Posted in Reimbursement

Big healthcare payers report smooth ICD-10 transition so far

Carl Natale
by Carl Natale
Big healthcare payers report smooth ICD-10 transition so far

Now that physicians have aired their frustrations about the ICD-10 transition, healthcare payers are talking a bit about how they're handling it.

Before Oct. 1, it was understood that the larger healthcare providers with abundant resources were the most prepared for ICD-10 implementation. It looks like the same can be said for healthcare payers. The bigger payers are in better shape. Apparently some of the smaller ones had to switch back to ICD-9 codes for processing medical claims.

That doesn't explain why California's Medicaid system has to crosswalk submitted ICD-10 claims to ICD-9 codes to process reimbursements. That is not a small payer.

There is some conflicting reports about ICD-10 specificity. Like Medicare, there are some private healthcare payers willing to accept ICD-10 codes within the same family of codes. Even if the payer will accept the less specific codes, I wonder how many electronic health records (EHRs) are programmed to allow less specific diagnoses.

There is one thing that healthcare organizations can agree upon; we will have a clear picture of denial rates soon.

ICD-10: So Far, So Good

  • For clearinghouses Navicure and eMDs, the ICD-10 transition is smooth.
  • But two unnamed smaller insurers had to revert back to ICD-9 codes because of system failures.
  • eMDs reports the ICD-10 claim acceptance rate is about the same as the ICD-9 acceptance rate.
  • Patrick Hall, executive vice president at e-MDs, believes that healthcare payers will be reluctant to deny ICD-10 codes within the same family — meaning they will follow Medicare's lead. (That's not what many healthcare providers are seeing.)
  • Navicure reports that it's payer rejection rate has gone from 1.0-1.2 percent to 2 percent mostly because insurers' systems aren't operating properly.
  • Navicure is correcting 1 percent more of the medical claims from healthcare providers. (Mostly due to date of service confusion.)
  • Both clearinghouses say the real sign will come when remittances are due.

(HealthData Management)

Payers Take Forgiving Stance in Accepting ICD-10 Claims

  • Humana and UnitedHealthcare say they're not enforcing specificity when accepting ICD-10 claims.
  • This might be why they are reporting low rejection rates. (Emphasize the word "might.")
  • But they expect to start requiring more specific ICD-10 codes in six months to a year.

(HDM Top Stories)

Smooth Rollout For New ICD-10 Medical Codes, Insurers Say

  • Humana reports that only .03 percent of calls from healthcare providers are about ICD-10 claims.
  • UnitedHealth reported within 10 days, about 50 percent of medical claims were ICD-10 claims. Most were done properly.
  • Robert Tenant, health information technology policy director at the Medical Group Management Association (MGMA), said the extra time really helped.
  • UnitedHealth reports a "slight uptick" in claim denials.
  • Tenant says there are some reports of smaller health plans having issues, but the large healthcare payers are doing well.


Cautious Optimism in the Early Days of ICD-10

The post is a roundup of the same MGMA session about how the ICD-10 transition is going. But what's really interesting is this comment:

"I wish our experience was as positive. We are getting an excessive reject rate due to use of "non-specific codes" especially from GA Medicaid. Often nonspecific codes are the appropriate code for a PCP to use, when a specific diagnosis cannot be made otherwise in the physician's office. For any payer to refuse all nonspecific codes makes one wonder why they were placed into system in the first place. Today we received a list of these codes from GA Medicaid (all 363 pages) that would cause claim rejection. This info should have been put out before October 1st by any payer that was not going to pay for the "appropriate" use of nonspecific codes."

(Physicians Practice)

ICD-10: What Early Reports from the Trenches Are Saying

  • Some healthcare payers report glitches in online referrals that don't accept ICD-10 codes.
  • There are reports of flitches in eligibility inquiries.
  • Some insurers have long wait times for phone inquiries.


4 Challenges from the First Days of ICD-10

  1. "The 'grace period' only applies to Medicare and Medicaid"
  2. "Some software isn’t equipped for ICD-10"
  3. "Your EMR templates may need updating"
  4. "Many hospitals don’t have adequate staff"


What to do while you wait for the ICD-10 denials to hit

  • Keep on treating patients and coding medical claims.
  • Be ready to track denials and analyze data.
  • Pay attention to industry trends.

(Revenue Cycle Insights)

ICD-10: The U.N. Occupies Medicine

  • The United Nations is taking over U.S. healthcare through ICD-10 coding.
  • This is mostly accomplished through dumbing down the Diagnostic and Statistical Manual (DSM).

(American Thinker)