DCH-i is the monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important information to you as physicians, dentists, hospitals, third-party payers, vendors, health care advocates, consumers and legislators. Our goal is to help create A Healthy Georgia -- together.
Write us at DCHfirstname.lastname@example.org.
Through effective planning, purchasing and oversight, the Department of Community Health (DCH) provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and underserved populations.
The mission of the Department of Community Health is to provide Georgians with access to affordable, quality health care through effective planning, purchasing, and oversight.
We are dedicated to A Healthy Georgia.
From the Commissioner
As a health care professional, you get pulled in many different directions. For better or worse, your work entails so much more than just helping and healing. You face dozens of competing demands that keep you awake at night, and it can be difficult to prioritize them.
There is one major change coming that I urge you to address: the transition to ICD-10. As you already know, ICD-10 is the new coding system for delineating medical diagnoses and procedures for care management and billing purposes. You need to be ready for it, and you need to get ready now.
ICD-10 will go into effect on October 1, 2014. It is mandated by the federal government and DCH is obligated to make payments in accordance with this mandate. It appears that there will be no more delays. Whether you do business with Medicaid, Medicare, or with the private insurance companies, you will need to have your business and IT systems updated to submit claims. It’s the law.
The transition will not be easy, and it will take time. But it is manageable – if you start now. We’ve devoted this issue of DCH-i to give you important information about how to get started with your ICD-10 transition. DCH is committed to helping you throughout the process, but you need to get started.
If you have questions about ICD-10 and Georgia Medicaid’s role in this transition, please e-mail us at email@example.com. We look forward to seeing you successfully transition to the new ICD-10 system by the October 1, 2014, compliance deadline.
David A. Cook
The Cure for What Ails You
Follow this regimen for a healthy ICD-10 outcome.
If you’ve not yet begun to integrate ICD-10 into your practice, you may miss the testing that begins later this year. That’s right, DCH and Georgia Medicaid plan to start beta testing with trading partners in the fourth quarter of 2013.
The mandatory date for ICD-10 compliance is October 1, 2014, but beta testing will begin in just seven short months.
If you haven’t started the transition to ICD-10, here are suggested action steps that you should take now. Our sources for these steps: the Centers for Medicare & Medicaid Services (CMS), other leading industry voices…and our own.
The transition to ICD-10 is not optional; it is mandatory for all organizations that are subject to the Health Insurance Portability and Accountability Act (HIPAA).
For more information, visit www.dch.georgia.gov/ICD-10.
Is there a difference? Why should you care?
According to the Federal Register, a rejected claim would be a claim sent back by the payer due to a misunderstanding of the new codes, need for additional information, lack of medical necessity, etc. An improper claim is deliberately miscoded in an attempt to gain undue reimbursement. Due to the specificity of the new ICD-10 system, it should theoretically be harder to submit improper claims, and easier for payers to find them.
We’re at 531 days and counting until October 1, 2014.
Come October 1, 2014 -- just 531 days away -- we all need to be ready to go with the ICD-10 flow. Right now, thousands of Georgia Medicaid providers and trading partners are hard at work on their transition to ICD-10. So are we.
The conversion to ICD-10 code sets is more than a routine IT system remediation with testing and transition. It’s business process and IT change…involving policy reviews with coverage and payment determinations, processing reviews and improvements, code mapping of more than 140,000 codes, internal testing, and external testing and transitioning with our providers and trading partners.
For DCH and Georgia Medicaid, ICD-10 is an important business initiative impacting our Medicaid and PeachCare for Kids programs and our Georgia Medicaid Management Information System (GAMMIS).
While the currents of health care change can be turbulent, DCH will be ready to process and pay claims using ICD-10 codes starting on October 1, 2014. What about your practice: up a creek or paddling right along?
DCH is currently undergoing internal testing using ICD-10 code sets and plans to begin external beta testing in late 2013.
To become a Beta Test Site, please e-mail your interest to firstname.lastname@example.org.
So just where are your peers in the transition to ICD-10?
For the past four years, our health care provider and stakeholder community has been inundated with trade news stories about the mandated transition to ICD-10. Many of you have heeded those advisories from CMS, DCH and your professional associations. But, many of you have not.
From our ICD-10 awareness and readiness research conducted to date, we’ve found that the majority of our provider community hasn’t begun the transition to ICD-10 – even with the mandated compliance date only 531days away.
