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

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Preparing for ICD-10 was difficult for two-physician Girgis Family Medicine in South River, N.J., and Linda Girgis, M.D., did not appreciate the lack of preparedness of multiple insurers and its clearinghouse when the compliance date came.

However, what really worried Girgis was how payers would reimburse the practice under ICD-10. She feared that it would receive lower payments “simply because they can do it.”

But now that it's received a few hundred remittance advices from payers in response to those claims coded in ICD-10, Girgis is more positive. “Remittance looks good; everything has gone as it should,” she reports.

However, the productivity of coders remains a work in progress as they continue to improve their selection of the most appropriate codes, and for now, they are working longer hours, Girgis says. But the bottom line is things are getting better.

The relatively smooth transition to ICD-10 has been a pleasant surprise for other healthcare organizations, as well, and appears to be for real. Alester Spears, CEO at Healthcare EDI Partners, an Atlanta-based consultancy, says that across the spectrum of stakeholders he has contacted, rejection levels on claims submitted to clearinghouses or to insurers and returned for corrections haven’t spiked. The final one-year delay to ICD-10 compliance gave the industry more time to prepare.

Some providers are being especially careful with claims submissions, delaying sending them in until problems with ICD-10 codes were worked out.

Everyone Spears has talked to is cautiously optimistic that the current experience will continue, he notes, “but they wonder if the tide has gone out and a big tidal wave is coming.” However, by this time, about the only wave that could come would be a wave of payment denials or lower reimbursements as the volume of remittance advice builds, and a better picture develops.

Also See: For One Small Family Practice, a Rocky Start to ICD-10

Payer electronic data interchange consultant Pat Kennedy of PJ Consulting has talked with a lot of insurers and they report that ICD-10 is going better than expected. There have been some minor issues, but they have been small and haven’t delayed payment by more than a few days.

“Payers are feeling good, but, volume of claims is down, maybe 10 percent or so, so the payers figure that some providers have had a delay in getting out the claims,” Kennedy says. Reasons for delay could be confusion about how to code or because providers were getting a higher than normal error rates with their own internal claims editing system.

Joshua Berman, ICD-10 lead at revenue cycle firm RelayHealth, which has processed about 13 million ICD-10 claims so far, says the metric “days to final bill,” which is how long it takes from patient discharge to a bill going out the door, hasn’t gone up at all. While still early, he’s also seeing rejection rates stable. A few payers were rejecting claims incorrectly, “but we called them, and it was fixed within the hour,” he says.

Overall, the industry appears to have cleared a huge first hurdle, Berman believes, but how well it handles remittance advices will be the next challenge. While early remittance looks good with no spike in payment denials and reasonable reimbursements, the industry may not know before Thanksgiving how remittance trends will continue.

Berman says a few insurers are making allowances when adjudicating claims, following a policy direction similar to that of Medicare, which is paying claims if they are submitted in ICD-10 code, even if they are not correct as long as they are in the most appropriate family of codes. However, most payers say they aren’t being this lenient, but still most claims appear to be going through.

EDI veteran Margret Amatayakul, president of Margret\A Consulting, suspects providers will need to go through a whole billing cycle before the picture becomes clearer. She also says small providers still will have issues for some time, but clearinghouses for now are “managing” the transition with mapping tools, so as long as this transition period continues, small providers should continue to experience ICD-10 success.

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