After months of discussions with the Cabinet for Health and Family Services (CHFS) via the KHA Medicaid Technical Advisory Committee (TAC) meetings, monthly Medicaid managed care organization (MCO) issue list meetings, individual meetings with CHFS and presentations to the Medicaid Advisory Committee (MAC), the Cabinet has made a final decision regarding sepsis.

On Wednesday, Department for Medicaid Services (DMS) Medical Director Judy Ann Theriot released a memo detailing coding and reimbursement guidelines for sepsis. CHFS will follow the CMS DRG and ICD-10 definitions of sepsis. MCOs are directed to "...base utilization management for sepsis on sepsis-2 criteria until such time that CMS adopts sepsis-3 criteria."

View the memo for more details.

The American Hospital Association (AHA) published a Member Advisory on September 28 providing guidance to hospitals on Thursday's transition to ICD-10:

Beginning October 1, health care claims must include ICD-10 codes for medical diagnoses and inpatient hospital procedures, marking a major change to billing transactions. The Centers for Medicare and Medicaid Services (CMS) will continue to pay claims and implement ICD-10 even if there is a government shutdown and Congress fails to act by October 1 on legislation to fund the government into fiscal year 2016.

Given the major changes that will occur with the move to ICD-10, hospital leaders are urged to pay close attention to their billing processes to ensure they identify issues quickly. AHA has distributed a chart, which outlines steps to monitor the transition and actions to address problems that could arise.

CMS has indicated...

While ICD-10 is almost here, you still have time to get ready, but you must get ready now. Each day this week the Centers for Medicare and Medicaid Services (CMS) has been highlighting 1 of the 5 recommendations to help you begin testing: 1) Why Test Now, 2) How to Get Started, 3) Testing with Trading Partners, 4) Types of Testing, and 5) Testing Tips. Yesterday's information on Types of Testing is shared below:

Acknowledgement Testing In acknowledgement testing, providers and other submitters, like clearinghouses, submit claims with ICD-10 codes and ICD-10 companion qualifiers. While claims are not adjudicated, submitters receive an acknowledgement that their claim was accepted or rejected.

Tip: Be sure to use ICD-10 qualifiers, which differ from ICD-9 qualifiers. Some providers have reported that ICD-10 qualifiers had to be manually set up in their systems.

Beyond testing with Medicare as described below, you can check with your commercial health plans, clearinghouses and billing...

During the week of July 20 through 24, a final sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The Centers for Medicare and Medicaid Services (CMS) is accepting additional July volunteers from May 11 through 22. This is an excellent opportunity to participate in end-to-end testing with Medicare prior to the October 1, 2015, implementation date.

Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.

To volunteer...

During the week of July 20 through 24 a third sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. This nationwide sample will yield meaningful results, since the Centers for Medicare and Medicaid Services (CMS) intends to select volunteers representing a broad cross-section of provider, claim and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.

To volunteer as a testing submitter:

Volunteer forms are available on your MAC website Completed volunteer forms are due April 17 CMS will review applications and select the group of testing...

To help you prepare for the transition to ICD-10, the Centers for Medicare and Medicaid Services (CMS) offers acknowledgement testing for current direct submitters (providers and clearinghouses) to test with the Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor anytime up to the October 1 implementation date.

CMS previously conducted two successful acknowledgement testing weeks in March 2014 and November 2014. These acknowledgement testing weeks give submitters access to real-time help desk support and allow CMS to analyze testing data. Registration is not required for these virtual events.

The first event for 2015 is happening now: March 2-6. Mark your calendar for the next testing week: June 1-5.

How to participate Information is available on your MAC website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically...

Reminder: the U.S. Department of Health and Human Services (HHS) issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015.

The rule requires 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.

For resources on transitioning to ICD-10, visit the ICD-10 website.

Health care providers can volunteer through October 3 to participate in an ICD-10 end-to-end testing opportunity with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor, the Centers for Medicare & Medicaid Services (CMS) announced Friday. About 850 volunteers representing a cross section of provider, claim and submitter types will be selected to participate in the testing, scheduled for January 26-30, 2015. Volunteer forms are available on the MAC websites, CMS said. The Department of Health and Human Services in July issued a final rule establishing October 1, 2015 as the date on which health care providers must begin including ICD-10 diagnosis and procedure codes on Medicare and other health care claims. AHA members can access an updated Executive Action Guide...

In regards to acknowledgement testing with providers, Change Request (CR) 8858 instructs Medicare Administrative Contractors (MACs) to promote three specific acknowledgement testing weeks with providers, and provide data and statistics to the Centers for Medicare and Medicaid Services (CMS) to demonstrate readiness for the International Classification for Disease 10th Edition Clinical Modification (ICD-10) transition.

For additional information, visit http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8858.pdf.

At a meeting on September 14, 2011, the ICD-9-CM Coordination and Maintenance (C&M) Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10, which would end one year after the implementation of ICD-10. The implementation of ICD-10 was delayed from October 1, 2014, to October 1, 2015, by final rule CMS-0043-F issued on July 31, 2014. 

A notice from CMS is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1240.pdf. The notice details who will be affected and what you need to know along with links to additional information to prepare.

The Centers for Medicare and Medicaid Services (CMS) planned to conduct ICD-10 testing during the week of July 21 through 25 to give a sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The July testing has been canceled due to the ICD-10 implementation delay. Additional opportunities for end-to-end testing will be available in 2015.

The Kentucky Hospital Research and Education Foundation (KHREF) presents the 2014 ICD-10 Webinar Training Series. This webinar training series will offer three webinars designed to get coders prepared for the mandatory ICD-10 conversion on October 1.

Overall Objectives of the Webinar Series:

Understand how ICD-9-CM compares to ICD-10-CM Understand the structure and format of ICD-10-CM Review and Coding of Diagnosis Codes in Chapter 1 – 21 of the coding book  Online registration for the following sessions is available at: http://secure.kyha.com/meetingregistration.asp:

Part 1 Thursday, April 10 2:00 p.m. - 4:00p.m. (ET)   Part 2 Thursday, April 24 2:00 p.m. - 4:00p.m. (ET)   Part 3 Thursday, May 1 2:00 p.m. - 4:00p.m. (ET) Please view the brochure...