December 17, 2015

Health Plans Report ICD-10 Success

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Health plans nationwide are touting widespread success in the implementation of ICD-10, according to comments made by three health plan representatives during the most recent edition of Talk Ten Tuesdays, the weekly Internet broadcast hosted by ICD10monitor.com.

 

Brian A. Parkany, senior director of strategic operations and ICD-10 operations and technology for Aetna, George Vancore, director of IT integration for Blue Cross Blue Shield of Florida, and Shelagh Kalland, transformational lead of stabilization and director of the ICD-10 program at Blue Cross Blue Shield Minnesota all had good things to say about life after ICD-10.

“I’ve got say that Aetna’s experience with ICD-10 (and I think, generally speaking, the industry’s) has been a lot like Y2K; there were some who thought that the ‘lights would go out,’ so to speak, and that claims would not be able to be submitted or paid. But I can say from our perspective that certainly was not the case, and I think a lot of credit for the success is a result of all the hard work and collaboration that occurred across the industry,” Parkany said during the broadcast. “At Aetna, we spent more than five years preparing for ICD-10.”

That process included several years of collaborative testing and, more recently, the identification of metrics included in Aetna’s ICD-10 dashboard – such metrics include, for example, claim intake and claim rejection rates, Parkany explained.   

“What was interesting is we actually saw our claim intake numbers increase in the weeks leading up to and just after Oct. 1. We believe this was the result of folks getting out as much of their ICD-9 inventory as they could in advance of Oct. 1,” he said. “Then, by the second week in October or so, we started to see a brief slowdown in claims … however, by November, we started to see a correction beginning, and by early December we (were) seeing both accepted claims and billed dollars in line with expectations. Our conclusion to date is that the ICD-10 transition is not having a major impact on the ability of the provider community to bill in ICD-10, or on our ability to process and pay the claims.”

Vancore said that an additional two years to prepare for ICD-10 – a product of federal delays – wound up paying huge dividends for his organization.

From an internal perspective, the extra time allowed us to ‘parallel process’ two full production days, (during which) we re-processed 197,000 claims that were ICD-10-enabled using a tool from Optum called Premier Picks – we compared denials, rejection rates, and claim payments – and we had six errors! That was incredible, to say the least,” Vancore said during the broadcast. “From an external perspective, the extra time allowed for more end-to-end testing with physicians, providers, delegated entities, business associates, and other electronic trading partners; our end-to-end testing environment allowed our providers to select any previously processed ICD-9 claim, recode (it) into ICD-10 using the associated medical record, and resubmit for processing – what a great way to test.”

Since Oct. 1, compared to the same point last year, Blue Cross Blue Shield of Florida is experiencing an increase in claim volume of 3 to 5 percent and an 8-percent decline in claim denials, Vancore said, attributing the good news in part to extra care being paid by physicians, providers, and billers in coding their claims. The organization even is seeing a decline in the use of unspecified codes, he added – something just about no one saw coming.

“If you were to ask me four years ago if financial neutrality was an achievable outcome, given the depth and breadth of the ICD-10 change, I would have told you emphatically, ‘no way!’” Vancore said. “However, that’s not what is playing out – we see no measurable differences and no payment anomalies across both professional and institutional providers – and believe me when I tell you, we are watching this one closely.”  

Blue Cross Blue Shield in Florida has experienced a few minor challenges, he admitted, mostly centering on authorizations, claims spanning the implementation date, and use of both ICD-9 and ICD-10 on the same claim, but he described such issues as “short-lived … and resolved quickly.”

Kalland did nothing to rain on anyone’s parade, either, echoing Vancore’s opinion that the delays of ICD-10, viewed as a nuisance by many at the time, wound up being a benefit.

In using the delay as intended – to provide greater testing time – we were able to identify issues earlier and modify procedures and systems so that we were ready to accept and use ICD-10 codes. Most collaborative members continued to move forward with preparations for go-live in spite of the last implementation delay,” he said during the broadcast. “We collectively created and used a set of approximately 220 test scenarios to simulate the more challenging and risky components of using ICD-10, (and) each provider submitted those test scenarios that were applicable to their particular patient population.”

The providers then met regularly to share interpretations, test results, and experiences before and after Oct. 1, Kalland noted.

“Our Plan is able to receive and adjudicate claims with ICD-10 codes, answer calls, handle managed care transactions such as pre-certifications and prior authorizations, and continue to produce reports and analytical analysis. Our key metrics have seen no statistically significant changes to indicate that ICD-10 has caused a disruption,” he said. “For example, our claim receipts have stayed consistent, our rejection rates have not increased either at the Plan or at our clearinghouse, and our call volume has not increased as a result of potential ICD-10-related questions.”

Still, Kalland added, no one in her organization is planning on relaxing just yet.   

“Over the next 6-12 months we will be keeping a close eye on metrics related to provider payment and risk scores, as well as the number of members that we are identifying for case and disease management to identify any anomalies,” she said.

 

Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years. 

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