Major insurers ready for ICD-10 claims processing

By Joanne Finnegan

With the Oct. 1 transition to ICD-10 fast approaching, the question looms about how prepared private health insurance companies are for the change.

To measure that preparedness, the American Academy of Family Physicians (AAFP) recently surveyed four large health plans, all of which said they will be ready by the implementation deadline, AAFP News Now reported.

While the AAFP has been urging physicians to prepare for implementation of the new code sets for outpatient diagnostic coding, the group said it's also important that private payers are ready for the transition so as not to delay payments to physicians.

In February, AAFP sent a list of questions to four health plans--UnitedHealthcare, Aetna, BlueCross BlueShield and Humana--to assess their readiness to process claims using ICD-10 codes. The survey asked questions about their testing processes and contingency plans.

Some of the plans indicated concern that small private practices were not further along in their preparations for ICD-10 implementation, AAFP News Now noted. A BCBS spokesman suggested part of the problem is a lack of preparedness by health IT vendor partners.

Payers are first working with their larger clients, such as hospital systems and large practice groups, before addressing readiness issues with smaller physician practices, according to AAFP's report on the survey results.

All of the health plans have set up ICD-10 pages on their websites to assist physicians in preparing for the new codes. Preparedness efforts centered around health insurers testing their internal products and processes, and moving on to begin external testing with healthcare facilities.

"Payers want this transition to run smoothly, too," Laura Schmidt, an AAFP private sector advocacy strategist who conducted the survey, told AAFP News Now. "They've invested a lot of time and money into the ICD-10 implementation, just as family physicians have. The bottom line is that no business, big or small, involved in this effort can afford a slowdown in its billing and payment processes."

So, what are some of the concerns of health insurers? Humana's top three ICD-10 worries included accurate use of ICD-10 coding for claims submitted after Oct. 1, vendor readiness to support ICD-10 early enough in the process for physicians to prepare for the transition date and physician readiness to use the new codes starting with the deadline, the article noted.

Meanwhile, the Obama administration is considering changes to the medical-loss ratio requirements to help insurers include ICD-10 conversion costs into the MLR calculations.

The U.S. Department of Health and Human services proposed a rule that will ease the Affordable Care Act requirement that insurers spend the majority of all premium dollars on medical care rather than administrative costs, according to a notice in the March 11 Federal Register. Under the proposed rule, the government will extend the period during which issuers may include ICD-10 conversion costs in the MLR numerator.

To learn more:
- read the AAFP News Now article
- read the Federal Register notice  (.pdf)

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