Healthcare providers weren’t the only ones trying to get their coding house in order prior to the Oct. 1 implementation date for ICD-10. EHR vendors were hard as work as well.
“The transition to the new ICD-10 set of diagnosis and medical procedure codes marks a monumental change across the healthcare industry,” said Shivani Mishra, senior product marketing associate, athenahealth, speaking to Repertoire one week before the implementation date. “It requires a lot of work on the part of hospitals, doctors’ practices and health insurance companies, and has been a source of stress for physicians especially, who have had to create an ICD-10 implementation plan, a budget and a detailed timeline.”
The impact of ICD-10 is massive, she said. “We are coaching clients to make sure they are ready, doing extensive payer outreach to understand the implications on their side, and monitoring our clients’ interfaces/vendors to make sure systems are operating smoothly with the transition. Our 24/7 Nerve Center is monitoring both client and payer performance metrics proactively, and ensuring we can respond quickly to changes.”
athenahealth’s cloud-based software has been ICD-10 ready since February 2014, said Mishra. “We’re continuously tracking payer readiness, and keeping our network informed in real time on who can and cannot support ICD-10 codes. Following the ICD-10 transition, athenahealth clients won’t have to track which payers are ready for ICD-10 when submitting claims, eliminating the worry of increased denials or disruption to practice revenue.”
athenahealth will actively research payer denials for all athenahealth practices, she continued. “Every single denial is added into the system as its own billing rule, with new rules added daily, to prevent each denial from ever happening again at any athenahealth practice.
“To further minimize financial risk, athenahealth is also actively testing interfaces across our cloud-based network to ensure our clients and their vendors are ready to send ICD-10 codes.” The vendor had tested 100 percent of charge interfaces prior to Oct. 1.
One week prior to implementation, athenahealth had tested 83 percent of payers. The EHR vendor’s discussions with payers prior to the implementation date were especially helpful, as those discussions resulted in payers clarifying whether the root cause of test claim denials were internal payer system issues or truly ICD-10-related, said Mishra.
Despite all the upfront work, some questions remained, she continued. Here are some of the most common myths athenahealth discovered from testing were:
- Myth 1: All payers are conducting end-to-end testing. “Not all payers are testing, and fewer are doing end-to-end testing.”
- Myth 2: All payers are testing with everyone. “Those doing end-to-end testing are often limiting participation to institutional claims or high-impact providers.”
- Myth 3: Payers are offering unlimited testing. “Testing is often limited to a handful of claims covering their prescribed scenarios.”
- Myth 4: Successful testing means payer readiness. “Testing results cannot adequately forecast the post-transition environment. Testing alone can’t guarantee against issues.”
“There’s no indication that claims acceptance rates will fall significantly,” Mishra said athenahealth would have a better idea after the Oct. 1 deadline.
EHR vendor’s role
The EHR vendor should act as a partner to the practice and ensure the practice has been working over the past year to create and implement a plan for ICD-10,” said Mishra. This should have included testing interfaces, adding ICD-10 to future and standing orders, practicing selecting ICD-10 codes in claims and encounters, planning for cash flow disruption, and having a general contingency plan.
The vendor should also have plans for various post-transition failure scenarios and mitigation strategies. “That means establishing lists of payer escalation contacts and developing a systematic approach to track any rejections and adjust as needed.
“At athenahealth, because of our cloud-based service, we are also able to monitor and track ICD-10 transactions and network performance in real-time immediately following the transition. We’ll know practice by practice if providers or billers are having difficulty selecting codes and if this is leading to a delay in charge entry. And as soon as we start seeing ICD-10 related rejections or denials, we’ll be ready to respond with updates to our patented Billing Rules Engine. In addition to tracking which payers are ready to receive ICD-10 codes and which are experiencing difficulties, we’ll also be tracking new denial codes, new medical necessity edits, and surfacing those trends on any future claims that may be affected.”