Tag Archives: WEDI

Greetings from Sunny Arizona! WEDI’s National Spring Conference Is Underway.

The 24th annual WEDI Conference is well underway in the very sunny (and hot!) Scottsdale, AZ.  Many representatives from Axiom are on-site including Sales (Bill), the senior leadership team (Paul, Sandra, and Rich), and those from the Consulting Services division (Gina, Peggy, Satish).  And we can’t forget about Gigi from the Phoenix office, either!

There are a lot of good topics on hand ranging from (you guessed it!) ICD-10, HIE, FHIR, and privacy and security matters.  Stay tuned for future blog posts for conference highlights.

Free WEDI Webinar: Property and Casualty ICD-10 Preparedness

Although Property and Casualty Insurers are not HIPAA covered entities and therefore not required to implement ICD-10, many have indicated they will do so with the new deadline of 10/1/15.  Will they be ready for this new compliance date?  WEDI is offering for free to their members a webinar to discuss this:

Campaign Payers, vendors, and providers that bill Property and Casualty (P&C) across states are required to comply with each state’s requirements. Join us for an update on the WEDI Property and Casualty ICD-10 State Readiness campaign and learn more about:

• Potential impact of state ICD-10 readiness on stakeholder testing and contingency plans • Update on WEDI P&C ICD-10 State Readiness Governor Outreach Campaign from Devin Jopp, President & CEO, WEDI • Which states have declared ICD-10 adoption • How to stay informed on the latest updates on State ICD-10 readiness • How to identify which payers are ready NOW for ICD-10 testing • Latest WEDI ICD-10 Resource Tools • How to stay engaged in the process to help your organization with their ICD-10 testing and implementation plan

Monday, November 24, 2014

3:00 – 4:00PM ET

Register here.  Note:  Axiom is a corporate WEDI member.  If you do not currently have a WEDI login (is required to sign-up for the webinar), please contact Peggy Honts and she can create a user ID and password for you.

Health Plan ID: The Difference Between Health Plan and Payer is Clear as Mud.

When Health Plan Identifier (HPID) first came on the health IT landscape a few years ago, it seemed pretty easy to understand.  It was a part of CMS’ continued administrative simplification effort within healthcare.

Boy were we all wrong.

Last week, Peggy H. and I attended a WEDI Summer Forum held in Minneapolis.  The topics ranged from ICD-10, Attachments, and HPID.  A CMS administrator presented a HPID session via conference call.  However, I think there were more questions and confusion rather than answers.

Over the course of the past few years (and during last week’s sessions), some of the concerns of implementing HPID are as follows:

1) How do health insurance companies (I purposely used this language) enumerate based on the definitions of Controlling Health Plan (CHP) and Sub-Health Plans?  It’s not as easy since this requires a deep dive into how a particular organization is structured.  Are they part of a greater organization with separate corporate entities operating in multiple locations, e.g. states?  That would be require a conversation w/attorneys and the finance folks.

2) Large provider organizations voiced concern about impacts to them.  (This was a complete surprise to me).  A provider may have their general ledger setup w/different health insurance companies they file claims to differently based upon who/how remittances are sent.  Will the right enumerators on claims/remittances be correct or could they potentially mess up a provider’s books?

3) HPID is required on the HIPAA-covered transactions based on how the Final Rule is currently written; however, it has surfaced that CMS may not have intended it to be used on transactions after all.  They apparently want to create a database that lists all payers (or is it health plans????) in a single location.  Uses for this single source of information is pure conjecture at this point.

4) There is a difference in the definition between a ‘health plan’ and a ‘payer’.  I have been in healthcare for over 15 years and in my experience, these two terms are used synonymously.

Gotten your head around any of this?

For the last point regarding the difference in the definition of health plan and payer, WEDI has published an issue brief that explains this further.

