Delays in ICD-10 Made Transition Easier, CMS Vet Says

The first two weeks of the ICD-10 transition were all about providers making sure they could select the right codes from the right information systems, submit claims to insurers and avoid large-scale claims rejections.

“In large part, we have seen that,” says Stanley Nachimson, a long-time official at the Centers for Medicare and Medicaid Services and now a consultant at Nachimson Advisors.

Overall, the front-end of the reimbursement process—getting the claims accepted, has gone quite well, as has the back-end of payers being able to adjudicate. Nachimson gives a great deal of credit for the relative smoothness of ICD-10 to the compliance date being extended twice in two years. That gave providers and insurers the time they needed, and most used the time well.

Insurers did a good job with end-to-end testing, finding problems and fixing them, he says. And, they worked hard at building new payment tables to ensure reimbursement would be about the same. Very early results from remittance advice show that payments generally are in the ballpark of what providers expected.

Vendors did a nice job getting ready overall, so apparently have Medicaid agencies, Nachimson says. CMS started working with Medicaid programs about five years ago to show them how to implement ICD-10 and the work looks like it paid off.

Also See: Can ICD-10 be This Smooth or Has Reality Not Struck?

But, like many other stakeholders, Nachimson is waiting on the first major wave of remittance advice back from Medicare and other payers. Hospitals generally take longer than ambulatory providers to submit claims to insurers, so the industry hasn’t seen a sizable number of hospital claims yet.

“We also need to see the range of codes being submitted,” Nachimson notes. “Long term, we need to see trends in payment adjustments and whether they are about the same, higher or lower.” That will take three to six months, he believes. When the dust settles, it will be time to start using the specificity of ICD-10 codes to support efforts to increase the quality of care, he adds.

Consultant Mitch Work, CEO at The Work Group, will be looking for a particular trend in the consulting business if ICD-10 remains smooth. “Right after Y2K, many consulting firms went into a fairly prolonged slump as hospitals realized that they had spent a lot on consulting fixes for Y2K, not all of which may have been necessary,” he says. “It will be interesting to see if history repeats post ICD-10 implementation.”