How Health Plans are Moving Forward with ICD-10

by: Jonnie Massey, CPC, CPC-P, CPC-I, CPMA

Houston, we have a plan!

As a coder who also works for a health plan, I was like everyone else, sure that there was no delay in the implementation of ICD-10 beyond 2014. I admit I had to catch my breath after learning we would implement ICD-10 in 2015. It took just a minute, though. Not only are we ready, but now we can partner, mentor, teach, test, train, implement, and just plain do the right thing to ensure that our business partners are ready beyond our initial readiness plan.

I contacted my network of coders at various health plans and asked for feedback on how they felt about the 2015 date. The overwhelming response was that they were ready. The extra time would be beneficial to ensure everyone was ready beyond the initial testing phase.

As a health plan, we have provider outreach. Our ICD-10 page contains updates, timelines, and the transparency of what we are doing as a health plan to ensure we are ready as well as all business partners. I am excited to move into ICD-10. I know as a health plan, we have tested vendors. We have tested our internal systems. We have conducted surveys of our provider community to determine readiness for moving forward.

The Centers for Medicare & Medicaid Services (CMS) provided General Equivalence Mappings (GEMs) that were referenced by our plan as a starting point for assessing and updating systems and procedures to utilize ICD-10 code sets. Clinical equivalence and the intent of medical policies is the primary consideration for individual applications of ICD-10 codes.

Medical policies with ICD-9-CM codes will be remediated with the appropriate ICD-10 codes prior to the compliance date of October 1, 2015.

Our pricing system will be fully remediated to price claims based on the submitted ICD-10 codes and will be configured based on the updated contracts that will contain ICD-10 codes.

We are committed to ensuring that our systems, business processes, policies, and procedures successfully meet implementation standards and deadlines without interrupting day-to-day business practices. We plan to use the additional time for internal and external testing.

We have an extensive ICD-10 Program to manage every aspect of the transition. Our provider outreach team has created a mailbox specifically for ICD-10 related questions and is committed to getting a response within 72 hours. Health plans are here to help in providers’ transition to ICD-10.

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Brad Ericson

Brad Ericson

Publisher at AAPC
Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

About Has 197 Posts

Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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