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Behind the Scenes: Preparing for ICD-10

by Elysha Fiabane, senior manager, product innovation

As many of you know, athenahealth has been ready for the ICD-10 transition since last February, with all the necessary changes and improvements already implemented on the cloud-based network that our clients use every day. But we’ve been taking advantage of the extra time from last year’s deadline delay to optimize our internal services and processes, with a focus on ensuring network readiness. And since we’re all about transparency, we wanted to pull back the curtain and explain some of the ways we’re humming along with ICD-10 preparations to make sure providers don’t see an impact on reimbursement and mitigate risk should issues arise with payers around the October 1 compliance date – now less than six months away.

ICD-10 Payer Testing

athenahealth takes on the work of payer testing on our clients’ behalf. We’re able to leverage the scale of our network – with more than 62,000 providers and 31.8 million claims submitted per quarter – as well as deep connections with payer organizations, so taking on this work is a no-brainer. In preparation for ICD-10, we’re utilizing these connections to monitor payer readiness, conduct extensive and targeted ICD-10 testing outreach and, ultimately, engage payers in proactive testing engagements. Our practices don’t have to deal with any of this because we do.

How thorough is our testing? Our Payer Outreach team is currently reaching out to payers that represent more than 93% of all athenahealth claim volume to determine their ICD-10 readiness and testing plans, and to engage them for collaborative testing opportunities.  What’s our measurable goal? Our ICD-10 testing team is aiming to successfully test with at least 80% of our payer volume, to ensure that we can send and receive claims on October 1, 2015 and identify any payers at-risk of failing after the transition date.

ICD-10 Interface Testing

We’re also working with clients to ensure that all data interfaces that send and receive ICD-10 codes are operational before the compliance date. These include charges, claims data, and lab orders. By proactively testing, we will minimize impact on any revenue that depends on interfaces working well. We’ve developed tools dedicated to testing the ways outbound interface messages are generated and inbound interface messages are received. Our Interface Operations team intends to test all inbound charge interfaces.

Product Updates

The ICD-10 code set is ready to go for all providers on our network, and able to be used for all their dates of service starting October 1.  Our clients are even able to practice with this new code set now, as they are coding their current claims!  Come October 1, athenahealth is ensuring that all of our providers are coding entirely in ICD-10, and should there be a payer that is not quite ready then athenahealth will automatically down-covert to ICD-9.

The ICD-10 code set becomes more specific, and includes episode of care, laterality, anatomical site and injury cause for certain diagnosis codes. We’ve incorporated these changes into our ICD-10 intelligence by generating filters that help providers and billers narrow down to the relevant ICD-10 codes quickly. For example, the SNOMED term “Sprain of ankle” can return 45 relevant results. By selecting just three filters: Encounter type=initial, Laterality=right, and Site=deltoid ligament the list is quickly reduced to one result, “S93.421A Sprain of deltoid ligament of right ankle, initial encounter.” A bit technical but you get the idea.    

Our clients have had the opportunity to practice coding in ICD-10 since February 2014, generating over 65,000 dual coded claims and counting. We’ve taken their feedback and usage data – like frequently used search terms -- to inform our continual improvements.  

Client Engagement and Communication

athenahealth is highly invested in ensuring that our clients are prepared for the transition. In fact, our commitment and confidence in helping clients navigate ICD-10 without disruption to care or cash flow is guaranteed. Under this program, we guarantee that athenahealth will be ICD-10 compliant or we will waive our fees until the compliance standards are met.

To ensure that success, we have developed a comprehensive 4-phase plan in our client’s online ICD-10 Readiness Center, designed to carefully guide them through key readiness tasks. The Readiness Center is the one place that brings all the administrative and configuration tasks together, so that our clients can conveniently execute and track their progress.

As an essential best-practice tip, we are urging athenahealth clients to elect an ICD-10 Coordinator at their organization, a staff member who will be responsible for managing the ICD-10 transition for their practice. We also offer a full schedule of webinars, outreach, and other content to keep clients informed and engaged. (And for those who may have a bit of ICD-10 fatigue, our “Zany ICD-10 Codes” blog series gives everyone a laugh at ICD-10’s expense.)

Post-transition

While we proactively prepare for the ICD-10 transition date, we are also planning for the post-transition environment. We know that despite best efforts throughout the industry, something is bound to go awry somewhere.

With that in mind, we are thinking through, and planning for, various post-transition failure scenarios and mitigation strategies. That means establishing lists of payer escalation contacts and developing a systematic approach to track any rejections and adjust as needed. We are also amping up our monitoring to track ICD-10 transactions and network performance in real-time immediately following the transition. We’ll know practice by practice if providers or billers are having difficulty selecting codes and if this is leading to a delay in charge entry. And as soon as we start seeing ICD-10 related rejections or denials, we’ll be ready to respond with updates to our patented Billing Rules Engine.

In addition to tracking which payers are ready to receive ICD-10 codes and which are experiencing difficulties, we’ll also be tracking new denial codes, new medical necessity edits, and surfacing those trends on any future claims that may be affected.

No matter what happens, no matter what date, no matter the disruption (or lack thereof), athenahealth clients can be assured of one thing: We have them covered. And as you probably know, we guarantee it!

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