10 CM and ICD PCS in electronic versions index and tabular sections that we update in June. And the vendors then use those files to produce paper versions of the codebooks or electronic encoders. And I’ve not used that myself. Apparently you can — I mean I go out there — you can actually open those files and look at the index and the tabular sections and use that in the interim. Tammy Keys: Right. Ruth Hicks: If that helps at all. Tammy Keys: Right but when are we getting the final, final version of that? Female Speaker: I don’t have a question for that. I would assume that that’s updated yearly. Female Speaker: In June. Female Speaker: Just like the GEMs would be and I just don’t have an exact date for that. Tammy Keys: Okay. Thank you. Female Speaker: Thank you. If you want some additional information I would suggest sending that question in to our ICD-10 questions mailbox and we’ll take a look at that. If it’s the codebook you’re talking about that’s online right now and it’s updated every year, then it would be another version next year, most likely. Tammy Keys: Okay. Ruth Hicks: This is Ruth, Denishia, in relationship to her previous question, I think there was a reference that you have — there’s some materials that we can provide additional information. Male Speaker: Your next question comes from the line of Cheryl MacDougall from DeVita. Your line is open. Cheryl MacDougall: Hi. Just a follow up question on the form 1500. I was just at a HIMSS conference earlier this week and one of the speakers, Robert Tennant, mentioned that the OMB just approved that form per a new BIC [spelled phonetically] meeting that he had participated in. So I was wanting to follow up on what then would be the next steps on CMS’s, I guess, approval of that form and what kind of timeline, because the proposed timeline had indicated a approval date by CMS of July with an implementation date of October of 2013. Female Speaker: That was the original timeline? We’ll have to take a look at that. We know that that’s been in clearance for some time so it may push some of those dates back, but we’ll have to take a look at that. Cheryl MacDougall: And how will that then get communicated out to the community so we all have enough time to get those updates aligned with all of our other priorities? Female Speaker: Sure, absolutely. You know the best way, and the way that we had planned to issue that once its ready to go, is that we have several listservs for ICD-10. If you go to our website you can sign up on our website to get any updates on forms, materials, things that are new and just coming out. So if that form was just approved — I know we’ve been checking in each week — in that case we would need to have some internal discussion and work through a plan to issue it. But it will take some internal discussions as well. Cheryl MacDougall: Thank you. Female Speaker: Thank you. Male Speaker: Your next question comes from the line of Betty Gomez from ZirMed NC Cycle [spelled phonetically] Your line is open. Betty Gomez: Yes. Thank you. You mentioned a representation — talked about testing and making sure that providers and clearing houses can test the ICD-10, and we’re a clearinghouse of revenue cycle management company, and we are — we’ve tried to get conversations with the MACs to get, you know, testing strategies. And what we are hearing from all the MACs that we’ve called or contacted is that there’s not going to be any testing at all with clearinghouses or even with providers or vendors. So can you clarify that for us please, because this is kind of conflicting information. It is very important and it’s very troublesome that we wouldn’t be able to test with our MACs. Female Speaker: Sure. So let me give you some information on that. Well first of all, one of the things that recently took place is that a decision was made to focus on the internal testing of our systems. And let me explain that a little bit because I think that would sort of add some context to the discussion. So right now when any type of release is done, any type of change to the internal systems, there’s a testing that happens right there. Towards the end, all of those systems that have been tested internally will be tested all together under a single testing contractor. And so we will be testing whether those systems are able to send and receive ICD-10 codes, and you know, testing of our edits and things like that. That will be an internal process. So yes, there has been a decision not to conduct external testing at this point, however, there’s also some preliminary discussions on perhaps looking at opportunities for — instead of national testing — some opportunities for bringing some groups together to conduct testing, who are interested in. And we do have a program that we’re working with HIMSS and WEDI National Testing Pilot that we’re plugging in to their testing. So there will be some cases, some scenarios that we’ll be testing through the NGS, MAC, and contractor. So we are looking at other opportunities to get involved and be involved in testing, but not on the national scale. Betty Gomez: Okay, so we shouldn’t even try to contact all of our MACs for testing. We should wait and see what is the national approach, or try to participate in the national program so that we can get the testing with NGS as it relates to that collaborative effort? Female Speaker: So there will be a select group, a small group of people testing under that contract. And so that’s still under discussion but I think there is promise there. So, you know, one of the things that we’ve been doing is talking with a lot of our stakeholders and partners. Many of them are conducting external testing and what they’ve found is that everyone doesn’t have to test with everybody. So they’re coming up with some scenarios that would be of interest. And some of them may be unique, depending on what setting you’re in. So they’re looking at the, you know, unique billing scenarios, unique things that may come in and will share those lessons learned with industry. And that’s being led again by HIMSS and WEDI, and CMS is playing a role in that. But again, it’s not a full-scale external testing with the MACs. It’s more of a pilot program that we’re considering under the HIMSS and WEDI pilot. Betty Gomez: Okay. Female Speaker: [affirmative] Betty Gomez: Thank you. Female Speaker: Thank you. You know, one thing I wanted to add to that is if there’s some interest from your organization, we are looking at how we could, you know, bridge several people together. There are some sort of early innovators, people who are out there, are testing right now and if there are people that are interested in doing something like that, we are looking to match a few folks up so please send your interests and if there’s a fit somewhere then we’ll certainly explore that opportunity with you. Thank you. Male Speaker: