Insurers prepare for ICD-10 by Liz Carmack
T
exas’ major medical insurers and the Medicaid and Medicare pro- grams are preparing for the feder-
ally mandated change from Internation- al Statistical Classification of Diseases and Related Health Problems (ICD)-9 to ICD-10. Payers say improved claim adju- dication, more accurate payments, and fewer rejected claims should result from the new coding system’s increased level of specificity. Most every insurer has developed
resources to help health care providers prepare for the transition and meet the Oct. 1, 2013, deadline. (In November, the American Medical Association ad- opted a Texas Medical Association reso- lution directing AMA to ask CMS to stop implementation of ICD-10.) In 2009, Blue Cross and Blue Shield
of Texas (BCBSTX) took its first steps toward ICD-10 implementation by com- pleting a management impact assess- ment. Today, the company is on sched- ule with internal development and test- ing, says Margaret Jarvis, BCBSTX senior manager of media and public relations. “We expect to be testing with vendors
and trading partners by the fourth quar- ter of 2012 to ensure we meet the Oct. 1, 2013, mandate,” Ms. Jarvis said. According to Ms. Jarvis, BCBSTX
plans to run parallel ICD-9 and ICD- 10 processing systems for two to four years after the deadline because “we could potentially have ICD-9 claims that were filed before the deadline and re- quire adjustments,” she said. However, she emphasizes that on or after Oct. 1, 2013, BCBSTX will accept only claims in ICD-10 format for outpatient services.
34 TEXAS MEDICINE February 2012
That also applies to claims for patients discharged from the hospital on or after Oct. 1, 2013. By law, insurers must require ICD-10 diagnosis and procedure codes on all inpatient claims for discharge dates on or after Oct. 1, 2013, and ICD-10 diag- nosis codes on all professional and out- patient claims made as of Oct. 1, 2013. The change will not affect physicians who use other codes, such as Current Procedural Terminology (CPT), Health- care Common Procedural Coding System (HCPCS), and Revenue Codes, Ms. Jar- vis says. To help providers get accustomed to
the new codes, BCBSTX has commit- ted to reviewing and analyzing a year’s worth of ICD-9 claims for its clients with an eye toward ICD-10 transition. “We will identify the primary ICD-9
diagnosis codes those providers used during that period, and BCBSTX cod- ers will work with providers to translate them into ICD-10, validating results and sharing information with the provid- ers to ultimately automate the process,” Ms. Jarvis said. “We need to work with providers because, unless we have accu- rate diagnosis codes that are consistent with procedure codes [CPT], it will af- fect claims processing and possibly cause delays.” CIGNA has spent the past couple of
years assessing ICD-10’s impact and pre- paring for the implementation. “We have a thorough and comprehen-
sive approach to implementation, and we will be ready when the compliance date arrives,” said Gwyn Dilday, senior director of public relations at CIGNA.
“This also includes working with clear- inghouses for a smooth transition.” The company’s efforts include collab-
orations with other stakeholders, such as the Healthcare Information Manage- ment Systems Society, the Workgroup for Electronic Data Interchange, AMA, and the Centers for Medicare & Medicaid Services (CMS). Ms. Dilday said CIGNA’s actions in
2010 focused on the overall planning and analysis of ICD-10’s impact. The company completed high-level system application and business resource esti- mates. Assessments included reviewing primary operational functions, such as medical management, claim processing, and customer service for customers and health care professionals. In 2011, CIGNA reviewed its remain-
ing functions — including sales, under- writing, analytics, and reporting — to assess ICD-10’s impact on those areas. Ms. Dilday said that during the sec-
ond half of 2011, CIGNA finalized its project planning and began preparations for project delivery in 2012. She said a multiyear ICD-10 training program for CIGNA staff is also in progress. Humana is pulling together its plan
by assessing in-house changes needed for ICD-10 compliance, says Louis Ho- chheiser, MD, Humana’s medical director for clinical policy development. “It’s a massive undertaking,” he ad- mitted. “It not only affects the claims system, but there’s also a tremendous amount of information technology work [needed] to meet the new requirements.” As is the case with other insurers, the switch will affect the company’s prod-
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