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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

ICD-10 Deadline: What to Expect after the Oct 1st Transition

by Elysha Fiabane, senior manager, product innovation

With only a few weeks left until the transition to ICD-10, we’ve heard from a lot of providers asking what to expect come October 1st.  We thought what better way to show that then to breakdown exactly what athenahealth is doing on behalf of clients – we’re all about transparency – and what providers should focus on. And if you’re not on our cloud-based network, use this as a starting point for a conversation with your vendor(s) on what they’re doing to help you – and what you’re expected to do.

For providers, the biggest impact of ICD-10 is during the patient visit. The increased level of documentation required may make it challenging for providers to diagnose in ICD-10.

You Do

  • Evaluate charge capture options in ICD-10 and print Billing Slips for ICD-10 if necessary
  • Update and refine clinical accelerators, such as Order Sets and Encounter Plans
  • Update and refine clinical accelerators, such as Order Sets and Encounter Plans

We Do

  • Provide support for billing slip updates, and specialty specific default billing slips
  • Surface department-specific ICD-10 Cheat Sheets
  • Use SNOMED terms to ensure problem lists are accurate for ICD-10
  • Prompt for ICD-9 or ICD-10 codes and update accelerators based on date of service
  • Partner with Mobile Charge Capture vendors to optimize charge capture with More Disruption Please (MDP) program
  • Provide a customized ICD-10 Readiness Center to serve up all tasks practices need to complete before October 1st.

For staff that generates and bills claims, the impact is in assigning the right ICD-10 codes and ensuring the payer receives them.

You Do

  • Ensure outgoing orders and referrals have ICD-10 codes
  • Work diagnosis code related rejections from payers
  • Continually refine processes and workflows for ICD-10

We Do

  • Monitor outgoing orders and data interfaces to make sure they are sent
  • Enhance SNOMED® based search functionality based on feedback usage across the network
  • Update Rules Engine® daily through root cause analysis on trending denials
  • Down convert ICD-10 codes to ICD-9 codes using a client approved Reimbursement Map if the payer isn’t ready or does not accept ICD-10 claims
  • Update Claim Alarms based on payer trending
  • Confirm payer acknowledgement of claims
  • Maintain Medical Necessity checks in the Rules Engine
  • Review local/network/custom rules to ensure they are firing appropriately

This change impacts payers as well. athenahealth is extensively monitoring payer status, and updating athenaNet in real time. We have a 24/7 Nerve Center in place to monitor payer trends and make sure claims are submitted, acknowledged by the payer, adjudicated, and denials are investigated.

You Do

  • Select the ICD-10 diagnoses based on clinical documentation
  • Check the ICD-10 Resource Center for Known Issues regularly so you know what has already been reported.

We Do

  • Send claims in ICD-10 or ICD-9 based on payer readiness
  • Monitor payer readiness and keep close contact with payer escalation contacts via regular payer calls
  • Map any new rejection codes and confirm what they mean with the payer
  • Monitor denial and payment trends, and respond with updates to the Rules Engine and athenaNet
  • Monitor performance metrics
  • Update quality measures to support ICD-10
  • Update you on ICD-10 Known Issues and resolutions via the ICD-10 Resource Center

athenahealth has been working hard behind the scenes to staff a 24/7 Nerve Center, ahead of the transition, that is extensively planning to monitor payer status and client performance. We’ll be ready, and we’ll be here to support our clients through this unprecedented industry change.

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Cloudview Blog

Ideas, insights and analysis to help physicians, medical groups and health systems stay informed and profitable in today's challenging health environment.

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Submitted by Tabatha - Thursday, October 01, 2015

Do I submit encounters that were before October 1st but billed after October 1st with ICD 9 codes?

Submitted by Michelle - Tuesday, October 06, 2015

Dr. Hardin, Stay tuned to the Resource Hub for an update on this within the next couple of days. - Michelle Mangino, social media manager, athenahealth

Submitted by Mark Hardin M.D. - Monday, October 05, 2015

Why can I not write in the ICD-10 code in the billing box and have it bring up the code? I have to either write in the ICD-9 code or freetext the description to get to and ICD-10 code. This is a time waster. When will this function be available?

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