US Healthcare Industry after the 45 Days of ICD-10 Implementation

ICD-10 replaced the decade old 9th edition on 1st October 2015. Even though claims are bouncing back from insurers due to unspecified codes and errors, the new coding system hasn’t created a widespread problem as expected.

• According to California Medical Association, providers in California reported very few problems with the ICD-10 transition. Only a minimal number of denials related to coding errors were reported
• According to Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians (AAFP), before ICD-10 implementation, physicians were worried about increased paperwork; however, it is being reported that physicians are taking only an extra two to three minutes for paperwork, per patient
• According to the CMS, between 1st October and 27th October, percentage of Medicare claims rejected due to incomplete information remained unchanged from the historical baseline of 2%
• According to a survey by Black Book in September 2015, almost 93% hospitals with more than 175 beds that outsourced their CAC and CDI for more than 9 months gained more than $1 million in proper reimbursement

Not just California but other states in the US have also had a smooth transition into ICD-10. Claims are being rejected by insurers due to lack of vital information or because a certain condition was listed as unspecified; however, the problem has not been catastrophic.

Other than some minor hiccups, physician practices across the country are submitting claims successfully and new codes are getting reimbursed by third party payers as of now. Even though ICD-10 hasn’t wreaked havoc on practices and their cash flow, more of the impact might be visible in a few more months.

Factors that Contributed to a Good Start for ICD-10

According to the industry experts, this positive trend can be attributed in part to Medicare’s decision to not deny claims based solely on code specificity for the first 12 months of the rollout. Medicare had specified that claims will not be denied as long as physicians will be choosing a valid code from the right family or category for a condition.

A good number of private health insurers have also followed Medicare’s lead as far as coding flexibility is concerned. This has helped physicians save their revenue cycle from cash flow disruptions as insurers are not being very strict.

Another factor that contributed to the good start for ICD-10 has been the willingness of clearinghouses, payers, software vendors and other concerned parties in fixing ICD-10 problems quickly and efficiently.

Outsourced ICD-10 Coding Trend on the Rise

The US healthcare industry is yet to see the true impact of this coding shift. Insurers have promised to get stricter in future and providers who don’t want to take the risk are outsourcing their coding needs to a third party such MedicalBillersandCoders.com. MBC’s ICD-10 trained coders are helping providers reduce claim denials and obtain maximum revenue for rendered services without having to worry about lack of code specificity or cash flow disruptions.

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Published By - Medical Billers and Coders
Published Date - Nov-20-2015 Back