Dawn of the ICD-10: Life in the Post-Transition World

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.

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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 RevCycleIntelligence.com.

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.

To-Dos

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.


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