The transition to ICD-10 has been relatively smooth during the first three weeks for Allegro Pediatrics, with 80 providers at eight sites serving the Bellevue-Redmond region of Washington State. However, that may change now that insurance remittance advice is starting to come in.
Brett Vandenberg, chief financial officer, says ICD-10 so far has been a positive experience. In the early days, coders faced challenges in making sure they were using updated forms and proper codes were on claims going out. The practice was getting regular acknowledgements back from the Gateway claims clearinghouse of TriZetto Provider Solutions and its insurers.
Now, a few thousand initial remittances from the separate Blue Cross and Blue Shield plans in Washington have arrived in recent days and they appear to be properly adjudicated with Allegro Pediatrics getting the reimbursement it expected, Vandenberg says. “I guess I would say I’m optimistic at this point that the claims will go through, at least with the large plans.”
The concern is with smaller regional plans who take longer to send remittance; Vandenberg still worries if they will be ready, based on their historical performance of improperly adjudicating or denying clean claims that were properly submitted.
Also See: ICD-10: So Far, So Good
Vandenberg doesn’t know for certain, but is of the understanding that larger payers are following a policy similar to Medicare in offering “allowances” when adjudicating early ICD-10 claims by paying them if the submitted code is wrong yet in the proper coding family. His concern is what happens in three to six months as allowances fade and insurers start being more stringent with code specificity and start denying more claims for medical necessity chart reviews, particularly injury-related claims.
Another concern is that Vandenberg has not heard of the smaller payers offering allowances on submitted ICD-10 codes; the practice soon will find out as those remittances come in. The problem with smaller payers is that they often outsource the adjudication to companies that don’t have optimal adjudication technology, he adds.
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