ICD-10 FAQ

Does the one-year delay affect your planning?

No. We are moving forward as planned with our ICD-10 program work. This includes remediation of our impacted systems and vendor tools, affected business processes, and policies. We plan to be fully ready to process ICD-10 claims by October 1, 2014.

What is your approach to testing? Will you conduct testing with providers?

Large-scale internal testing of ICD-10 will start during the first half of 2013. Targeted external testing will follow later that year. Testing will continue into 2014.

We will contact you directly if we plan to test with you. We select testing partners based on several factors. One factor is ICD-10's effect on the contract's reimbursement methodology. Contact your clearinghouse partners to initiate test planning in order to ensure readiness.

What is Aetna's position on the final rules?

We plan to meet all applicable timeframes for compliance. We will work closely with providers and clearinghouses as they also strive for compliance.

We feel that the more detailed coding is helpful and brings the United States in line with countries that have already adopted ICD-10. The ICD-10 codes allow for more accurate information to accompany a claim. This will allow for more accurate claims payment and coverage decisions.

What is Aetna doing to prepare for the ICD-10 conversion?

Impacted areas are doing business assessments. We are planning for the move from 18,000 ICD-9 codes to more than 140,000 ICD-10 codes. We have a multi-year plan which incorporates system design and development, development of business processes and policies, and communication and training for those affected.

We are also working with the medical community to share information and minimize disruption related to the ICD-10 conversion. We are working across the industry too. We are collaborating with America's Health Insurance Plans (AHIP) to address challenges related to transition and implementation. We will continue to follow CMS direction and look for opportunities to provide input on the ICD-10 conversion.

What should physician practices and facilities do to prepare for the new October 1, 2014 ICD-10 compliance date?

The conversion date of October 1, 2014 may seem far off. However, the complexity of conversion requires immediate and ongoing action to address business and clinical issues associated with the transition. The ICD-10 conversion affects nearly all provider systems and many processes. The largest impacts will likely be on clinical and financial documentation, billing, and coding.

It is critical not to delay planning and preparation. It is important that providers contact their billing or software vendor to understand their plans for conversion and testing.

Will the ICD-10 conversion have an effect on provider reimbursement and contracting?

Possibly. We are evaluating the impact of ICD-10 on our contracting and clinical operations. The ICD-10 conversion is not intended to transform payment or reimbursement. However, it may result in reimbursement methodologies that more accurately reflect patient status and care.

What is Aetna's approach to mapping ICD-9 codes to the ICD-10 codes?

CMS has provided General Equivalency Mappings (GEMs) as an approach to define reasonable alternatives for mappings between ICD-9 and ICD-10 codes in both directions. While the GEMS provide guidance and a starting point for crosswalk development, there is currently no industry standard for mapping. The CMS GEMS is being used by Aetna as a clinical equivalence tool to remediate business rules with ICD-9 codes.

Will Aetna use a crosswalk for claims processing?

No, we will not use a crosswalk for claims processing. Starting on October 1, 2014, standard transactions must be submitted with ICD-10 codes. After that date, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to October 1, 2014.

Will Aetna support dual intake of codes?

We plan to meet all applicable timeframes for compliance. We anticipate that our providers and clearinghouses will do the same. After the compliance date, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to October 1, 2014. We will continue to closely follow the communications from the regulatory authority, and will adapt our approach as permitted.

When will Aetna begin to accept the revised CMS HCFA 1500 paper claim form version 02/12?

Starting January 6, 2014, we will accept the revised CMS HCFA 1500 paper claim form version 02/12. We will continue to accept and process paper claims submitted on the CMS HCFA 1500 paper claim form version 08/05. The revised HCFA 1500 paper claim form version 02/12 supports various coding requirements and prepares for the conversion to ICD-10 diagnosis coding effective October 1, 2014. For more information visit the National Uniform Claim Committee website.

Where can I find more information on ICD-10?

These industry resources will help with your planning and preparation:

• Centers for Medicare & Medicaid Services (CMS)
• Workgroup for Electronic Data Interchange (WEDI)