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ICD-10 Readiness


It’s January 2014 and ICD-10 implementation is only 10 months away. While some organizations are still asking for another delay, CMS is standing by the October 1 date.

AdvantEdge has been preparing for the ICD-10 transition for the past two-plus years and will continue to focus on ICD-10 before and after the implementation date.

AdvantEdge ICD-10 Project Committee

The AdvantEdge ICD-10 Project Committee, with representatives from Executive Management, Operations, Client Management, HR, IT and Compliance is charged to organize and implement a plan that assures our employees and our clients are ready for the transition to ICD-10. In addition, they are identifying areas of the revenue cycle that will be vulnerable to the effects of the implementation of ICD-10 and developing appropriate counter measures.

Some of the areas being addressed include:

  • How to best help our clients prepare for ICD-10
  • For clients who do their own coding, how to assure proper submission of charge information.
  • How to address incomplete/incorrect clinical information received from clients, including provider response time to our requests, training of physicians to document enough specificity of clinical information, etc.
  • Prior Authorizations – what, if any, additional information will be needed to obtain them
  • Potential impact of coding uncertainties and inaccuracies
  • Decreased coding productivity in the first few months during the learning curve with variation expected by specialty
  • Accounts Receivable – potential of increased denials and delays for utilization and medical necessity reviews and identifying these denials by payer, provider, referring provider, diagnosis

The committee is also reviewing external software that could help clients work through individual project plans for identifying gaps in current documentation (versus the additional documentation needed to apply ICD10 codes).  Further investigation is under way to determine the viability of this versus other approaches.

AdvantEdge Coding

Our coding team has been preparing for ICD-10, using the guidelines of the AAPC (American Academy of Professional Coders) which includes expanded coder training in anatomy and physiology. Our coders are completing the 10-Chapter Anatomy and Physiology module, and have attended various ICD-10 webinars and seminars presented by CMS, AAPC and other experts.

Two of our coders attended the AHIMA (American Health Information Management Association) training sessions in Chicago last November and will soon be certified as trainers in ICD-10.  They will be qualified to hold training sessions for our coders and clients in actual ICD-10 coding, which is generally recommended to start approximately 9 months before the cutover. These sessions will use the final 2014 ICD-10 code version.

All AdvantEdge coders will be required to be certified in ICD-10 coding by December 2014, although many coders will be certified before then.

Computer Assisted Coding

AdvantEdge uses the OPTUMInsight software for computer assisted coding for Radiology and Pathology.  AdvantEdge was selected as one of a handful of beta sites to test the software’s functionality and implementation of ICD-10 codes. Factors being evaluated include design, ease of use and operation of the system, such as:

  • functional issues that could present a compliance risk or negative impact to the client revenue cycle,
  • improvements to the look and feel of the system and
  • suggestions to remediate critical issues in advance of the system’s deployment of dual ICD-9/ICD-10 coding .

Two of these testing sessions are complete with the final session scheduled shortly.  The sessions test both ICD-9 and ICD-10 functionality, so that both coding systems are available for billing, depending on the timing and the payer.

In March and April of 2014, AdvantEdge will continue the beta testing of submitted radiology and pathology reports to ensure that the interactions between our billing system and the OPTUM software work seamlessly.

AdvantEdge Billing Software

Our development team is managing a major project to prepare our applications to process ICD-10 codes—in parallel with ICD-9 codes.  We are currently at Level 1 of the project.  Level 1 includes internal readiness and preparation to initiate testing of the ICD-10 codes in a test or production environment.

The modifications to AdvantEdge’s Virtual Manager and other software to accommodate ICD-10 include:

  • Data Base changes across the enterprise to accommodate a much larger number (68,000 vs. 13,000) of longer codes, formatted differently than ICD-9.
    • Application changes to accommodate ICD-10. Here are a few examples:
    • Our claims filing engine was updated for ICD-10 when ANSI 5010 was implemented last year.
      • Diagnosis code master files have been updated.
      • The PQRS database has been expanded.
      • Fields on system screens have been expanded.
      • Reports have been re-formatted for the longer codes.
    • Dual validation of ICD-9 / ICD-10 based on date of service (before or after October 1, 2014) and type of service, e.g. workers’ compensation or no-fault cases.
    • Additional validation by trading partners (payors) to accommodate both ICD-9/ICD-10.

Claims Filing

We anticipate payor/trading partner testing to begin as soon as payors become ready. AdvantEdge has been ready to test since last fall. AdvantEdge has been selected to partner with Emdeon to test ICD-10 processes since our systems are ready to test earlier than most others. Other payers where AdvantEdge operates direct interfaces will be tested as soon as the payers are ready.