ICD-10 Fears: Lots of Light, Little Heat

The early reports regarding the October 1 transition to ICD-10 have been remarkably positive. In fact, it’s been the absence of reports that have impressed the experts  – in that respect, the changeover from ICD-9 has been a lot like the “Y2K bug” issue at the turn of the century. There was enough apocalyptic doom-and-gloom in the last couple of years to ensure that most providers and payers were prepared for even the worst-case scenarios.

Now two weeks in, I spoke with Pam Jodock, Senior Director for Health Business Solutions at the Healthcare Information and Management Systems Society (HIMSS), following a review meeting of the HIMSS ICD-10 Task Force. The task force includes providers from both hospitals and practices, as well as payers, consultants and vendors.

“We’ve been pleasantly surprised by how few problems have been reported,” Jodock said, summing up the meeting. “It’s too early to fly the victory flag, but anecdotally, we’ve not seen a spike in claims or pended claims from either CMS or other payers.”

Meanwhile, task force chair Bonnie Sunday, MD, has promised “to monitor for challenges that arise after the October 1 transition date and [to] make education available on mitigation strategies for problems that may be encountered.”

Jodock pointed me to a RelayHealth web site that uses internal data to monitor potential disruptions to claims data. The site is tracking four metrics to measure the impact of the transition: (1) Days to Final Bill, (2) Days to Payment, (3) Denial Rates, and (4) Reimbursement Rate. The data show that all metrics for the first two weeks of ICD-10 are equivalent to, or better than, the three months preceding the transition.

Based on both anecdotes and available claims data, Jodock concludes that organizations which used the time between the final rule’s publication in 2009 and this month’s implementation to prepare have experienced “business as usual.”

Reports from the field support that assessment.

“Many in the press have asked me about the first few days of ICD-10,” John Halamka, CIO at  Beth Israel Deaconess Medical Center in Boston, blogged. “The answer for my institution, like many, is that other than a few small refinements, the impact has been unnoticeable.”

Stacey McIntosh, an HIM Project Manager at Memorial Hermann Health System, echoed those sentiments in her comments to Healthcare Finance News. “We didn't really expect any major issues day one,” she said at the end of the go-live date. “The few items that we experienced today were relatively minor. We expect bigger bumps in the road as we start coding in ICD-10 and send claims off to payers."

But it hasn’t been problem-free. Jodock said some providers with homegrown systems have found the transition challenging. And physicians have reported some glitches which could prove expensive if not addressed.

Writing a blog that appeared in The Medical Practice Insider, Linda Girgis, MD, a family physician in South River, N.J., catalogued a number of “glaring and disruptive” issues she faced in the first week. She worried that commercial payers wouldn’t follow Medicare’s lead on a grace period for accepting unspecified codes as long as they were n the right family. She also said her clearinghouse kicked out all unspecified codes and wouldn’t submit them to payers.

“Some insurance on-line sites were updating and unavailable for the first 2 days,” Girgis wrote, noting that her office couldn’t check eligibility on some patients. “Any patient I saw on the first two days of October who we were unable to verify their insurance was treated for free and [there’s] nothing I can do about it. I know some people will say not to see them without this verification but they were sick. What good is a doctor who doesn't treat sick patients?”

So now that the actual transition date has passed, what’s next? The American Academy of Family Physicians recommends that providers take the following steps to ensure that transition goes as planned:

  • Monitor all claims acknowledgement and acceptance/rejection reports.
  • Promptly correct and resubmit all rejected/denied claims.
  • Evaluate post-implementation cash flow until claims filed with ICD-10 are consistently paid.
  • Evaluate need for contingency activities (e.g., overtime, consultant, credit line).
  • Monitor payer news regarding claims adjudication issues and resolutions.
  • Monitor reimbursement accuracy and timeliness of payer per contract.
  • Conduct coding review for accuracy and compliance.

Do you think that the relative smoothness of the transition and the consistency of claims data over the past two weeks portend an equally smooth reimbursement process?