Health IT vendor GE Healthcare has built pattern recognition software to analyze for its clients how insurers are reimbursing providers for medical services under the new ICD-10 codes.
The new analytics platform looks for reasons for denials and correlations of the reasons to find patterns that establish root causes for denials, says Jon Zimmerman, senior vice president and general manager of the clinical business solutions unit of GE Healthcare.
These denials could be just the normal course of business where there is an error in the submitted claim, either in the ICD-10 code or another field. Or, providers could be experiencing “integrity denials,” under which a claim is denied payment when it should not be, or providers are not being paid to the level they expected.
In the first two days after ICD-10 became effective, GE Healthcare was not seeing much ICD-10 traffic, nor should it have, Zimmerman said. Because of the lag time for providers to generate and submit claims, and the two to four weeks until insurers send remittance advice, remittance traffic will increase over time.
Zimmerman expects to see early indications within two weeks and a good bit of information on payment trends within 30 to 45 days. So far, “intake mechanisms,” under which providers are successfully submitting claims appear to be working, “but that’s not where the problems will be,” he adds.
Clients will get a report on their own claims along with visualizations to drill down and find broken processes and their root causes. For example, a provider may find that certain coding errors happen only on Tuesdays and Thursdays, when a specific coder is working with a specific doctor.
The new pattern recognition analysis platform, built with four customers, is in pilot mode now. The first version will be available only to GE Healthcare clients, but the company expects to make it available to all providers sometime in 2016, Zimmerman says.
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