Yes, as of this writing, the ICD-10 compliance deadline has been proposed for a delay to Oct. 1, 2014.

With that in mind, we have devoted an entire section of our website to ICD-10 knowledge for physicians, practice managers and anyone else who needs a clear picture of what it takes to manage the leap from some 13,000 to about 68,000 diagnosis codes.

As the year goes on, we will add updates to the section and let you know about each one. If you have questions that aren’t reflected in the FAQs, please comment here and we’ll get your answers.

With all the action in the health IT industry these days, an electronic transaction format conversion has to be one of the least sexy topics out there. But the latest transition has been fraught with danger.

Heading into the last quarter of 2011, the ANSI 5010 conversion had the potential to have a huge negative impact on providers. An unsuccessful conversion would have been disastrous for medical billing: Claims would have been unreadable by payers and payments could have been sent to the wrong locations. In an extreme case, the past decade’s successful migration to electronic transactions could have unraveled, forcing providers back to paper in order to get paid.  

Every month, 15 million electronic claim, remittance, eligibility and claim status inquiry transactions flow through athenahealth—and before the ANSI 5010 conversion, we knew the change would impact nearly every one of those medical billing transactions. So, we slated a gradual implementation over a full year.

And yet, despite our best efforts to push early adoption with payers, we had only three payers ready for claim submission in the 5010 format as we headed into the third quarter of 2011. Three payers, accounting for less than 1% of our volume.

Fast forward seven months.  

Although the Centers for Medicare and Medicaid Services (CMS) have twice postponed enforcement of these standards (currently scheduled for June 30, 2012), more than 97% of athenahealth’s transactions are now exchanged in ANSI 5010. We’ve since moved on, tackling our 2012 initiatives, including preparations for the massive ICD-10 code update. And those remaining 2.1% of transactions are awaiting payer or intermediary readiness. So, we’ll continue to move these payers and monitor them throughout this year, and probably into 2013.  

So, how did the ANSI 5010 conversion go?

It hurt, but it could have been so much worse.

We started Q4 2011 with less than 1% of claims submitted in 5010—by the first week of January, 2012, we had  more than 85% of claims in the new format. This rapid conversion wasn’t without serious impacts to our providers: 

• Without warning, in November, Medicare had unveiled 5010-only enrollment for providers. This meant conversions within each state needed to be completed before any new athenahealth providers could start submitting claims in 5010. If the associated intermediaries could keep up with the testing, and 5010 approvals were done in a timely manner, this could have been manageable. But many couldn’t keep up and some of our new providers suffered as a result. Despite this, we were live with most Medicare carriers by mid-November and fully live in all states before the conversion deadline, minimizing the impact on our providers.
• With internal communication gaps and the implementation of external tools, many payers couldn’t tell athenahealth how they were interpreting the standards in advance of moving to production. Because of this, athenahealth’s front-end rejection rate, which typically hovers around 1.5%, peaked at 2.4% in January, 2012. While we weren’t thrilled, the only other vendor we’re aware of that shared this metric was happy with their 5% rejection rate. We credit this manageable increase to our production testing process, which mitigated risk by submitting the bulk of claims in 4010 while gradually increasing the 5010 volume with each payer who supported it. 
• Payers and intermediaries who didn’t have careful controls processes in place were, at times, unable to answer basic questions about submitted claims: Who submitted them? How many claims are there? or What is their status? This widespread issue resulted in false compliance warnings, processing delays and reporting errors, and some providers were hit harder than others. Again, through vigilant monitoring and escalation of missing claim research with payers and intermediaries, we were able to resolve these issues. The situation then improved dramatically in February. Some of our providers had significant payment delays, which would have been more extreme had we not detected issues early, analyzed the available data and resubmitted affected claims once we became confident of the best way to move forward.     

Here’s why our cloud-based services ease transitions like these:

• Our cloud-based model allows unparalleled visibility into the financial health of our clients. We’re invested in the whole claim lifecycle—we don’t just pass through a claim and hope it gets to the payer. We confirm receipt, track claims’ progress and ensure remittance is received. And we’ve set up alarms to let us know when  claims don’t get on file as expected. Within a week of a claim submission, if we haven’t seen acknowledgement as expected, we begin escalating issues with the intermediary and payer. 
• We had a testing cycle that was so thorough it elicited ridicule from some trading partners early on. Yet, by the end of the implementation, several payers and clearinghouses were thanking us for our help in their implementation. As an early adopter, we were able to help them detect issues and address major problems before the rest of the pack was ready to start testing. For example, in January alone we encountered nearly 50,000 false rejections from clearinghouses or payers who needed to update their systems and reprocess our clean claims.
• We allocated the appropriate time, money and people to the change, monitored maniacally, and reacted quickly. Our “war room” processed hundreds of issues with our Development and Rules teams present in the room so that a new requirement or issue could be swiftly implemented as soon as it was defined.

