After years of postponements and preparations, the vastly expanded coding methodology known as ICD-10 is officially, actively in play for medical practices across the U.S. Like other highly publicized calendar dates (Y2K comes to mind) the October 1, 2015 ICD-10 deployment date came and went without a major glitch, and even the groups most vehemently opposed to ICD-10’s government-mandated implementation have been mostly silent in the weeks since.
Yet as a medical billing company we know that just because the transition has so far gone smoothly doesn’t mean the ICD-10 struggle is over. Medical practices are still experiencing an adjustment period, as billers and coders get familiar with the new code set and doctors and medical practice managers await its impact on their reimbursements.
As the repercussions of ICD-10 begin reverberating through the U.S. healthcare system, here are the top issues we’ll be keeping an eye on. (If you’re worried ICD-10 will take a bite out of your income stream, contact a medical billing service to see how they can help you avoid potential problems.)
- A Spike in Coding Questions
No matter how much time your coders spent practicing ICD-10 coding or poring over the new methodology, there are bound to be more questions plaguing them now than there were before October 1, 2015. The most prominent issue at hand: agreement (or lack thereof). Questions arise when coders onsite are unable to come to a consensus about how to code a particular case. The problem isn’t the codes themselves, or even the breadth or depth of them, but simply the lack of experience coders have with them at present. There’s no ICD-10 expert at any practice yet; even the most experienced coders are newcomers to the methodology, so no coder’s judgment is more proven right than any other’s. The only fixes for that issue may be the simplest: patience and time.
- Potential Payer Mistakes
Advance testing has helped keep the payment impact of ICD-10 mostly at bay for the time being. In an October 30 update, the Centers for Medicare & Medicaid Services (CMS) said that of 4.6 million total claims submitted per day, only 2 percent have been rejected due to incomplete or invalid information – a number that’s on par with historical statistics and expectations.
Some issues have arisen, however. Robert Tennant, health information technology policy director for the Medical Group Management Association, said his physician medical group practice leader membership has been dealing with some “sporadic issues” with Medicare Administrative Contractors (MACs) but not commercial plans. “One problem area has been rejections of claims for screenings, such as a colonoscopy,” Tennant said. “Providers need to put on the claim a non-specific code, since there is no diagnosis, and some of the MACs had issues with those.”
"There have been some hiccups here and there, mostly just with faulty loading of LCDs (local coverage determinations)," said Holly Louie, president elect of the Healthcare Billing and Management Association and chair of its ICD-10 committee. "But they have been very prompt and very responsive in fixing those problems.”
- Practice Productivity Hits
As with any big change, the biggest adjustment is often the adjustment itself – as in, the time it takes for a medical practice to simply adapt to the new reality. Coder productivity between now and the end of the year is the area most likely to be impacted, as many hospitals and health systems reported productivity hits in October 2015.
"Mitigation of productivity drops is critical," said Cassie Milligan, RHIT, CCS, manager of quality improvement at H.I.M. ON CALL. But of course, you can’t mitigate what you don’t understand.
"The first step is to open the lines of communication with coders to better understand the reason for productivity decreases,” Milligan continued. “Is it due to insufficient documentation? Poor EHR navigation? Slow connectivity? Frequent system log-outs? Lack of coder confidence?" Pinpoint the sources of any problems, comb through your reports, and get comfortable with the now-permanent ICD-10 landscape… after years of waiting, the 68,000-code reality is finally here to stay!
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