Practice Management Alert

Question: We’ve gotten a lot of guidance on how Medicare wants us to prepare for ICD-10. Has there been any guidance from private insurers on the ICD-10 transition? I would like to round out our practice’s training by including some tips from private insurers.

New York Subscriber

Answer: You should check with some of your private payers ahead of the official October 1 ICD-10 implementation, as their policies on the ICD-10 transition might differ slightly from Medicare’s.

Private insurers might also focus on different areas from Medicare when it comes to ICD-10 training.

Since you’re working in the Northeast, consider this guidance on ICD-10 from Aetna Health, which has a heavy presence in the Tri-State area (New York, New Jersey, and parts of Connecticut):

Training: “Clinicians and billing staff should receive documentation training and coding training, respectively, and other staff should have ICD-10 overview training,” Aetna states. The insurer recommends looking into local specialty societies and training vendors that offer specialty-specific ICD-10 training. These training sessions can be done online or in person, depending on the program, Aetna reports.

Also, Aetna recommends you get in touch with your electronic health record (EHR) software vendors; many of them are partnering with training vendors to offer ICD-10 training tools.

ICD-9 availability: Aetna warns providers that all payers might not be ready for the ICD-10 switch. If this occurs, you’ll have to be able to adjust your diagnosis coding on the fly.

“In cases where a payer is not ready [for ICD-10 on Oct. 1], … you may need to submit a subset of your claims in ICD-9,” Aetna states.

To make sure you are ready for ICD-9 and ICD-10, Aetna recommends that your software vendor make ICD-9 codes available after the transition date.

“But to make the transition easier for your practice, you should be able to operate and code diagnoses in ICD-10, with your vendor converting claims to ICD-9 on your behalf for any payers not accepting ICD-10,” Aetna reports.