Almost two weeks have passed since the ICD-10 mandate took effect and early results from major health insurers Humana and UnitedHealthcare are very encouraging.
Executives from both payers told the Medical Group Management Association’s 2015 conference in Nashville on Monday that they believe the code switchover is going well based on their initial data.
“It’s been a pretty smooth transition, certainly exceeding—I think—everyone’s anticipation upfront,” Sidney Hebert, Humana’s vice president of provider network operations, told an ICD-10 town hall meeting at MGMA15. “Everything has proceeded the way it should. So far, that’s what we’re seeing. That’s not to say it will continue that way. But, I think we have enough data under our belt that says we’re not going to have major catastrophic issues.”
Hebert announced that a mere 0.3 percent of ICD-10 submitted claims have been rejected. “That means almost everyone who’s submitting claims is getting it right,” he said. Further, Hebert asserted that the turnaround time for ICD-10 claims is “pretty much within our normal turnaround times.”
On average, more than 50 percent of in-bound claims submitted to Humana in recent days have been ICD-10 claims, according to Hebert. In addition, he said that the bulk of the payer’s authorizations have the new code set.
Hebert revealed that only 3 percent of Humana’s normal call volume into its call center has been associated with ICD-10 questions. “It’s pretty astonishing to me that there would be that low level of inquiries,” he commented.
To monitor transactions in real time between providers and Humana, Hebert said the payer created an ICD-10 command center about a year ago. The center is performing “hands-on monitoring” on a daily basis that will continue until the end of the year, he said, which will be followed by “hands-off monitoring” starting in 2016 in what he called a “post-implementation” phase. However, Hebert added that Humana will maintain its ICD-10 monitoring program for as long as necessary.
“There have been no critical internal issues,” he exclaimed. “The few issues we had were easily resolved. We do keep a running daily tab and meet twice a day to review any issues. I think we’ve had a total of three.”
According to Hebert, Humana on average processes more than half a million claims each day. “If we had just a small degradation in our ability to process those claims, the cost to the company would be impactful as well as high impact to the providers who are waiting for payments,” he added.
Ross Lippincott, vice president of provider regulatory programs at UnitedHealthcare, gave a similarly positive report on his company’s experience so far with ICD-10. As of Oct. 9, Lippincott said the health insurer has successfully processed more than 2 million ICD-10 claims, though he hastened to add that there has been a “slight uptick in our rejection rates.”
Like Humana, he remarked that UnitedHealthcare’s call center volumes have been “very stable, very normal.” Lippincott said that UnitedHealthcare also established an ICD-10 command center which he described as “critical to being able to react quickly to issues that providers encounter” but “surprisingly very limited need for that to date.” He also credited the payer’s internal ICD-10 “early warning system” for enabling the company to be “proactive” in identifying issues before they become problems.
Health insurance companies have collectively spent more than $1 billion to prepare for the transition to ICD-10, according to Humana’s Hebert, who called it a substantial investment that is paying off.
Likewise, from MGMA’s perspective, the ICD-10 transition is going well. Robert Tennant, director of health IT at MGMA, reported that “generally things are moving very, very smoothly” based on what the association is hearing from physician practices in online communities.
“People are pretty confident that claims are moving through—at least on the front end of the process—understanding that it’s still fairly early in the game,” Tennant said. “But, I think if there were massive software issues or large health plans that weren’t ready we would have found that out by now.”
However, not everyone provided MGMA with a rosy picture of the ICD-10 transition. In a separate presentation in the MGMA15 exhibit hall, Pete Bekas, sales engineer for clearinghouse TriZetto Provider Solutions, said that “within the last 12 days we’ve already seen nearly 10,000 denials as a result of ICD-10.”
Bekas added that he anticipates the claim denial rate will increase 200 percent as the healthcare industry continues to transition to the new code set. According to the company, TriZetto works with more than 350 health plans “touching” more than half the U.S. insured population and reach more than 250,000 providers.
Emdeon, a revenue/payment cycle management vendor that processes more than 8 billion healthcare transactions annually, said it is not aware of any payer that is technically incapable of receiving ICD-10 claims.
Moreover, Mike Denison, Emdeon’s senior director and ICD-10 program manager, told MGMA’s ICD-10 town hall meeting that based on his company’s data “99.5 percent of the claims that should be coded ICD-10 are in fact coded ICD-10.” Though Denison acknowledged there was an “increase in baseline clearinghouse rejections” after the Oct. 1 compliance date, he said it was “not significant.” Denison’s summation of the code switchover is “so far so good” and he remains “cautiously optimistic” that providers will continue to be successful in submitting ICD-10 claims.
“We’re now at the point where we actually can move information back and forth between providers and payers,” concluded Hebert of Humana, who said the ICD-10 initial launch is “progressing nicely.” But, he cautioned that “we’re only at the beginning of this journey and there’s much work before we can safely say we are done.”
Similarly, Lippincott of UnitedHealthcare added that “while everyone’s pleased with the results to date, we’re definitely not dancing in the end zone yet by any means because we know there’s still quite a ways to go.”
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