As the healthcare industry braces for the ICD-10 compliance deadline on October 1, there's a difference of opinion between physicians and business managers as to whether payment delays will occur—a scary prospect for practices that could see their cashflows and revenues hurt by any delays or denials.
Most doctors expect payment delays but in general, their billing and revenue cycle management personnel are far more optimistic.
Doctors were overwhelmingly pessimistic about what lies ahead, according to a survey of participants in a social media network for physicians operated by SERMO, which polled their online community on the ICD-10 transition; the poll was conducted September 24 to 28. That pessimism is despite a one-year Medicare payment accommodation period agreed to by the Centers for Medicare and Medicaid Services and the American Medical Association.
Asked whether there will be delays in payment in coming weeks as a result of the code change, 93 percent of respondents said yes and only 7 percent of those surveyed said no. In addition, when asked whether they believe there still will be delays in payment after the one-year Medicare payment accommodation period is over, 91 percent responded in the affirmative and a mere 9 percent said no.
“One of the reasons there’s so much pessimism is that a lot of doctors feel that ICD-10 is just an added burden,” says Linda Girgis, M.D., practice owner of Girgis Family Medicine in South River, N.J. “Over the last how many years we’ve seen more clean claims being denied by insurance companies, so a lot of us have a mistrust of the insurance companies who might use it as a means to further deny claims from us.”
To prepare for this contingency, a third (33 percent) of the physicians in the SERMO survey indicated that they have taken out a line of credit to protect their practices against the financial impact of ICD-10 payment delays.
However, Joshua Berman, director of business analytics and ICD-10 lead for vendor RelayHealth Financial—a McKesson company—says their firm has conducted similar surveys of providers’ business offices to gauge their opinions but with very different results. According to Berman, only about 8 percent of business and revenue cycle managers said they expect payment delays as a result of ICD-10.
“That’s a huge delta between doctors and those in medical practices responsible for billing,” he observes, noting that the perspective of those staff actually responsible for the business side of practices needs to be separated from those providing patient care. “This is a process change. This is a business change. And, those opinions will definitely be different depending on who you talk to.”
Physician billing supervisors and directors of revenue cycle management are much more upbeat than doctors when it comes to anticipating the potential impacts of ICD-10 on their practices, argues Berman. “It’s not a crack on doctors, but there’s a separation between them and business offices—which is a good thing,” he says.
“In small practices, we don’t have business managers and IT staff. We pretty much have to do everything ourselves, so this is a very big learning curve for us,” laments Girgis. “It’s much different for big medical groups or hospitals compared to doctors who are in private practice.”
As far as taking out a line of credit to prepare for potential delays in payment due to ICD-10, Berman believes it’s a good step to take as a contingency plan and hedge against any unforeseen circumstances. “It’s best to be prepared,” he advises.
“We have our reserve cash for things that go wrong,” says Tim Ledbetter, director of revenue cycle operations at Granger Medical Clinic in West Valley City, Utah. “We started it six months ago and we finalized our line of credit in the last month. The banks wanted to see what our cash revenue has been up to the current date and we had to present our revenue cycle plan in how we are going to approach ICD-10.”
Girgis feels that the biggest problem with the ICD-10 rollout will be unforeseen technology problems. “In order for everything to go smoothly, there has to be compatibility between the practices, clearinghouses, and insurance companies,” she remarks. “So, I think we’re going to see some mapping errors where things don’t get transmitted correctly and there will be some corresponding delays.”
Yet, Berman argues that ultimately what unfolds after October 1 is “a matter of preparation and how you run your business.” Bottom line, he says: “You still have to code a claim correctly to get paid.”
At the same time, Berman does not think delayed ICD-10 payments will be the fault of health insurers. “We tested about 190,000 test claims and we didn’t see any payer problems,” he comments. “Where we saw problems was the ability for providers to properly create claims.”
Girgis adds that “doctors trying to figure out what the insurance companies want” is one of the biggest hurdles to their getting paid on time. She worries that physicians’ claims will be denied by insurers “because the codes are not specific enough for them.”
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