Slideshow 10 Surprises About ICD-10

  • October 28 2015, 10:36pm EDT
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10 Surprises About ICD-10

America’s healthcare industry was on pins and needles as the ICD-10 compliance date came. Were providers and insurers ready? The early answer—at least for now as providers wait for remittance advice—is that there were plenty of glitches but most were quickly resolved. The transition was as smooth as anyone could have hoped. That was the biggest surprise; here are 10 more.

The Implementation Delay Worked

The first two weeks of the ICD-10 transition were all about providers making sure they could select the right codes from the right information systems, submit claims to insurers and avoid large-scale rejections. Stanley Nachimson, a long-time official at CMS and now a consultant at Nachimson Advisors, gives a lot of credit for the ease of the transition to the compliance date being extended twice in two years. That gave providers and insurers the time they needed, and most used the time well. (Photo: Fotolia)

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Vendors, Medicaid Agencies Were Ready

Vendors also did a nice job getting ready overall. And apparently, so have most Medicaid agencies, Nachimson says. CMS started working with Medicaid programs about five years ago, showing them how to implement ICD-10, and that advance work looks like it paid off. (Photo: Fotolia)

One Happy Doctor

Linda Girgis, M.D., practicing at two-physician Girgis Family Medicine in South River, N.J., worried that insurers would lower reimbursements under ICD-10 “simply because they can do it.” Surprisingly, when a few hundred remittance advices started coming back to the practice, there was no immediate financial crisis, at least based on early returns. “Remittance looks good; everything has gone as it should,” she says. (Photo: Fotolia)

Claims Appear to be Clean

Patrick Hall, executive vice president at physician software vendor and clearinghouse e-MDs, says that, 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 or providers for corrections—were about the same as under ICD-9. Hall talked to several competitors, and they saw the same trend. (Photo: Fotolia)

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Rejection Rates Stay Low

The payer rejection rate for clients of claims clearinghouse Navicure was 1 to 1.2 percent before October. By mid-October, the rate was only about 2 percent, primarily because some insurer systems were not operating properly; for example, some were incorrectly rejecting claims with ICD-9 codes, for claims with dates of service before October 1 but submitted in October. (Photo: Fotolia)

Coding Corrections are Under Control

Surprisingly, Navicure in mid-October was making only 1 percent more corrections to provider-submitted claims (before they were submitted to payers) than it did before October. The corrections Navicure was making generally were because providers sometimes used ICD-10 codes for services that were rendered before October 1, or used ICD-9 codes for services provided after October 1. (Photo: Fotolia)

Only Minor Repairs Needed for Most Glitches

As the third week of ICD-10 arrived, clearinghouse RelayHealth had processed 13 million ICD-10 claims. The metric “days to final bill,” which is how long it takes from patient discharge to a bill going out the door, didn’t go up at all, says Joshua Berman, ICD-10 lead. While it’s still early, rejection rates have remained stable, and while some payers were rejecting claims incorrectly, “we called them, and it was fixed within the hour,” he adds. (Photo: Fotolia)

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Accepting Advice Helped

One surprising trend that payer software and clearinghouse vendor TriZetto Provider Solutions has seen is that when vendors or others give providers some ICD-10 guidance, those providers adopt it and improve their ability to use the new code set, says Paul Kaiser, senior vice president. (Photo: Fotolia)

Vendor Bearing Gifts

GE Healthcare has a pleasant surprise for clients. The vendor has built pattern recognition software to analyze how insurers are reimbursing for medical services under ICD-10. The new analytics platform looks for reasons for denials and correlations of the reasons to find patterns that establish root causes for denials.

These denials, says senior vice president Jon Zimmerman, could be just the normal course of business where there is an error in the submitted claim, or providers could be experiencing “integrity denials” under which a claim is denied payment when it should not be, or providers are not being paid to the level they expected. (Photo: Fotolia)

Is a Big Surprise Coming for Consultants?

Consulting firms made a lot of money off ICD-10 and may be in for a big surprise. Consultant Mitch Work, CEO at The Work Group, will be looking for a particular trend in the consulting business if ICD-10 remains smooth. “Right after Y2K, many consulting firms went into a fairly prolonged slump as hospitals realized they had spent a lot on consulting fees for Y2K, not all of which may have been necessary. It will be interesting to see if history repeats post ICD-10 implementation.” (Photo: Fotolia)