News Feature | March 24, 2014

Health Payers Ready For ICD-10

Katie Wike

By Katie Wike, contributing writer

HTO Insurance Definition

Insurers say they will be ready to process claims when ICD-10 deadline hits in October

The American Academy of Family Physicians (AAFP) writes, “A big part of (ICD-10 transition) preparation entails adequate end-to-end testing between hospitals, large health systems, independent physician practices, and the health insurance companies who pay for a good deal of those health care services. In particular, it is important that the nation's largest private payers including UnitedHealthcare (UHC), Aetna, BlueCross BlueShield (BCBS), and Humana, are ready for the transition so payments to physicians are not delayed.”

With that in mind, AAFP “sent key contacts at each of the companies a list of questions” to determine their readiness to manage October’s transition. The AAFP asked each insurer to:

  • confirm that testing of their internal products and processes was complete;
  • acknowledge that "upstream" testing of incoming data/processes from the clearinghouses and other health IT companies with which the insurer partnered was complete;
  • identify how many provider groups had, or planned to, submit claims to test the "downstream" process;
  • share any problems or issues that testing revealed;
  • ensure the availability of contingency plans to tackle problem areas;
  • provide opportunities for multiple testing episodes for physician practices to test the claims process; and
  • divulge plans for how any post-implementation issues would be resolved.

The last thing physicians should be worried about during a costly and time consuming coding transition is whether or not payers will be ready to process claims. While less than 10 percent of physicians are ready for the switch, Health Data Management reports “all surveyed payers ‘had set up ICD-10 preparedness pages on their individual websites specifically dedicated to assisting physicians.’ And, ‘most importantly, that all of the health insurance companies who responded said they would be ready for the Oct. 1 deadline.’”

"Payers want this transition to run smoothly, too," Laura Schmidt, an AAFP private sector advocacy strategist who conducted the survey, told AAFP News Now. "They've invested a lot of time and money into the ICD-10 implementation, just as family physicians have. The bottom line is that no business, big or small, involved in this effort can afford a slowdown in its billing and payment processes."

Fierce Health Payer explains some of the concerns of insurers are: accurate use of ICD-10 coding for claims submitted after Oct. 1, vendor readiness to support ICD-10 early enough in the process for physicians to prepare for the transition date and physician readiness to use the new codes starting with the deadline.

Aetna Senior Medical Director Christopher Jagmin, M.D., reported that his company began large-scale internal testing and targeted external testing in 2013 and would continue throughout 2014. "We plan to use what we learned from our testing as we work with all of our providers and vendors in coming months," Jagmin told AAFP. "We are evaluating the best communication mechanisms for sharing our testing results industry wide," he added.