More on ICD-10 & Coding

Healthcare providers wait for rude-awakening after ICD-10

It’s tempting to assume the biggest challenges to any major conversion come in the beginning.

Chris Nerney, Contributor

It's far too early to declare with certainty the impact of the ICD-10 transition on healthcare revenue cycles and productivity.

Initial data shows the apocalyptic warnings about ICD-10 immediately leading to claims rejection chaos were misplaced. The Centers for Medicare and Medicaid Services late last month said invalid ICD-10 codes comprised only 0.09% of error-based denials from October 1 (when ICD-10 went into effect) through October 27.

While CMS said it was "pleased to report that claims are processing normally," it's worth keeping in mind that the government agency has taken several temporary steps to smooth the transition to ICD-10 which may be masking problems that could manifest themselves down the road, including a claims denial amnesty for 12 months and advance payments to physicians in the event of processing problems related to ICD-10.

[Also: CMS says 10% ICD-10 claims rejected, but only a fraction due to coding issues]

Private payers also have been going easy regarding coding requirements in the early days of ICD-10, Avery Hurt writes in Physicians Practice. And that, she believes, may be giving providers a "false sense of security" about their ICD-10 processes.

"If you're counting on payers continuing to accept codes that are only 'in the family of codes' or 'just make sense,' and trusting your software to know things that you don't, you are living on borrowed time," Hurt says.

In other words, the fact that CMS and private payers are granting wide latitude to providers who weren't fully prepared for ICD-10 on October 1 may lull hospitals and private practices into believing they're fully up to speed on the new medical and diagnostic coding system, which includes nearly 70,000 codes, or almost five times as many as ICD-9.

[Also: RelayHealth logs $25 billion in ICD-10 claims, though payment issues still not known]

It's tempting to assume the biggest challenges to any major conversion come in the beginning, and that performance improves over time. But in the case of ICD-10, the process may be reversed as the initial leeway granted by CMS and private payers gives way to more stringent coding requirements. That's when the holes in a provider's ICD-10 performance will begin to show, and those holes could lead to a level of claims delays and denials not yet seen in the first months after the transition.

Providers that considered themselves unprepared for ICD-10 as October 1 approached shouldn't assume their currently low claims rejection rates mean their self-assessment was overly pessimistic. If they felt they were unprepared, they probably were. And if they were unprepared for ICD-10 on October 1, they probably still are.

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