ICD-10 update

Friday, November 01, 2013 12:36 PM

Payers on target with ICD-10

Marilyn Rissmiller, Senior Director, Health Care Financing

The Colorado ICD-10 Training Coalition has held monthly webinars since March to help practices form their ICD-10 implementation plans to be ready for the Oct. 1, 2014 implementation date.

The September webinar featured four private payers who presented their ICD-10 strategies and resources, and answered questions. Representatives from Anthem BCBS, Cigna HealthCare, Rocky Mountain Health Plans and UnitedHealthcare all said that they will be ready to process claims by the ICD-10 implementation date and they do not anticipate any delays in payment. They advised practices to be sure any middlemen – such as clearinghouses, vendors or billing services – are also prepared to process claims by the implementation date.

Jolice Smith from Anthem said Anthem will process claims submitted after Oct. 1, 2014 in either ICD-9 or ICD-10 based on the claim’s date of service initially but will not process mixed claims, or claims filed with both code sets on the same claim as is consistent with guidelines from the Centers for Medicare and Medicaid Services.

None of the payer representatives said they would be able to test with each physician practice before next year. However, Anthem will provide a self-guided tool that will give feedback to the claim submitter, likely a clearinghouse, whether a test claim has gone through. Practice staff would then need to communicate with their clearinghouse to receive the outcome of the self-guided test. Anthem’s ICD-10 news and resource page can be found at http://tinyurl.com/ICD-10-Anthem.

Mark Laitos, MD, and Patti Guerin from Cigna advised practice staff to pay careful attention to the service date and discharge date. Cigna will accept claims submitted with ICD-9 codes if that authorization was requested and services start prior to Oct. 1, 2014, but authorizations for services starting on or after the implementation date will need to be submitted with ICD-10 codes.

Cigna will start testing with trading partners and vendors in the fourth quarter of 2013. They suggested practice staff take one of CIGNA’s ICD-10 e-courses by going to the medical e-courses page of the resources section of www.cignaforhcp.com.

Monika Tuell with Rocky Mountain Health Plans said RMHP has begun internal ICD-10 testing and will start external testing with clearinghouses, direct submitters and application vendors in the second quarter of 2014. She also recommended providers contact their clearinghouses and test directly with them, and encourage their clearinghouse to test with RMHP. To confirm that their clearinghouse has tested with RMHP, practice staff can call either RMHP professional relations representatives or the clearinghouse directly.

Aaron Sapp from UnitedHealthcare said there is no need for contracted physicians to remediate or recontract based on ICD-10. They will begin internal testing in the third quarter of 2013 and will begin testing with providers, vendors and regulatory agencies in the first quarter of 2014. They’ll widely release information from their partners with whom they test so practices will stay informed. Find ICD-10 resources on UnitedHealthCare’s website at http://tinyurl.com/ICD-10-UHC.

This transition is perhaps the largest project to date for payers and physician practices. Open communication between all vendors involved in claims processing will be crucial to ensure claims are successfully submitted and processed come Oct. 1, 2014. To view the webinar and access other resources from the Colorado ICD-10 Training Coalition, go to www.cms.org/icd-10.