How long will it take after October 1 for the healthcare industry to have an inking about whether the ICD-10 rollout will be relatively smooth or a mess?
Sigrid Warrender, director of health information management at three-hospital Aria Health in suburban Philadelphia, is looking at November 1 as a good barometer. Providers getting their Medicare claims submitted by October 13 will get paid late in the month and could have enough remittance advice to assess what the trend is, she believes.
For now, Aria Health is wrapping up loose ends before the deadline, such as final testing, putting the ICD-10 systems into production mode, and adding staff to the patient accounts department to work on denials.
The organization will use software from IOD Incorporated, now part of health information management vendor HealthPort, to check coder accuracy and get a score on what they are doing well and doing wrong, so they can prevent coders from falling into bad habits.
While Medicare Part B is the only major insurer to publicly announce it will make some allowances for claims not perfectly coded during the first year of ICD-10—paying the claim if the submitted code is in the appropriate family of codes—Warrender thinks other payers will offer a similar service, but not for an extended period. She sees some leniency coming but only until the payers have sufficient data to understand trends, and then providers could see more concrete denial reasons coming through. She hopes Medicare quickly expands its policy to Part A claims. Still, there will be some insurers denying claims because of unspecified or wrong codes from Day One, and that’s fair game, she warns.
Medicaid could be a different animal, as its actions come in waves, Warrender says. There could be a period where providers are inundated with Medicaid denials, and then the providers won’t hear from Medicaid for months, if not longer.
Because 90 percent of commercial insurers working with Aria Health pay claims based on Diagnosis Related Groups, Warrender doesn’t see unspecified codes as causing a big financial problem for hospitals unless insurers change payment policies. But there still can be adverse reactions for providers, she says. Use of unspecified codes can lower an organization’s scores on mortality rates and other quality indicators, which could affect public perceptions about a provider’s quality, and could affect payments linked to outcomes scores.
But for now, there are new ICD-10 compatible systems to bring online and that’s the immediate worry for Warrender. “My big concern isn’t payment, but if the staff can log on and work on the screens we’ve developed.” The staff initially will have screens supporting ICD-9 and ICD-10, with the ICD-9 screens going away after all claims generated under the old code set have been processed.
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