Late last year I had an in-depth discussion with a representative from Idaho Medicaid regarding our company’s willingness to work with them when they were ready to test. As a result, Medicaid and their claims processing contractor’s ICD-10 implementation team reached out to our third-party medical billing company to serve as their beta testing partner for physician claims early in 2014. It was immediately apparent that they had invested heavily in the work required for the ICD-10 transition. The planned testing included full end-to-end adjudication (837 and 835) with the correct claim adjustment reason codes (CARC) and remittance advice remark codes (RARC) based on the correct coverage policies. To ensure a representative sampling, our billing company was to submit claims using both a proprietary system and a purchased practice management vendor system billing software. Accounting for claims processed directly and through a clearinghouse was also addressed. Lastly, multiple specialties and physicians were included in the testing. A coder certified in both ICD-9 and ICD-10 was to assign the diagnosis codes used for adjudication comparisons so we could mirror our normal coding processes.
Idaho Medicaid shared its work plan with us, and testing details and dates were confirmed through phone meetings. Preparing the test batches was a simple programming process for our company and our vendor. Test claims were submitted in a separate batch at specified times so the Medicaid workgroup literally could watch how the claims were processed through their system. Immediate feedback on any issues was provided via email and phone calls. Some very minor technical data entry problems on our end were quickly corrected, and all claims and batches were processed correctly. We then reviewed the adjudication to identify any ICD-10 claims that appeared unexpectedly or had a different result than current claims. Again, no problems were identified. The entire testing process was so smooth that it was completed more quickly than anticipated in the work plan.
So, what were our teachable moments and takeaways from this experience? First, there are payors that will test with smaller practices, companies, and physicians – not just the large hospitals or major submitters. Second, take advantage of beta testing opportunities. In fact, go look for them! Talk to your vendors, clearinghouses, and payors. Even though we are now in a holding pattern, we can use the additional time to perform and perfect the work required for the smoothest possible transition. Last and most importantly, claims and payment disruptions can be minimized and possibly avoided if we all work together as one team.
I plan to use this experience to pressure our other payors to perform similar testing. If the little guy can do it, so can they. Kudos to Idaho Medicaid.
