In early July, the Centers for Medicare and Medicaid Services struck a deal with the American Medical Association in which CMS agreed to a one-year Medicare payment accommodation period after the ICD-10 October 1 compliance date in which claims incorrectly coded would be paid as long as they are coded in the appropriate family of codes.
This was a big step as CMS expects ICD-10 compliance yet won’t demand perfect coding. But, what about state Medicaid agencies and private insurance companies? Where are their accommodations for providers? So far, there have been no big announcements.
Health Data Management contacted seven national insurers, the Blue Cross and Blue Shield Association and America’s Health Insurance Plans for information on their contingency plans for commercial insurance services (non-Medicare). Only Humana, Aetna and AHIP responded and none addressed the core question of accommodations for commercial insurance claims.
But don’t fret, says Pat Kennedy, president of PJ Consulting Inc., which specializes in electronic data interchange and insurers. Commercial insurers are not broadcasting but often are offering some concessions. It simply is not in insurers’ best interests for providers to have cash flow problems, and Kennedy believes at least large payers will bend over backwards to be accommodating for at least six months.
While insurers generally have made arrangements with their larger providers, they aren’t making general industry announcements yet because they want to keep the pressure on providers and vendors to be ready, Kennedy says. The same thing has happened each time the HIPAA transaction standards have been updated—at some point there is no further delay, no formal contingency plan, “but they do make allowances.”
In four weeks, Kennedy expects payer announcements of reassurance. Providers are going to make mistakes when the deadline hits, but insurers know that they also will make mistakes and many will have extra staff to smooth things out, but there will be some suffering by everyone.
Not all providers will be happy, particularly those who have done little or nothing to get ready for ICD-10, Kennedy warns. Providers who have shown a concerted effort will get help, but he’s not sure payers will help those who haven’t done anything.
The help coming from smaller regional payers, however, may not be sufficient as they don’t have the resources of the big boys. Providers with small percentages of claims going to regional insurers, maybe 5 percent or so, could see payment interruptions.
Physician practice management companies also face limitations. The top 25-30 practice management vendors covering about 90 percent of physicians have been busy working with clients. But some small PPMs are not ready and are hoping claims clearinghouses will solve their problems, so some practices “could be in for a rough ride,” Kennedy says.
The bottom line: Get ready for some pain regardless of how ready and how big you are, he warns. There have been a lot of revenue cycle changes over the years, but ICD-10 is so much bigger and more difficult to get ready for. “This is a tough one, tougher than anything we’ve ever had to do, and the payers and vendors know that.”
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