For One Small Family Practice, a Rocky Start to ICD-10
The early days of ICD-10 were difficult for Girgis Family Medicine in South River, N.J., as the practices payers and claims clearinghouse were not ready on October 1.
The early days of ICD-10 were difficult for Girgis Family Medicine in South River, N.J., as the practice’s payers and claims clearinghouse were not as ready as advertised.
While the situation has improved somewhat, Linda Girgis, M.D., provided a long list of problems the practice encountered as it entered this new era of coding:
* The local Medicare carrier encountered technical difficulties the first two days after the transition and couldn’t accept the new claims.
* Several regional payers couldn’t accept the new claims either for one or two days because they had not completed ICD-10 updates.
* The practice was not able to complete referrals with the local Medicaid HMO—its biggest payer—because the online referral system wasn’t accepting ICD-10 codes.
Also See: GE Healthcare to Analyze ICD-10 Payments for Clients
* The practice’s staff typically encountered wait times of about three hours for phone calls to insurance companies; wait times now remain longer than normal, Girgis says.
* When an insurer answered a call, it took down basic information and questions and said it would call back with information; no immediate help was offered.
* Girgis Family Medicine’s claims clearinghouse was not accepting unspecified codes for Medicare claims, despite a Medicare announcement several months ago that it would offer a more lenient claims processing policy, under which physicians would only have to put in a code from the appropriate coding family during the first year of ICD-10.
Coding specificity at the practice improved as the week went on, Girgis says, but ICD-10 coding is more time-consuming. Girgis doesn’t believe that the new code set will play a large role in increasing quality. The specificity of coding in ICD-10 is more for billing and reimbursement processes than quality. Quality is more likely to be improved as the nation’s healthcare system embraces innovation and new technologies, she believes.
Girgis Family Medicine did not receive any remittance advice during the first week, so the practice does not yet have an indication of whether there will be changes in reimbursement. Girgis’ big fear with ICD-10 is getting lower reimbursement from insurers, “simply because they can do it.”
While the situation has improved somewhat, Linda Girgis, M.D., provided a long list of problems the practice encountered as it entered this new era of coding:
* The local Medicare carrier encountered technical difficulties the first two days after the transition and couldn’t accept the new claims.
* Several regional payers couldn’t accept the new claims either for one or two days because they had not completed ICD-10 updates.
* The practice was not able to complete referrals with the local Medicaid HMO—its biggest payer—because the online referral system wasn’t accepting ICD-10 codes.
Also See: GE Healthcare to Analyze ICD-10 Payments for Clients
* The practice’s staff typically encountered wait times of about three hours for phone calls to insurance companies; wait times now remain longer than normal, Girgis says.
* When an insurer answered a call, it took down basic information and questions and said it would call back with information; no immediate help was offered.
* Girgis Family Medicine’s claims clearinghouse was not accepting unspecified codes for Medicare claims, despite a Medicare announcement several months ago that it would offer a more lenient claims processing policy, under which physicians would only have to put in a code from the appropriate coding family during the first year of ICD-10.
Coding specificity at the practice improved as the week went on, Girgis says, but ICD-10 coding is more time-consuming. Girgis doesn’t believe that the new code set will play a large role in increasing quality. The specificity of coding in ICD-10 is more for billing and reimbursement processes than quality. Quality is more likely to be improved as the nation’s healthcare system embraces innovation and new technologies, she believes.
Girgis Family Medicine did not receive any remittance advice during the first week, so the practice does not yet have an indication of whether there will be changes in reimbursement. Girgis’ big fear with ICD-10 is getting lower reimbursement from insurers, “simply because they can do it.”
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