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ICD-10 Nerve Center: What the Data is Telling Us in Week Three

by Nick Maselli, Senior Manager, Performance Analysis

We’re more than two weeks into the ICD-10 transition, and the data we’re seeing at our 24-7 ICD-10 Nerve Center is beginning to tell us a story about how practices and payers are performing post-October 1st.  

In advance of the ICD-10 transition, athenahealth established four ICD-10 Nerve Centers across our offices to better equip our cross-functional teams to react and collaborate quickly to respond to any transition issues. Our goal: To make the transition to ICD-10 as easy as possible for athenahealth clients. We’re monitoring payer trends and making sure claims are submitted, acknowledged by the payer, and adjudicated. Our teams also investigate and determine the root cause of any denials, work with payers to get erroneous denials reprocessed, and update our patented Billing Rules Engine® daily to prevent new denials from happening again.

So, what is the ICD-10 data that we’re monitoring in our nerve centers telling us? Here’s a breakdown of initial findings through the middle of October:

Claim Volume

  • As of last week, we have submitted more than 4.3 million ICD-10 claims to over 1,700 payers
  • October 6th was the first day we billed more ICD-10 claims than ICD-9 claims, and by October 16, 78% of our claims were submitted in ICD-10 format

Client Performance

  • The lead into October 1st saw more claims billed as clients cleaned out buckets in preparation for ICD-10. (Thank you to our clients for all your hard work here!)
  • Overall, appointment volume was unaffected by the transition, and charge volume remains on track with historical data at the mid-month point
  • HOLD and MGRHOLD buckets remain stable
  • We observed a slight increase in Provider Documentation Time and a slight decrease in Same Day Encounter Close Rate in the first week of October, but these have recovered to normal levels by mid-month

Payer Performance

  • Only a few small payers representing 0.003% of athenahealth’s claim volume were not ready for ICD-10 by the deadline. (We will continue to monitor for any developments here.)
  • As of mid-month, our key payer metrics (Days in Accounts Receivable, Front-End Rejection Rate, Back-End Denial Rate, and First Pass Resolve Rate) remain stable
  • Most diagnosis-related rejections or denials we have seen thus far have been erroneous, low-volume, or both. We have been working with payers and internal teams to have these claims automatically reprocessed with no client action required.

Payments

  • As of October 15th, 320,900 claims from 465 payers were paid by 10/15
  • Humana and BCBS stand out as the fastest to pay
  • 31 state Medicaid programs and 52 Medicaid managed care plans have paid ICD-10 claims as of October 15. These payers are not typically associated with paying quickly or easily, so this has been a pleasant surprise. 


While the initial findings are quite positive, it’s still early, and we have a lot to continue monitoring in the coming weeks. We will keep you updated through blog posts, and on our ICD-10 Nerve Center. And to our clients, we encourage you to take advantage of our ICD-10 Resource Center on the Resource Hub and we appreciate the time and effort you spent preparing for ICD-10. It helped make for a smooth transition on all fronts. 



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Comments

Submitted by Michelle Mangino - Monday, November 2, 2015

Hi Stuart, All ICD-10 codes are available in athenaNet. We only surface the billable codes in the billing workflow to avoid submitting unbillable codes, but all ICD-10 codes are available. If you have feedback or questions on a particular code, please submit a case through the CSC or ask your question on the Resource Hub. - Michelle Mangino Social Media and Blog Editorial Manager, athenahealth

Submitted by Neil Leitsky MD - Sunday, November 1, 2015

agreed, the transition was and is a non event.

Submitted by Ryan Poston - Tuesday, October 27, 2015

Sounds promising... I just received a query on a claim denial which, after research, showed that the LCD has not been correctly interpreted - the procedure in Group 2 and medically appropriate ICD10 is also. (We encountered the same issue with a common lab (A1C) procedure because the LCD instructions for services more frequently than 90 days was applied to all A1Cs.) Just hoping that someone is taking a closer look.

Submitted by Stuart D. Patterson MD - Monday, October 26, 2015

It is appalling that Athena still does not have all the ICD-10 codes listed in the EMR. As a hand surgeon I have encountered numerous diagnoses that are unavailable. This is highly inappropriate for a company that states it is ready for ICD-10.

Submitted by Mary Ellen Crociata - Thursday, October 22, 2015

Thanks to Nick and all the other wonderful people at Athena. ICD-10 has been an unexpectedly easy transition on the billing side of our practice. Our EHR(not Athena) lags way behind, and is the only source of extra work. Most importantly, I would like to thank you all for the ICD-10 look-up that does NOT require an extra mouse click to start typing in the search field-Yeah!!!

Submitted by Candyce Underwood - Thursday, October 22, 2015

ICD-10 has been a breeze; thanks to athenahealth. The transition was smooth and easy. My doctor stated that she felt like it was 'Y2K' all over again; a lot of hype but then no big deal. Thanks athenahealth!!

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