Some of you might remember all of the hype around Y2K. Rumors and speculation were abuzz, and there were people who thought all hell was going to break loose when the clock struck midnight on January 1, 2000. And then—dun, dun, dun—nothing happened.

9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs - Regular Banner9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs - Small Banner

The Hyperbolic Hype

The lead-up to October 1 was similar in many respects, albeit on a much smaller scale. People all over the healthcare community were freaking out about the unknown; some large practices and hospitals even had ICD-10 “war rooms” in place just in case things got really crazy. But most of the folks in those strongholds were relieved of duty by the middle of the day, because by and large, the transition itself didn’t disrupt business as usual in the healthcare world. In fact, many providers and payers are reporting ICD-10 claim-denial rates of only fractions of a percent. Furthermore, many are experiencing close to normal turnaround times for those claims. (As Emdeon reported in a recent email recap, “Overall claim rejection rates continue to remain close to baseline averages,” and “Support call and case load volumes are up slightly, but within forecast.”) Plus, there have been no reports of any payers or clearinghouses that are flat-out incapable of receiving ICD-10 codes.

The Waiting Game

Now, that’s not to say that it’s going to be all sunshine and rainbows from here on out. After all, we won’t truly be able to call the transition a success until we know how things turn out on the payer end. Because while providers seem to be selecting codes and submitting claims without any big problems, there’s no guarantee that they’re picking the right codes or that payers will be able to correctly process and pay those claims.

CMS, for example, won't know for sure how well the transition to ICD-10 is going for a while, because most providers batch their claims and submit them every few days. Then, even after submission, Medicare claims take several days to be processed, and by law, Medicare must wait two weeks before issuing payment. On a similar note, Medicaid claims can take up to 30 days to be submitted and processed by states. The good news is that in the weeks and months leading up to the switch, CMS repeatedly assured the healthcare community that they were totally ready for ICD-10, thanks to extensive testing and re-testing.

Ultimately, we’re still in a waiting period to see how the real impact of the transition will play out. But, we have heard some preliminary news:

  • Many providers reported that some insurance companies’ online portals were unavailable for the first few days post-transition due to updates. This tremendously slowed eligibility checks and mucked up initial visit workflows.
  • Any billers phoning insurance companies during the first few days after the transition just about memorized the hold music, because the wait times were significantly longer.
  • Many clearinghouses are kicking out unspecified codes. But this is a good thing, because providers should not be submitting unspecified codes anyway.
  • While Humana and UnitedHealthcare have focused less on code specificity and more on the relevance of care, no private prayers have publicly embraced CMS’s “grace period.”
  • Physical therapists haven’t been too outspoken about the switch, but physicians definitely have vocalized their discontent. According to Fierce Practice Management, physician practices have reported the conversion has caused delays in care and made accessing payer sites difficult. In fact, a recent SERMO survey found that “86% of physicians say ICD-10 diverts focus from patient care,” reports

The Current State of Affairs

And speaking of payers: the majority are accepting ICD-10 codes just fine. However, there are a handful of payers who were not ready to process claims with ICD-10 codes by October 1, despite being mandated to do so. For example, Medicaid fee-for-service programs in California, Louisiana, Maryland, and Montana still need to receive ICD-9 codes in order to reimburse claims. To work around this issue, those payers are accepting claims with ICD-10 codes, but then crosswalking the codes to ICD-9 in order to calculate reimbursements. It’s a messy solution to say the least, and it could cause delayed and/or inaccurate payments.


While ICD-10 thus far has been akin to the overhyped—and ultimately, uneventful—Y2K milestone, we’re not out of the woods yet. In fact, we’ve officially entered the payment zone. So, as reimbursements start flowing in—hopefully—and billers manage their A/R buckets, make sure you and your staff:

  1. Conduct internal audits of your workflow and systems. Ask: Where is your practice most vulnerable in terms of ICD-10 documentation insufficiencies? What are some of the most important educational opportunities for coders, billers, providers, and administrative staff?
    1. Furthermore, if any of your systems—be it your documentation solution or your billing software—are handling ICD-10 in a way that hinders your ability to treat and get paid, and those systems have not indicated that they’re improving anything, then now is the time to change things up—before your clinic gets comfortable with inefficiencies or workarounds.
  2. Improve communication among all documentation and claims touchpoints. That includes front and back office staff, billers, coders, and/or RCM service reps. You all need to be talking to each other so you can quickly identify any issues and implement appropriate fixes.
  3. Turn your focus on denial prevention, rather than denial management. As you manage denials, you should notice trends. Once you’ve got an idea of the top reasons your ICD-10 claims are getting denied, develop plans to prevent those issues from occurring in the first place. Then, educate your entire staff on those plans so you can successfully implement them.

Was your switch to ICD-10 happily uneventful or woefully hellish? Have you experienced hiccups from payers, clearinghouses, or software? Share your experiences in the comment section below.

