October 25, 2015

ICD-10: Smooth Transition for Claims, PMS Vendors Cautiously Optimistic

By Jill Finn

EDITOR’S NOTE: The following is a rough transcript of comments made by Jill Finn during the Oct. 12, 2015 broadcast of Talk Ten Tuesdays.

The HATA (Healthcare Administrative Technology Association) practice management members as well as our members from organizations like the AMA (American Medical Association) and UnitedHealthcare have been touching base through email almost daily since Oct. 1, and we’re meeting weekly with Denesecia Green, who is the CMS (Centers for Medicare & Medicaid Services) ICD-10 Lead, to exchange issues and find solutions.

From a support perspective, across the board for HATA members, call volumes for our service departments have been lower than anticipated, some as much as 25 percent lower than we had projected, so that’s been great news for our employees who were expecting to be taking calls around the clock.  

We’ve also seen a change in call types, whereas a few weeks ago the majority of calls were around setup and configuration and now we’re seeing a shift into more coding and claims-related questions.

From a provider readiness standpoint, what we’ve seen so far is that a large percentage of our clients are submitting ICD-10 claims, and while that number is increasing on a daily basis, there are still some stragglers. Some are still working through their ICD-9 backlogs, some have processes to submit in batches on a certain cadence (so this could be weekly, bi-weekly, etc.), some are holding onto their claims to double and triple-check their coding, and a few are just letting the dust settle before they submit. What it comes down to is that there’s still a bit of anxiety about getting paid. 

While we hope to not have to utilize this often, one thing that all of our HATA members have done for our providers is build contingency plans into the software to allow offices to toggle between ICD-9 and ICD-10 codes in the event that a payer isn’t ready to accept ICD-10 codes.

As far as ICD-10 claims submission goes, we’re not seeing any glaring issues, which tells us that those years of preparation for our software, staff, and customers has been successful. We’re receiving positive feedback from customers on our readiness, and for the most part, the rejections and exclusions we’re seeing are typical. For the few that aren’t, our clearinghouses and payers have been very responsive. 

Mid-last week, we all started seeing payments come back. AdvancedMD, one of our large billing services, reported that they’ve seen thousands of payments come through. They had payments from Medico in 22 states and insurances like UHC, Tricare, BCBS, Aetna, and Cigna have released or approved the first set of the payments across the states for most of the specialties they work with. 

Medicare has also acknowledged the claims and is currently working through processing, so we should have a solid update on those claims. We’re all patiently waiting to see what the next week or two of adjudication brings and will continue monitoring denials, rejections, exclusions, and other trends.

We’re also keeping a close eye on the few issues that have come out like medical necessity and ensuring that LCD and NCD policies contain accurate information for ICD-10. Having this collaboration across the industry and within our member group has allowed us to keep our services departments and our customers informed and aware of potential impacts.

HATA practice management vendors are experiencing a surprisingly smooth transition for claim setup and submission, and we’re staying cautiously optimistic about a positive claims adjudication experience for our customers in the weeks ahead.

About the Author

Jill Finn is the Information Technology Release Manager at ADP AdvancedMD.  She has more than 10 years of experience in the healthcare IT industry, leading teams to success across a diverse range of products, including practice management, revenue cycle management and human capital management.  She is a board member of the Healthcare Administrative Technology Association (HATA) and served on the Advisory Committee for the Practice Management System Accreditation Program (PMSAP) led by EHNAC and WEDI.

Contact the Author

 

Comment on this Article

Related Stories

  • CMS Releases 2019 Proposed Physician Fee Schedule
    CMS proposes to change physician evaluation and management (E&M) coding with a drastic overhaul. EDITOR’S NOTE: The following report first appeared on RACmonitor on July 13, 2018 After soliciting comments from many stakeholders in the last year, the Centers for…
  • Is All Airway Protection Acute Respiratory Failure?
    Document it right on the front end; avoid fighting a denial on the back end I was recently asked about a post from Hospital Performance regarding acute respiratory failure and airway protection (https://soundphysicians.com/blog/2018/06/20/from-the-appeals-desk-acute-respiratory-failure-part-1-2/), and I wanted to expand on what…
  • Incorporating Socioeconomic Status for Medicare Advantage: Addressing the Social Determinants of Health
    Accounting for socioeconomic factors is critical to the sustainability of healthcare. A recent blog headline in the American Council of Science and Health captured the healthcare industry’s attention. The headline read, Medicare Could Cover Food, Air Conditioners...Is Sex Next? The…