Testing Helps Providers Gain Confidence in Preparation for ICD-10 Transition and Identifies Additional Areas for Testing in 2015
ZirMed, the premier cloud-based enterprise financial and clinical performance solution for healthcare, recently announced results from its latest ICD-10 end-to-end testing efforts. After surveying its clients, ZirMed found overall that those who have started testing have gained confidence in their ICD-10 coding strategy and found additional areas for testing in 2015.
End-to-end testing helps providers prepare for the impending transition from ICD-9 to ICD-10 by allowing them to receive remittance advice from payers on submitted ICD-10 codes. Testing ensures ICD-10 compliance internally and externally and helps providers anticipate denials and payment impact.
One ZirMed client who has benefitted from testing is Floyd Memorial Cancer Center of Indiana. “From our perspective, testing was a great exercise because we were able to identify our errors and make the adjustments that needed to be made,” said Jacqueline Chenault, Coder and Biller at Floyd Memorial Cancer Center. “Our first round of testing revealed some issues, but ZirMed helped walk us through the process so that we were able to get the claims accepted and adjudicated the second time around. We’re looking forward to more end-to-end testing opportunities so that we can fine tune our processes.”
Wisconsin-based ThedaCare, began proactive outreach with its top payers and engaged with ZirMed early in the testing process. “To date, our results have increased our confidence for a successful transition and also incentivized us to continue testing with additional payers and third party administrators,” said Beth Malchetske, Director, Business Integration and ICD-10 program owner at ThedaCare. “We’ve leveraged our learning in this process to drive the metrics we plan to put in place from an enterprise perspective prior to the transition. It is a critical strategy to assure that the organization is not negatively impacted by the transition, whether it be with information flow, claims formatting, or payment of services. Early warning signs in the revenue cycle will be key to mitigation.”
As ZirMed engages in testing with payers, the company has identified front-end edits to enable miscoded claims to be rejected first by ZirMed. This gives the provider time to correct the claim before it ever reaches the payer, to save time and ensure optimal reimbursement. ZirMed is also in the process of writing rejection messages that will provide an easy-to-understand explanation to fix each rejection.
“Once providers have a round of ICD-10 testing under their belt, they realize that ICD-10 is not as horrific as they thought it would be,” said Betty Gomez, director of regulatory strategy, ZirMed. “One client, for example, submitted 1,070 claims and received a 97 percent pass rate on all of the remits they received. Currently, the biggest challenge facing providers seems to be the lack of payers offering ICD-10 testing, limiting providers’ options for testing opportunities.”
ZirMed began its end-to-end testing efforts with commercial payers like Blue Cross Blue Shield of Florida back in April 2014, and continued testing throughout 2014, with several government and commercial payers. ZirMed gives 24/7 access to a self-serve test area which allows its clients to review and correct any ZirMed and payer rejections before the files are sent to the payer for testing. ZirMed also offers ICD-10 educational tools to its clients including:
- The ICD Translator, which helps providers understand changes from ICD-9 to ICD-10
- A diagnostic usage report that shows each organization a list of its most commonly used diagnosis codes, sorted by volume and frequency
- A payer dashboard that sorts each organization’s top payers by volume and helps clients identify which payers are offering ICD-10 testing To learn more about ZirMed’s comprehensive ICD-10 strategy and end-to-end testing efforts, please visit the company’s ICD-10 Resource Center.
Founded in 1999, ZirMed is the nation’s only company delivering proven cloud-based financial and clinical performance management solutions to meet the challenges of optimizing fee-for-service and fee-for-value reimbursements. ZirMed combines innovative software development with the industry’s most advanced transactional network and analytics platform to improve the business and process of healthcare, give organizations a clearer view of their financial and operational performance, and streamline critical connections between providers, patients, and payers. ZirMed’s industry-leading technology and client support have been recognized with awards from KLAS, Healthcare Informatics, Best of SaaS Showplace (BoSS), and Black Book Rankings. Our nationwide network facilitates, manages, and analyzes billions of healthcare transactions, driving bottom-line performance with population health management, clinical communications, comprehensive analytics, eligibility, claims management, coding compliance, reimbursement management, and patient payment services including credit card processing, online payments, statements, estimation, and payment plan management. For more information , visit www.ZirMed.com.