0 Presentation to: Providers, Trading Partners & Billing Firms Presented by: Sheldia Evans-Maddox Department of Community Health (DCH) Medical Assistance Plans Division September 24, 2015 ICD-10 Implementation Overview and Updates

1 Mission We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

2 Topics for Discussion ICD-10 Basics Are you Ready? DCH is Ready Questions and Comments

3 ICD-10 Basics

4 Mark Your Calendars

5 ICD-10 Facts Moving from ICD-9 to ICD-10 -U.S. is last industrialized nation to adopt ICD-10. Transitioning to ICD-10 -National impact, mandatory for all HIPAA-covered entities -If you use ICD-9 codes TODAY, you must migrate to ICD-10 codes. For dates of services rendered on or after October 1, 2015 –All claims must use ICD-10 codes –All claims using ICD-9 codes will NOT be accepted For dates of services rendered before October 1, 2015 –All claims must use ICD-9 codes Systems must accommodate BOTH ICD-9 and ICD-10 codes –Effective with the October 1, 2015, compliance date

6 ICD-10 Facts Significant Code Increase from ICD-9 –Increasing from 13,000 to approximately 68,000 ICD-10-CM codes –Increasing from 3,000 to approximately 87,000 ICD-10-PCS codes –ICD-10 has more than nine times the codes in ICD-9 ICD-10 has no direct impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

7 Are You Ready?

8 Provider Survey Results 89% of the respondents had not tested with Georgia Medicaid 76% of the respondents do not anticipate any major obstacles to successfully implementing ICD-10 by the compliance date. 20% of the respondents are very confident and 32% are confident of their ICD-10 Readiness

9 General Equivalence Mappings Tool Provides an ICD-9 diagnosis code mapped to an ICD-10 diagnosis code. The GEMs tool is a basic tool and is not inclusive of all of the new ICD-10 codes. –2014 ICD-10 PCS and GEMs2014 ICD-10 PCS and GEMs –2014 ICD-10-CM and GEMs2014 ICD-10-CM and GEMs –2015 ICD-10 PCS and GEMs2015 ICD-10 PCS and GEMs –2015 ICD-10-CM and GEMs2015 ICD-10-CM and GEMs GEMs are not a substitute for learning to use.

10 General Equivalence Mappings Tool An example of GEMs S35411A S35411D V S35411S

11 Code Translator AAPC has a tool called the ICD-10 Code Translator. This allows you to compare your ICD-9 to ICD-10 codes. This tool only converts to ICD-10-CM codes.

12 ICD-10 Training Attending training sessions, webinars is just another way to obtain practice and prepare for ICD-10. –Self-learning tools –Train the Trainer –Association training sessions –Webinars

13 CMS ICD-10 Checklists CMS has created ICD-10 Checklists to assist your organization with overall ICD-10 compliance. –Large PracticesLarge Practices –Small and Medium PracticesSmall and Medium Practices –Small HospitalsSmall Hospitals –PayersPayers **Please note that checklists still reflect the October 1, 2014, compliance date. Source:

14 Tips on Getting Ready Last Minute Preparedness Tips 1.Call your vendors—right now. Find out what their readiness is and get any updates you might need. Although you may not have time to go through testing with them, they will be able to provide you with data from earlier testing that they have done and explain what they learned during testing and make it clear how they’ll handle any issues on/after Oct Get your staff trained quickly. There are ways to get your staff trained before Oct. 1. The Centers for Medicare & Medicaid Services (CMS) and the AMA also offer a variety of resources, some of them specialty-specific. 3.Focus on mapping/coding your top 25 most commonly used diagnosis codes, since these codes will account for the majority of revenue. 4.Remind everyone in the practice to watch acknowledgement reports and remittance advices (RAs). There will be a period of time when your staff will be using both ICD-9 (for services before Oct. 1) and ICD-10 (for services on or after Oct. 1), things could get confusing. Watch acknowledgement reports and RAs closely after you submit claims so you can spot problems immediately. 5.Establish cash reserves - Check with your payers about how to handle getting claims paid should any challenges arise. Make sure you have cash reserves on hand or look into lines of credit should payment get interrupted and you need them. This information was taken from American Medical Association’s website. The website address is: wire/post/last-minute-guide-prepping-icd-10