  • The Ultimate ICD-10 FAQ: Part Deux Image

    articleSep 24, 2015 | 16 min. read

    The Ultimate ICD-10 FAQ: Part Deux

    Just when we thought we’d gotten every ICD-10 question under the sun, we got, well, more questions. Like, a lot more. But, we take that as a good sign, because like a scrappy reporter trying to get to the bottom of a big story, our audience of blog readers and webinar attendees aren’t afraid to ask the tough questions—which means they’re serious about preparing themselves for the changes ahead. And we’re equally serious about providing them with …

  • FAQ: Physical Therapy Billing Live Q&A Image

    articleAug 30, 2019 | 51 min. read

    FAQ: Physical Therapy Billing Live Q&A

    Earlier this week, Heidi Jannenga, PT, DPT, ATC—WebPT’s Co-Founder and Chief Clinical Officer—and John Wallace, WebPT’s Chief Business Development Officer of Revenue Cycle Management, paired up to answer rehab therapists’ most burning billing questions during a live Q&A-style webinar . And, boy, did we get a lot of great ones. So many, in fact, that we couldn’t possibly get to them all live, so we created this massive post-webinar post (our biggest yet) with the most commonly …

  • Common Questions from Our PT Billing Open Forum Image

    articleAug 18, 2018 | 34 min. read

    Common Questions from Our PT Billing Open Forum

    Last week, WebPT’s trio of billing experts—Dr. Heidi Jannenga, PT, DPT, ATC/L, WebPT President and Co-founder; John Wallace, PT, MS, WebPT Chief Business Development Officer of Revenue Cycle Management; and Dianne Jewell, PT, DPT, PhD, WebPT Director of Clinical Practice, Outcomes, and Education—hosted a live open forum on physical therapy billing . Before the webinar, we challenged registrants to serve up their trickiest PT billing head-scratchers—and boy, did they deliver! We received literally hundreds of questions on …

  • ICD-10 Open Forum Image

    webinarOct 5, 2015

    ICD-10 Open Forum

    On October 1, the US officially said RIP to ICD-9 and brought ICD-10 to life. For some of you, the transition might’ve been all sugar and spice—a real treat. But for many others, the switch to the new code set might’ve left you feeling overwhelmed, tricked, or even a bit scared. At the very least, you might be haunted by some lingering questions. That’s where we can help. We’ve brewed a cauldron filled to the brim with …

  • ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs Image

    webinarSep 2, 2015

    ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs

    It’s officially here: the last month before all HIPAA-eligible professionals must switch to the ICD-10 code set. As the regret of procrastination washes over many of those professionals, they’re scrambling to ready themselves and their practices for the big switch. If you, like so many other rehab therapists, find yourself asking, “ICD-what?” then you’re in dire need of straightforward training—stat! Otherwise, you could leave your practice vulnerable to claim denials after October 1. Join us at 9:00 …

  • Beware of ICD-10 Shortcuts: The Case Against One-to-One Crosswalking Image

    articleFeb 24, 2015 | 7 min. read

    Beware of ICD-10 Shortcuts: The Case Against One-to-One Crosswalking

    ICD-10 is inherently more sophisticated and specific than ICD-9, but that doesn’t necessarily mean it’s more complicated. So, why are healthcare professionals pulling their hair out over the mandatory transition to these new codes? Because learning ICD-10 is like learning a new language. If we were going into this with a clean slate–like a newborn babe—perhaps it wouldn’t be so tough to learn the language. Unfortunately, though, the US healthcare industry has relied on ICD-9 codes for …

  • Founder Letter: Is the ICD-10 Period of Flexibility Your Saving Grace? Image

    articleAug 6, 2015 | 5 min. read

    Founder Letter: Is the ICD-10 Period of Flexibility Your Saving Grace?

    Transitions aren’t always easy. And as the mother of a young daughter, I’m more than familiar with the frustration and tantrums that can come as a result of change. But as professionals in the healthcare industry, we don’t have time for tears or frowny faces—especially when it comes to  ICD-10 . With under two months to go before the big transition, there’s no room for meltdowns; we need to put our heads down and take on the …

  • Your Roadmap to ICD-10 Image

    articleOct 10, 2013 | 5 min. read

    Your Roadmap to ICD-10

    By now you’ve already—hopefully—heard the news about the big ICD-10 transition that’s going down on October 1, 2015. But, if you’re like most US healthcare providers—about 75%, according to this article —you haven’t exactly stuck to the suggested preparatory timelines that CMS released a while back. We get it; you’re busy, and the last thing you have time for is sitting down and mapping out a plan of action for your clinic’s transition to ICD-10. But putting …

  • The PT's Guide to Billing Image

    downloadJun 7, 2016

    The PT's Guide to Billing

    When it comes to physical therapy billing, you have to know your stuff—because even the simplest mistakes can cause denials. Of course, knowing billing backwards and forwards doesn’t have to be complicated. That’s why we created a comprehensive billing resource specifically for PTs. Take the guesswork out of billing. Enter your email address below, and we’ll send your free guide.

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.