WEDI Emergency ICD-10 Summit Highlights

After the ICD-10 compliance date was officially moved back at the beginning of April, WEDI organized an emergency ICD-10 Summit in Reston, VA on April 30 to bring folks from different sectors of the industry together and formulate a roadmap of where all as a whole should go next w/this change in date.  Several of us from Consulting Services attended this session.  Many thanks to Peggy Honts for writing up a summary of what transpired at this meeting.  -GP

WEDI ICD-10 Summit: Developing an Industry Action Plan for ICD-10 Implementation

AXIOM attended the WEDI emergency ICD-10 Summit focused on the announced delay and how the industry can moved forward.  Approximately 200 people participated with 100 in the room and the others on-line.  The summit was divided into four sections:

  • What are the real underlying issues?
  • Impact & Unintended Consequences of the delay to all industry stakeholders
  • Building the industry roadmap forward
  • Next steps for WEDI and the industry

A great deal of the discussion centered on getting CMS to announce the new compliance date.  The day after the meeting did in fact announce that October 1, 2015 would be proposed new date Public display copy of the 2015 IPPS NPRM may be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-10067.pdf.  The statement on page 648 of the proposed rule speaks to the new date.

Since the above announcement the issue of CMS announcing the date is off the table.  Below is a summary of the key points with a link to the full summit minutes.

The key underlying issue was the credibility of the new date. It has been changed several times before and in light of the fact the last delay was a result of Congress and not CMS there is a high level of uncertainly and credibility in the new date.  The only way to build credibility is gain endorsement from the people opposing ICD-10 and find ways to get the industry prepared for the new date.  If the industry believes and is prepared, there should not be a reason for a further delay.

The foundation of an industry roadmap forward was discussed and needs to be discussed further to assure the industry is committed to common objectives, approaches and the compliance date.  The roadmap will include defining ways to remove or mitigate barriers and identifying a value proposition to gain buy-in.  If these root cause issues are not addressed we will be faced with the same problem next October.

In addition to the roadmap, the summit recognized the consequences and impacts for those organizations that were ready or would be ready this year.  20 plus States have passed legislation to mandate the use of ICD-10 codes for Workers Compensation carriers.  (These are currently non-HIPAA covered entities and not being mandated by CMS to use ICD-10).  Most organizations need to re-evaluate their plans and roll-back some of their function or processes.  This effort will come at a cost and perhaps a large cost to many organizations.

Ideas to move the industry forward include:

  • Clarify Terminology.  There is much confusion between the differences between dual processing versus dual coding and run-off claims.
  • Outreach and Messaging.  There is a real need to develop and deliver more positive communication regarding ICD-10 versus the negative and funny jokes that have been  communicated in the media and the internet, e.g. ICD-10 diagnosis codes for running into a lamp post.  Otherwise, in a year we could still be in the same position we are today.  We have to do a better job engaging those that are resistant to ICD-10 today.
  • Testing.  It was acknowledged that all entities in healthcare will not be able to test with everyone.  It was agreed that a more effective approach to testing needs to be determined.
  • Vendor Readiness.  One of the underlying issues was the lack of some vendors not being ready in time to support testing.
  • Milestones to Implementation.  One idea was to develop a new milestone plan for each type of stakeholder with criteria in order to determine if you had met the milestone.

A report is to be published on the summit but below is the link to the WEDI site that contains notes captured during the session.   http://www.wedi.org/knowledge-center/resource-view/resources/2014/05/06/notes-from-icd-10-summit-developing-an-industry-action-plan-for-icd-10-implementation

ICD-10: CMS has Surfaced…..

Like those watching for whales out in the ocean, CMS has finally surfaced after bombshell that rocked the healthcare industry when President Obama signed into law legislation that effectively delayed ICD-10-again.  CMS sent out the following as an email to those subscribed on their email blasts:

On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

If you read closely, here are the points that give some clear indication as to where they are headed w/the updated regulations for compliance:

-This new compliance date is 10/1/15.

-This will be a single cut over for all HIPAA (yes, even CMS misspelled this in their message above) covered entities.  There will not be any exemptions or a phased-in approach from my reading of this.

-This is an interim final rule.  I believe this means that there will not be a public comment period open for this and should move swiftly into regulations.  

WEDI CEO and President Devin Jopp also announced in an email that CMS administrators will be present at the WEDI Spring Conference in Hollywood, CA the week of May 12th to address more specifics as to this announcement.

As they say in the news business, stay tuned for updates to this developing story……