ucts, policies, and communications to members and providers.
“Humana intends to have its systems set up so that we will be able to con- tinue to pay claims in a quick manner, and there will not be any interruption in claim payment,” Dr. Hochheiser said.
“We’ll be in a position to identify glitches coming from providers and will get that information back to them quickly so that we understand one another. We will have people available to talk to provid- ers to make sure that there are no issues around payment.” UnitedHealthcare formed a team that
is dedicated to ensuring the company is fully compliant with ICD-10 by Oct. 1, 2013, says Kim Whitaker, the company’s director of public relations. “The team has scoped the impact of these changes on our systems and policies for commercial, Medicare, and Medicaid claims processed by all of our health care plans,” she said. “And we are working closely with the provider community to understand the impact of these changes on physician offices and facilities, while working with their vend- ers, such as software systems and clear- inghouses, on how to best facilitate this transaction.” Spokesperson Anjie Coplin said Aetna is implementing ICD-10 changes, as well. “We have engaged the impacted areas of our company in business assessments and are planning for the move from 18,000 ICD-9 codes to 140,000 ICD-10 codes,” she said. “We are developing a three-year roadmap that incorporates remediation of our impacted systems and vendor tools, our affected business processes, and our policies.” Aetna will work with the medical community to share input on the conver- sion process and minimize disruptions related to the ICD-10 conversion, Ms. Coplin says. The payer also is joining a consortium of organizations, such as America’s Health Insurance Plans, to ad- dress ICD-10 transition and implemen- tation challenges. Aetna plans to align itself with the direction given by CMS, Ms. Coplin said.
Meanwhile, on the state level, the Texas Health and Human Services Com-
mission (HHSC) has formed several interdisciplinary workgroups to cover issues regarding ICD-10 policies, pro- vider outreach, and systems migration, says spokeswoman Stephanie Goodman. HHSC is communicating closely with its business partners to ensure that there will be no disruptions to providers or to recipients during the transition. As of last summer, Medicaid and
Medicare programs were in the final stages of compiling an ICD-9/10 busi- ness and technical impact analyses, says Ms. Goodman.
“This will be used to develop an im- plementation plan to ensure compliance with the deadline set by the U.S. Depart- ment of Health and Human Services,” she said. “Texas Medicaid is committed to ensuring a smooth and successful transition. We have a dedicated ICD-10 project team that was established just shortly after the announcement of the final rule on Jan. 16, 2009, and that will continue well past the Oct. 1, 2013, deadline. “We are well connected with major health care workgroups and provider organizations throughout Texas to en- sure that we are continually exchanging information and keeping everyone well- informed,” she said. According to the CMS website, as ear-
ly as 2008, the organization was work- ing with the American Health Informa- tion Management Association to identify and assess the business processes, sys- tems, and operations under CMS’ direct responsibility that potentially would be affected by the ICD-10 transition. In 2009, it began collecting feedback from the health care industry about the code change. Providers can review CMS’ find- ings so far at
www.cms.gov/icd10.
More accuracy, fewer rejections Payers anticipate a number of positive results due to ICD-10’s more extensive coding set. “Two benefits of the new ICD codes
are that they will improve claim adjudi- cation through more precise coding and improve health care payment through improved medical coding accuracy and detail,” said CIGNA’s Ms. Dilday.
Ms. Jarvis of BCBSTX said her orga- nization expects the ICD-10 codes will lead to:
• Accurate payments to providers for new procedures not currently covered by ICD-9 coding;
• Fewer rejected claims, thanks to the more specific and defined code desig- nations;
• Improved patient disease manage- ment; and
• Synchronized disease monitoring and reporting worldwide.
Humana’s Dr. Hochheiser agrees that
claim processing should improve as a re- sult of ICD-10. “When used appropriately by provid- ers and Humana, there will be fewer times when we have to question claims,” he said. “The review process should be much smoother, which should mean that providers’ office staff won’t have to be resubmitting so many claims. We should be able to auto-adjudicate many claims quicker, reducing everybody’s costs.” CMS nurse consultant Rodney Mc-
Donald points out that the ICD-9-CM is simply outdated. “Technology has changed and evolved over 30 years,” he said. “Many of the ICD-9-CM categories are full, and ICD- 9-CM codes may not be descriptive enough.” He adds that the ICD-10 coding sys- tem will be “flexible enough to quickly incorporate emerging diagnoses and procedures and exact enough to identify diagnosis and procedures more precise- ly.” The end result of all this will be en- hanced quality care through better eval- uated medical processes and outcomes.
No grace period Payers stress that physicians should al- ready be working toward implementa- tion of ICD-10.
“The transition to ICD-10 will affect all parts of the health care system,” Ms. Dilday said. “It’s not too soon for hos- pitals and physicians to plan for imple- mentation, working with their clearing- houses, reviewing contracts if they refer to ICD-9 codes, and considering internal
February 2012 TEXAS MEDICINE 35
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