Two revenue cycle management vendors who also operate claims clearinghouses say that the first two weeks of using the ICD-10 codes has been surprisingly smooth.
Remittance advice will start flowing from insurers to providers with increasing frequency soon; it’s too early to say now if denials will soar.
But the initial news is good, says Ken Bradley, vice president of strategic planning and regulatory compliance at Navicure. “The initial events seem to indicate it was not a catastrophic event.” When adequate amounts of remittance advice start coming, “hopefully, data will tell us that payment will be made as expected and it will be correct,” he adds.
Two smaller plans that Navicure submits claims to soon reverted back to ICD-9 after October started when they realized their information systems were not ready for the new code set. But overall, most insurers appear to have been ready and should be credited, Bradley says.
Patrick Hall, executive vice president at e-MDs, concurs. “Actually, it’s been a lot smoother than we thought, frankly.”
In the first week of October, about 30 percent of claims submitted to the clearinghouse were coded in ICD-10 and acceptance rates—meaning the claims were accepted by insurers and not sent back to clearinghouses for correction—were about the same as under ICD-9. Just like with the Y2K fears in 2000, there have been far fewer problems than expected, Hall says, cautioning that volume hasn’t really gone up yet. But in talking with competitors, they see the same trends, he adds.
Hall tends to agree with one competitor, who said he expects that during the first few months, no payer will want to be called out for rejecting claims because of most appropriate code wasn’t used even if it is a code in the appropriate family of codes. So, early on, there are indicators that many insurance companies have a policy of allowance similar to Medicare’s policy to pay claims if the submitted code is in the proper family of codes. “It will be interesting to see what happens in three to six months,” he notes. Medicare will follow its policy for the first year of ICD-10.
Navicure in mid-October is seeing about 60 percent of its normal claims submission volume as providers completed submission of ICD-9 claims for services before October and now ramp up getting their ICD-10 claims out the door. And so far, the rejection rate for submitted claims—sent back by insurers to clearinghouses or providers to fix errors—is relatively low, Bradley says.
The payer rejection rate for Navicure clients was 1.0-1.2 percent before October. Now, the rate is about 2 percent, primarily because some insurer systems are not operating properly, such as incorrectly rejecting ICD-9 claims with dates of service before October but submitted in October.
Importantly, Navicure is making only 1 percent more corrections to provider-submitted claims before submission to payers than it did before October. These corrections generally result because a provider was coding ICD-10 for a date of service before October, or coding ICD-9 for a date of service after October.
Bradley believes payers are doing relatively well under ICD-10 because they had time to learn what in their systems was working and not working during the slow ramp-up to submission of ICD-10 claims. But he and Hall of e-MDs caution that the real measure of smoothness will come when larger volumes of remittance advice start popping up in mailboxes.
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