Your next question comes from a participant whose information was not gathered. APress star one and ask your question. Please introduce yourself with your first and last name, as well as your organization. Your line is open. If you have queued up for a question your line is now open. Female Speaker: I have a question for you. Are you there? Female Speaker: Yes I’m here. Female Speaker: Okay. When October 1st of 2014 comes around — we’re a DME provider — how is this going to affect our certificates of medical necessity that are already on file? And we have ongoing rentals. How — are we expected to get new CMNs with new diagnosis codes on everything? Female Speaker: You know, we’re getting a lot of questions about that and I think that you all have a unique situation. It’s definitely something that has to be discussed and decided, so we will definitely take that back. There’s been a lot of questions as to whether you need to, you know, resubmit using an ICD-10 code or not. Let us get some additional clarification and it may be a policy decision that needs to be made on that. Female Speaker: All right. Thank you. Female Speaker: But if you could do me a favor and send in your specific question, that will jog our memory. We actually host a weekly, sort of, policy session on ICD-10 and topics that come in through our mailbox we actually explore if there hasn’t been any final decisions made on those questions. And it allows us to be able to develop a fact sheet around it and, you know, get that out to everyone that’s on our listserv. So share that. Female Speaker: Okay. Female Speaker: But I’m interested in your specific question. Is it more about the billing or is it more about the certificate of medical necessity or both. Female Speaker: Well, I guess — I mean the CMNs affect the billing. If — well I mean if you’re saying that we have to do a split billing for — how am I going to say this? Are we going to have to do for rentals? Do we have to split it up? I mean I don’t know how the computer is going to do that. Say you have oxygen on rent, September — like she said — let’s say September 29th through October 28th. We will, I mean we’ll just use the one diagnosis code or is there going to have to be split billing for that? Female Speaker: I think it’s going to be your from date of service. And I — the monthly billing has been quite a challenge. I think we need to get some more clarification on that. There are some unique cases like anesthesia and those things that have a tricky billing situation. But I think yours would be based on from date of service. Female Speaker: Okay. Female Speaker: I believe that how those are being billed. Female Speaker: Okay. Because the thought of having to get all new CMNs, I mean, that’s a horrible task. Female Speaker: Right. Right. Female Speaker: You know, to get all new paperwork. That’s a monumental task in itself. Female Speaker: But I think that is something we can definitely put on our topic to explore further. One of the things that we’re looking to do is to have some special calls with DME groups, home health, some of you know SNITHS [spelled phonetically] and other unique situations to get their perspectives on some of the things that they’re dealing with with regards to the transition. So please, if you are interested in being a part of that, please send your information in because we’d like explore, you know, what are the challenges? We’re also thinking about developing some fact sheets that speak directly to those issues. Female Speaker: Okay. Female Speaker: Thank you. Female Speaker: And which is the — what email address? Female Speaker: That is the ICD-10 questions mailbox. Female Speaker: Okay. Female Speaker: Thank you very much. Female Speaker: Thank you. Male Speaker: Your next question comes from the line of Callie Berrigan [spelled phonetically]. Your line’s open. Callie Berrigan: Thank you. I work for a medical laboratory and this is kind of along the same lines as the last question with respect to standing order patients that, for instance, transplant patients that need labs on an interval basis. Would we use the ICD-10 consistently? Would we need to convert it? Let’s say it started in September and they have a weekly pro time, and it extends for six months. And the same thing. Female Speaker: Lab services. Callie Berrigan: Yes, clinical laboratory services. Female Speaker: So it looks like that would be a split claim issue. Callie Berrigan: That’s a lot easier for us in the lab world, so we would use the ICD-9 on September 30th and then 10 going forward? Female Speaker: Sure. Yes. And again, there’s been a lot of questions about billing, and how you bill, and how you submit that to Medicare and Medicaid, and we have some guidance from our Medicare office that we can share with you that’s publically available on the website, but I always believe in sending out a link because I think that helps to get you right there. So we can certainly share that with you — Callie Berrigan: Great. Thank you. Female Speaker: — and the participants of this call. Female Speaker: I believe we barely have time for one more question and then we’re going to have to end. We’re already past the top of the hour. Male Speaker: Your final question comes from the line of Natalie Nelson from Scripps Mercy Physical Healthcare. The line is open. Natalie Nelson: Hi. Thank you. I just need clarification on HCPCS, so J codes and that kind of thing. We represent about 650 private physicians so — in small groups primarily. Did I understand correctly that the HCPCS are not changing? Female Speaker: Not for ICD-10. Natalie Nelson: Okay. So you’ll submit with a new ICD-10 procedure code, so to speak, but HCPCS will remain what they are now. The — Female Speaker: That is correct. Natalie Nelson: Okay, the alpha character then four, five — generally four numeric characters after that. Female Speaker: Right. Your HCPCS will remain the same. Any CPT coding will remain the same. It’s just — it would be your ICD-10 code. And of course the structure has changed in your code. Natalie Nelson: Right. Okay. But HCPCS will be the same. All right. Perfect. Thank you very much. Female Speaker: You’re very welcome. Thank you. Female Speaker: Well thank you all for participating in the webinar today and, as you can see you know, if you have questions that we weren’t able to get to please feel free to submit them to the questions mailbox that we have on the slide there. And the presentation slides are available for download. That we’re going to put the file share box that you see above. Just be sure and highlight that file name, and make sure that’s highlighted before you hit the download or save to your computer. Thank you all very much for attending and we hope you have a great day. Female Speaker: Thanks everyone. Male Speaker: This now concludes today’s webinar. Thank you for your participation.