We’re already working on preparations for the big switchover to the ICD-10 code set and tapping into the lessons we learned from 5010 to make it go as smoothly as possible. As always, we want to help providers focus on their patients by serving up the right information at the right time, in the right place.

Delays and more delays

Originally, the 10th revision of the International Statistical Classification of Disease and Related Health Problems–aka ICD-10–was slated for adoption here in the United States on October 1, 2011 by all “covered entities” under HIPAA.

As early as January 2009, the deadline was pushed out to October 1, 2013 and with it, migration to ANSI 5010 moved to January 1, 2012 in order to support ICD-10 codification. If, like me, you have become so immersed in the politics of such timing, just remember that the ANSI 5010 standard and ICD-10 code set updates are intended to be helpful, streamlining and improving transactions and improving diagnosis reporting and analysis.

Anyway, the “best-laid schemes of mice and men oft go awry”… unless you’re living in France, or one of the Nordic countries…circa 1997.

The industry transition to ANSI 5010 has been less than smooth and the Centers for Medicare and Medicaid Services (CMS) recently extended the enforcement start date to July 1, 2012. In response to feedback from organizations like the American Medical Association (AMA) regarding the administrative burden and cost of the ICD-10 transition, CMS announced in February that the agency would also consider postponement of ICD-10 implementation.

No lack of points of view

Finally, on April 17, the Department of Health and Human Services (HHS) published a Notice of Proposed Rulemaking (NPRM) in the Federal Register to propose a one-year delay to the implementation of ICD-10 until October 1, 2014. Prior to the release of the NPRM, policymakers and thought leaders weighed in with a wide range of opinions as varied as: “Don’t delay!”, “Make it a 2 or 3 year delay”, “Let’s just move on to ICD-11”, “Do we even need ICD-10 or can SNOMED suffice?” (While this last idea may seem a bit radical and unlikely, we tend to agree with its potential to simplify—removing the administrative burden on providers and avoiding redundancy.)

But at this point, the length of a delay doesn’t really matter. What does matter is that delays continue for everything—ANSI 5010, Meaningful Use, ICD-10, the Sustainable Growth Rate resolution. And with each delay, the innovative doctors, vendors, patients, health systems and payers aren’t rewarded for their speed and efficiency.

I understand the thoughtful arguments of advocates on all sides and I know we’re collectively tackling monstrous issues. But, the culture of delay is really beginning to keep our industry stuck in a rut. The discussion seems to be increasingly focused on “When will we?” rather than “How can we?”

As always, we’d love to hear your thoughts and, more importantly, encourage you to share them with the feds, who take the comment process very seriously.

You can review the NPRM at the Federal Register. The rule also includes proposals for the adoption of a standard for a unique health plan identifier (HPID), a data element that would serve as an “other entity” identifier (OEID) and a National Provider Identifier (NPI) requirement. Comments are due no later than 5 p.m. on May 17, 2012 and instructions regarding submission can be found on page 22950 of the rule.

To say Florida Woman Care has been an expanding medical practice across the Sunshine State would be an understatement. At the end of 2009, its first year in business, Florida Woman Care had 38 physicians. After its second year, that number grew to 158. The practice now has some 260 physicians and almost 400 total clinical providers on staff, at locations across the state from Pensacola to Miami.

When Florida Woman Care was looking for physician billing services and an EMR that would support its growth goals, the leadership wanted a solution that allowed them to drill down into data, get paid efficiently and avoid running the practice like a patient conveyor belt.

Find out how Florida Woman Care has made the most of athenahealth’s cloud-based services to satisfy these needs.

Do you feel like you’re working harder for less pay? When you were young, did you have dreams of being a noble caregiver, only to spend your days worrying about reimbursements or getting sued or the next cumbersome government regulation? Are your collections late? Did life NOT improve after the local health system acquired your practice?

Okay, forget being in the health care business—we are all patients sometimes, too. Do you feel like an actual human in the exam room or a numbered paper gown with dollars signs attached to it? Has trying to get well ever nearly bankrupted you?

Well, you’re not alone.

This is a tough time to run a medical practice—or be a patient—and we all know that is why, in fact, athenahealth exists. We are here to make it suck less.

For a light-hearted look at your plight—and ours—we have a little video. It’s a parody of a song from the Tony Award-winning musical “Avenue Q.”

Hang on. Things get really great at the 3:29 mark….