Smooth Rollout For New ICD-10 Medical Codes, Insurers Say

FORBES/ Pharma & Healthcare

OCT 13, 2015 @ 07:55 AM


The launch of tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the billing process has seen few problems in the early days of its launch, large health insurers say.

The news of a smooth rollout thus far comes from Humana HUM +0.52% (HUM) and UnitedHealth Group UNH -0.16% (UNH) despite reports that one in four doctor practices weren’t ready for the October 1 transition to International Classification of Diseases, Tenth Revision, known as “ICD-10.” After two years of delays, medical care providers had to be ready at the beginning of this month for the conversion to 140,000 new codes that they will use in order to bill government and private insurers. The delays to help doctor practices get ready seem to have paid off.

“The extra time has helped,” Robert Tennant, health information technology policy director at the Medical Group Management Association told more than 200 doctors at a panel featuring insurers at the group’s annual meeting in Nashville this week.

Humana (HUM) said calls in the first week into the insurer that were specific to ICD-10 amounted to “only 0.03 % of all calls from providers regarding benefits, claim status, spanning date of service, and authorization.”

Pediatrician Lanre Falusi examines an infant’s ear in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland. Photographer: Andrew Harrer/Bloomberg  Lanre Falusi

“It’s been a pretty smooth transition so far,” Sid Hebert, who heads the ICD-10 implementation team at Humana (HUM) said. “We are about ten days into this and already have 50% of our claims coming in. Almost everyone who is submitting claims is getting it right.”

At UnitedHealth Group (UNH), the nation’s largest health insurer said claims are being paid and call volumes from providers of medical care have been “normal.” Ross Lippincott, vice president of UnitedHealth’s regulatory implementation office, said the insurer has seen only a “slight uptick” in claim denials.

MGMA said there have been a small number of reports that smaller health plans have had issues, but the rollout in these first two weeks has been fairly seamless with the nation’s large insurance carriers. “If there were large health plans not ready, we would’ve found that out by now,” Tennant said.

The conversion to the new medical codes is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The outgoing ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” the Centers for Medicare and Medicaid Services (CMS) has told doctors.

Doctor practices processing claims with government health programs in certain parts of the country may, however, have problems. Four states – California, Louisiana, Maryland and Montana – have confirmed they are not ready for the conversion to ICD-10. In those states, Tennant said Medicaid is going to “crosswalk that claim” and “match it to an ICD-9 code” to alleviate claims issues.

Questions about ICD-10 reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 or [email protected]
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