Want to know more about what we’ve learned from you and your colleagues during February through early April of this year?
This research has been very telling to us at DCH. We’re making sure our people, processes and technology are ready to start testing later this year. We’re continuing our education and outreach. And, we’re listening to you. Need help dealing with the ICD-10 peer pressure? Drop us a note at email@example.com.
Research Sources: Surveys with the Medical Association of Georgia (MAG) membership (Feb. 2013)*; other major medical associations and societies in Georgia (Feb./Mar. 2013)*; DCH WebEx attendees (March 2013).**
Start ICD-10 Transition Now
As Georgia Medicaid’s fiscal agent, Hewlett-Packard Enterprise Services (HPES) maintains and operates the Georgia Medicaid Management Information System (GAMMIS). Major operational functions include provider enrollment, claims processing/resolution, provider payment, and state and federal reporting. HPES works closely with the Department of Community Health (DCH) to implement Medicaid and PeachCare for Kids policy changes and other enhancements in the system brought about through legislative health care initiatives such as the mandated 5010 transaction standards and ICD-10 code sets.
The transition to ICD-10 will impact every system, process and transaction that contains or uses a diagnosis or procedure code. This predominately affects physician and outpatient claims (diagnosis) and inpatient claims (diagnosis and procedure).
What does this really mean? GAMMIS processes claims based on Medicaid policy. Diagnosis and procedure codes are key elements used to implement those policies. Just as the medical community needs to learn and transition to ICD-10 codes, GAMMIS needs to “learn” and transition to ICD-10 codes, while still being able to accommodate ICD-9 codes for services rendered before the October 1, 2014, compliance date.
DCH and HPES began the transition to ICD-10 in October 2011. We started with an impact assessment of processes, procedures and policies. Since that time, our combined ICD-10 teams have completed analysis, business and technical design for the system upgrade to ICD-10. We’re looking at:
How does GAMMIS know a claim is ICD-9 or ICD-10? Providers must indicate whether a claim is ICD-9 or ICD-10 at the time of submission. The 5010 claims transaction standard (a system prerequisite to ICD-10) includes qualifiers to designate whether the diagnosis and procedure codes are ICD-9 values or ICD-10 values. For example, a qualifier of “BK” indicates ICD-9 primary diagnosis whereas “ABK” indicates ICD-10 primary diagnosis. Paper claims will have an ICD-9/ICD-10 indicator at the claim level.
To ensure accurate processing and enforcement of CMS mandates, new system checks or claim validation edits are being added. The ICD-10 “go-live” and compliance date of October 1, 2014, is a hard date, meaning there is no overlap or grace period where providers can submit either ICD-9 or ICD-10 claims. The ICD-10 compliance date applies to the date of service (rendered to the patient) rather than the transaction processing date or current date. This drives the following claim validity edits:
Will the ICD-10 claims process be different? Yes. Electronic 837 claims pass through a translator to check for valid values before the claim is processed. Electronic 837 claims will fail compliance checks and will be rejected if billed inappropriately. If the claim passes compliance checks but does not pass the new ICD-10 validity edits, it will be denied and noted on our remittance advice.
HPES in collaboration with DCH has been reaching out to the provider community since 2012 with webinars stressing the impact of ICD-10. In addition, HPES’s Field Service Representatives (FSR) have notified providers about the upcoming transition while making provider visits throughout the state. This includes directing providers to ICD-10 workshops, emphasizing the importance of the implementation, and demonstrating how to access material from the GAMMIS web portal.
While the transition to ICD-10 will impact payers and providers alike, there is still time to prepare for a smooth transition – but only if you start now.
DCH and Georgia Medicaid will continue to host webinars, speak at association meetings, post updates to our DCH website pages on ICD-10, and distribute e-newsletters like this one.
To join our mailing list for ICD-10 news, webinars, events and more, e-mail us at AskDCH@dch.ga.gov.
To attend one of our upcoming webinars, check out the IT Events page.
Remember to bookmark the DCH website at http://dch.georgia.gov/icd-10 for the latest news about ICD-10.
Below is a partial list of ICD-10 resources that you may find helpful. We’ll continue to update as warranted.
PeachCare for Kids® is a registered trademark of the Georgia Department of Community Health.