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An ICD-10 Guarantee: Offering Peace of Mind to Physicians and Practices

by Todd Rothenhaus, MD, Chief Medical Officer

It might be a bit of stretch to say athenahealth guarantees its clients success with every U.S. Government health IT mandate, but we’re off to a solid start. We already guarantee that our clients will receive Medicare incentive checks for Meaningful Use—this now covers Stage 2—and 96% of our participating providers attested in 2012. And today, we took another step toward standing by our practices, announcing our ICD-10 Guarantee*. You may ask, “Why so many guarantees, athenahealth?” Well, it’s really confidence in our ability to help our clients succeed. It’s a proof point for us. It’s also an internal rallying cry within the company to ensure that we’re all aligned with our clients in helping them thrive through change.

The impact of all this government regulation can’t be taken lightly. Early last year, when the ANSI 5010 transaction set was launched, our PayerView team saw a reduction in the first-pass resolution rate for claims during the transition, which resulted in a small reduction in our clients’ actual cash flow. With ICD-10, we’re concerned that a cash flow reduction could be more significant. We know we’ll be ready, but if past is prelude, there may be a host of payers and clearinghouses that aren’t, so here’s what we’re telling our clients:

athenahealth guarantees that we will be ready for ICD-10 by the October 1, 2014 deadline. Additionally, any new clients who experience significant interruption in cash flow may be eligible to receive a cash loan from us**. In fact, we’re setting aside 50M for this assurance. (See details about the ICD-10 Guarantee.)

An obvious next question: What exactly are you doing to prepare for ICD-10 and get it right?

  • Keeping the physician top of mind. You know the codes are going to more than five-tuple, from around 13,000 ICD-9 codes to roughly 69,000 ICD-10 codes. At athenahealth, we’re doing a ton of development work on the user experience and user interface to ease this massive transition. We’re always on top of optimizing usability for our clients, and we intend to stay that way.
  • Ensuring that we can receive codes from any other EHR vendor. For our clients not yet using our cloud-based electronic health record (EHR) system, athenaClinicals®, we’re working to make sure our athenaCollector® practice management system is capable of receiving codes from any other EHR system. We’re also identifying and developing coding-related educational opportunities that practices can take advantage of, and we’re creating coding programs practice leadership can use to help ease the transition for the clinicians they serve.
  • Standing by… in the cloud. Long before D-Day (October 1, 2014), our clients will become ICD-10 compliant at the same time, all working off the same single source of updated cloud-based software. There’ll be no need to find a consultant, and then pay for, load and test a new version. That would be ludicrous in the 21st century.
  • Providing an interest-free bridge loan. If a practice is at risk of a significant cash flow reduction as a result of the transition to ICD-10, we’ll provide that client with an interest-free bridge loan.

OK, I am biased but I am pretty convinced ICD-10 could be a real hassle for medical practices using other EHR and practice management systems. As the number of codes grows and changes, ICD-10 can very well bring offices to a crawl. I just don’t see other vendors doing anything similar to what I’ve outlined.

When October 1, 2014 arrives, every vendor needs to be equipped to generate those ICD-10 codes, and every payer must be able to receive those codes. It’s going to be a pretty big day in the United States for health information technology, to say the least, and we believe the process has to have already begun.

Let me offer some advice (if you’re not already an athenahealth client, that is): Ask your practice manager, CMO, or CMIO what they’re doing to prepare for ICD-10. Ask your current vendor their plans for preparation and testing. What will your service look like? How will you navigate an enormous code set when you may already be struggling with a current code set roughly one-fifth its size?

These questions, quite frankly, need to be answered now. Talk to your leadership and your vendors.

And if you don’t like their answers, let us know.

*This Guarantee covers ICD-10-CM codes and does not cover the ICD-10-PCS code set.
**Eligibility for the cash advance is limited to independent practices that (i) are live on athenahealth’s athenaOne services, or on our athenaCollector, athenaCommunicator and athenaClinicals services, by June 30, 2014; (ii) have an overall average days in accounts receivable (DAR) of more than 60 days in regard to transactions occurring on or after October 1, 2014; (iii) have Client-responsible DAR of seven days or less for such month; and (iv) are not in breach of the athenahealth Master Services Agreement; provided, however, that the total aggregate amount of cash advances made by athenahealth to its clients will not exceed $50 million dollars in the aggregate and cash advances made to each practice will be capped based on the number of MDs and mid-level providers in such practice. Additional terms and conditions apply; please see your sales representative for more information.

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