ICD-10 has been called the Y2K of healthcare: all hype and no havoc. But, how do providers feel?
The majority of healthcare providers (80 percent) report the transition to the 10th iteration of the ICD code set was smooth, according to a KPMG survey. Partners HealthCare, based in Boston, is among the healthcare organizations to successfully overcome this hurdle years that has been years in the making. Partners HealthCare has been working with MedAssets since 2009, and the health system and the vendor prepared together for ICD-10. Here the two companies detail the experience.
Please note, responses have been lightly edited for length and clarity.
Question: How did MedAssets help prepare its clients for ICD-10 prior to the Oct. 1 deadline?
Janett Checo, Director, Edit Research, MedAssets (Alpharetta, Ga.): From a product standpoint, the development teams were ICD-10-ready since 5010 [the conversion requiring all HIPAA-covered entities to adopt new standards for electronic transactions], and the content teams and clearinghouse teams worked to address the needed rules to support clean claims to the payer. There were thousands of rules that required updates and/or creation to address the needed changes. Our team began preparing for the needed rule changes initially over three years ago. We enabled the rules in the testing environments so that our providers could test the rules prior to submitting test claims to the payers. In addition, we provided webinars to help our providers focus on areas of risk or provide clarity on areas of challenge.
Q: When did the health system first begin preparing for ICD-10?
Paul Dufresne, Patient Accounts Business Manager, Partners Healthcare (Boston): We began working on this in February 2014 in anticipation of the original launch date of Oct. 1, 2014. When the delay was announced, we took a break for a couple of months and picked up the baton again in January.
Q: What did you anticipate would be the biggest challenge?
PD: Based on what happened during the conversion to 5010 a few years back, we figured the biggest challenges would be payers not being ready. During that conversion, payers went up on 5010 at various times because of their system issues, and even then when many of them went up, things did not go smoothly at first, causing many invalid rejections issues. Part of the lessons learned from that experience was to closely watch rejection rates and rejection reasons to quickly try to catch the brush fires before they became raging infernos.
Q: What changes has MedAssets seen since Oct. 1? Any increase in denials?
JC: There have been some increased rejections from payers and some increased denials from those payers. Our organization works with both the providers and payers to assess the validity of these issues and address corrections if needed. Denials are anticipated to rise initially but we can't speculate on how much. We are hearing about some initial issues with increased invalid denials both from payers and providers. For example, various Medicare contractors have published notifications of issues with some local coverage determination policies missing some codes resulting in denials. Providers are advised to monitor remittance advices for these invalid denials.
Q: What continued support is MedAssets providing its clients for ICD-10?
JC: We continue to monitor rejections or denials for providers. In addition, we have been holding ICD-10 team meetings multiple times per week to ensure that we share ICD-10-related issues and tracking updates and solutions. We continue to maintain and report our known payer issues on the Rejection Tracker. We advocate on behalf of our providers on payer rejections and through cases opened to our teams, we provide various levels of support in addressing systemic invalid processing issues at the payer to address invalid rejections or address invalid denials. In addition, we provide our customers the needed content support to address denials based on span claims to empower them in their discussions with the payer.
In the first few weeks of ICD-10, MedAssets was in most cases identifying issues for invalid rejections proactively through monitoring rejection reports, researching the validity of the rejection, and contacting the payers for the invalid rejections at times prior to the issue even being identified by providers or payers. It has been a long-standing distinction as MedAssets acts often as an advocate for our providers.
Q: Considering the level of concern prior to the implementation of ICD-10, how do you think the healthcare industry is faring post-implementation?
JC: Overall, the industry is faring well if compared to the implementation of 5010. However, there is a need for more payer transparency on rules implemented and content support for denials based on coding. The need to understand coding-based denials or rejections and their sourcing is important. The increased number of ICD diagnoses codes should not change electronic data interchange rules regarding the acceptance of valid for use codes in terms of ANSI acceptance. Providers should be allowed to submit valid claim transactions for adjudication without receiving rejections for more specified coding. These new rules that are appearing are examples of changes in the industry that represent the need for oversight and transparency with respect to business rules used in EDI.
Q: Was the transition to ICD-10 smooth or were there issues after Oct.1?
PD: I don't want to say this too loud as to jinx it, but yes so far things have gone very smoothly this time around. There have been minor hiccups here and there, but nothing like the previous experience, [the 5010 conversion].
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