15 ICD-10 Resources Centers for Medicare & Medicaid Services (CMS) CMS Overview - CMS ICD-10 Implementation Planning Guides/Checklist - HHS, CMS ICD-10 Final Rule - CMS, HHS Complete list of code sets for ICD-10-CM and ICD-10-PCS; Final Rule and Official ICD-10-CM Guidelines – World Health Organization (WHO) ICD-10 Page –

16 We Are Ready

17 DCH ICD-10 Testing Internal Testing – Risk Base Testing Completed on August 7, 2015 External Testing – Testing with Georgia Medicaid Trading Partners and Billing Services Completed on September 3, 2015 Providers Completed on September 3, 2015

18 Testing Stats Total Claims Submitted: 3048 Total Claims Paid: 1126 / 37% Total Claims Denied: 1762 / 58% Here are the most frequently posted diagnosis related edits/errors that caused the denials: ST ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC ND ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC RD ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC TH ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC TH ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC

19 Testing Results As a result of testing, DCH would like to reiterate the following: Non-specified codes are set to deny for all claims except inpatient (COS 010), Outpatient (COS 070) emergency (Revenue code 45X), Swingbed (COS 080), and Nursing Home (COS 110/160) claims. Prior authorization (PA) requests already approved prior to the ICD-10 transition before October 1, 2015, will not need to be resubmitted. If the PA request is submitted for approval on or after October 1, 2015, the request form must have ICD-10 diagnosis (CM) codes for claim processing. Any PA renewals or requests submitted on or after October 1, 2015, will need to have ICD-10-CM (diagnosis) codes. A claim cannot contain both an ICD-9 and ICD-10 code; therefore, you will need to split bill to prevent the claim from denying. The date of service on the claim determines which code set to use. For Hospital Services (inpatient and outpatient), the date of discharge determines which code set to use. Georgia Medicaid will not be issuing interim or advance payments as a result of the ICD-10 implementation.

20 DCH and the Transition to ICD-10 DCH is on track for ICD-10 compliance.  DCH is continuing its education as scheduled. -Phases of implementation Awareness, Assessment, Remediation, Testing, Transition -Status as of September 2015 Awareness – ongoing Assessment – completed Remediation – completed Testing – completed Transition – started

21 Triage Team DCH and HP has created a team of dedicated resources that will assist in identifying issues and issue resolution. If your organization have an issue specific to ICD-10 after October 1, 2015, please contact DCH at or HP via the web portal contact us feature at or by calling the call center at or

22 Information Needed ICN – is the ICN of the claim that has been denied or the claim that has an issue Provider Name - is the name of the provider on whose behalf the issue claim has been submitted Your Name – is the person making the call as the provider representative or any person who made the call to DCH/HP Your Phone Number – is the phone number of the person who made the call, so DCH/HP can contact them back once the issue has been resolved Your address - Is the address of the person who made the call, so DCH/HP can them back once the issue has been resolved.

23 Resources

24 More ICD-10 Resources DCH Resources – DCH Dedicated ICD-10 Website – DCH Website for ICD-10 Webinars/Downloads – DCH ICD-10 Education Outreach and Resources – ICD-10: A Four-Part Series (Video) HP Enterprise Services Statewide Workshops –Check GAMMIS for future ICD-10 workshopshttp://mmis.georgia.gov

25 Contact Us HP Call Center – or We welcome your questions and comments at

ICD-10 Webinar Series Register Now Open Discussion Forum Thursday, October 15, 2015 To register for the above webinars: Visit » Each webinar is scheduled for up to one hour, 10:30 – 11:30 a.m. ET. » Unless otherwise noted, all webinars are targeted to Providers and Trading Partners. » Please be advised that webinar dates and times are subject to change.

27 Questions and Comments Use the WebEx Q&A Feature Questions submitted will be answered via within 4-6 business days of this event. Or you may us at This presentation will be posted within two business days at

28 Thank You