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Cautious Optimism in the Early Days of ICD-10


The early returns on ICD-10 from payers and a clearinghouse have been positive. Yet, no one is ready to pop the champagne and celebrate quite yet.

For two payers and a clearinghouse, the early returns on ICD-10 are positive. However, they are just that - early.

In a panel led by the Medical Group Management Association's (MGMA's) Health Information Technology Policy Director, Robert Tennant, representatives from payers, such as Humana and UnitedHealthcare, as well as representative from Emdeon, a clearinghouse, said they have seen very low rejection rates and no major issues in the early days of ICD-10. They were all, however, very cautious and not willing to get overly excited.

"Everyone is pleased with the results … but no one is dancing in the end zone quite yet," said Ross Lippincott, vice president of provider regulatory programs at UnitedHealthcare. "We have quite a ways to go. We're keeping our foot on the gas in monitoring, outreach support, [and] collaboration, and the whole industry shouldn't be taking a premature sigh of relief."

As of Oct. 9, Lippincott said United Healthcare had processed 2.3 million ICD-10 claims. He noted that provider call center volumes were within the normal range, pre-authorizations were processing as expected, and there was only a slight uptick in rejection rates, at less than 0.2 percent.

Both Lippincott and Sid Herbert, director of the ICD-10 implementation team at Humana, touted their organizations' efforts to prepare providers for ICD-10. Like UnitedHealthcare, Humana has also seen low rejection rates and a normal call volume thus far. More than 50 percent of claims, by Oct. 7, were coded in ICD-10.

"It was somewhat similar to Y2K; we worked like demons, and everything proceeded the way it should have," Herbert said. "That's not to say it will continue that way, but I think we have enough data that says we won't have major catastrophic issues."

'At the Beginning of This Journey'

It wasn't just payer representatives who had a positive message on the transition. Mike Denison, senior director for regulatory programs at Emdeon, which has a large all-payer network for its clearinghouse services, said even though a lot of providers didn't conduct any readiness testing with the company before the transition date, most are using ICD-10 codes when they should be. Moreover, he said they haven't seen a significant increase in claim rejections, as it's trending in line with prior daily averages.

Denison said he was "cautiously optimistic," going forward.  The efforts to keep providers prepared, the three said, will continue past the Oct. 1 deadline. All three companies offer an ICD-10 command center.

Overall, the MGMA's Tennant said he is hearing that claims are moving through the system. He said if there were massive issues, the organization would've found out. Still, in the spirit of waiting to celebrate, he said there were short- and long-term questions on ICD-10 that needed to be answered. Specifically, he had questions around the four state

Medicaid agencies (California, Louisiana, Maryland, and Montana) which aren't accepting ICD-10 codes, and whether granular coding would actually lead to better data and improved quality of care.

Tennant, seemingly half-kiddingly, said that when the same roundtable convened in a month, they'd be talking about the increase in denials. However, considering CMS' previous projections of post Oct. 1-denials, he may very well be right.

"We're only at the beginning of this journey. We're now at the point where can move information back and forth between providers and payers based on real-world conditions. We're beginning a learning process that will benefit us all over a short period of time. This is beginning of the journey. I'm hopeful the issues will be small, but be assured, that it's in the payers' best interest to actually pay a claim quickly, accurately, and effectively. Anything beyond that causes rework and dissatisfied the provider, so there is no real positive result," said Herbert.

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