Updated on: January 30, 2014

Survey: Clearinghouses Ready for ICD-10

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Original story posted on: December 9, 2013

Tim McMullen, JD, CAEIn a survey conducted by the Cooperative Exchange this fall, a large number of clearinghouses report they are well positioned for implementation of ICSD-10 on October 1, 2014.

The Cooperative Exchange (CE), established in 2002 to promote and advance electronic data exchange for the healthcare industry by improving efficiency, advocacy, and education to industry stakeholders and government entities, connects with over 60 percent of all submitting providers, with more than 5,200 payer connections. As part of its advocacy efforts and support of industry initiatives, the CE surveyed its clearinghouse members’ readiness for ICD-10. The survey was conducted Oct. 21 to Nov. 4 with a large majority of the member clearinghouses responding.

More than 85 percent of CE clearinghouses say they have completed programming to accommodate ICD-10 initiatives. The survey showed all clearinghouses will be ICD-10-ready to engage trading partners in ICD-10 initiatives by the end of 2013 to include production-like testing, including two-thirds engaged in end-to-end testing or testing with payers. All CE clearinghouses have the capability of performing end-to-end testing, if the payers have that capability.

CE clearinghouses identified a number of benefits to ICD-10 implementation, including:

  • Greater specificity of ICD-10 codes provides potential for increased reimbursements based on submission of detailed codes associated with services provided;
  • Global consistency of coding increases transparency of healthcare treatment;
  • Payers must release edits modified for ICD-10 as soon as possible.

Without updated edits in place prior to industry ICD-10 testing, testing will need to be repeated after the release to ensure seamless transition in the production environment.

CE clearinghouses also identified a number of challenges to ICD-10 implementation, including the fact that an industry challenge will be to continue submission of ICD-9 and ICD-10 for rebills (up to two years post implementation), property and casualty, and Workmen’s Compensation transactions (CE Clearinghouses will provide the capability to send either ICD-9 or 10 based on requirements), and providers’ lack of system readiness to test ICD-10. Selective provider testing may or may not engage clearinghouses. Providers must engage clearinghouses and vendors to support contingency plans should their systems not be ready by Oct.1, 2014.

CE Clearinghouses have a variety of contingency plans to provide ICD-10 business continuity post-implementation. These include: tools to help derive ICD-10 to ICD-9 or ICD-9 to ICD-10; provider portals to edit claims and add the ICD-10 diagnosis code selected by the provider; analytic tools to help discover underpayments, overpayments, and zero pay claims that can help identify areas of concerns post-implementation; and ongoing educational outreach to facilitate ICD-10 adoption as well as ICD-10 bridge strategy solutions to facilitate migration.

CE members identified issues that have caused delay and/or lack of progress in ICD-10 planning and implementation. Customer lack of readiness ranked highest, followed equally by vendor challenges with the availability of test data and competing priorities. However, almost one-third report no issues or delays.

Cooperative Exchange Clearinghouses realize they are an integral part of the ICD-10 initiatives. Providers must include the clearinghouses during preliminary discussions coordinating testing and transition submissions to payers. CE Clearinghouses have committed themselves to ensure their products, services, testing, and contingency plans assist in making this a smooth transition.

CE members include: ACS EDI Gateway; American Medical Association (AMA); Apex EDI; AXIOM Systems, Inc.; Availity; CareMedic Systems; Capario; ClaimLogic; Claimsnet; eProvider Solutions; Gateway EDI; GE Healthcare; GHN‐Online; HDM Corp.; Healthcare Billing and Management Association (HBMA); Health-e-Web; Jopari Solutions; Medical Electronic Attachment (MEA); NextGen Healthcare; OfficeAlly; OptumInsight; RealMed, an Availity Company; RelayHealth; Secure EDI; Siemens HDX; The SSI Group, Inc., Streamline Health, Utah Health Information Network (UHIN); WEX, Inc. and ZirMed.

About the Author

Tim McMullen is executive director of the Cooperative Exchange

Contact the Author

For full survey results, go to www.cooperativeexchange.org

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Tim McMullen, JD, CAE

Tim McMullen is the executive director of the Healthcare Administrative Technology Association (HATA). The association represents healthcare administrative technology and other affiliated stakeholders to protect the interest of and to promote the core values of this key market segment.