Leading up to the healthcare industry’s transition to the ICD-10 coding set on Oct. 1, 2015, there seemed to be a collective feeling of uncertainty on the part of providers—particularly physician practices that frequently expressed doubt about their readiness for the shift. What’s more, numerous pieces of legislation were introduced into Congress, several of which advocated a “grace period” where healthcare providers’ ICD-10-based claims submitted to Medicare and Medicaid would not be denied due to coding errors. This led to providers becoming even more leery if the transition would indeed occur on the set date, given that it was delayed three times previously. As such, many organizations were additionally unsure of the impacts that the transition would have on productivity and cash flow.
Despite all this perplexity and trepidation, the implementation deadline was not moved and the industry made it through Oct. 1 sans disaster. At the end of October, the Centers for Medicare & Medicaid Services (CMS) reported that claims have been processing normally since the transition, with 10 percent of claims being rejected and only .09 percent rejected due to invalid ICD-10 codes. However, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed by states.
Now, approximately two months from the transition date, provider organizations have a better idea on where they stand with ICD-10. As such, over the course of the last month, Healthcare Informatics “took the pulse” of multiple providers and consulting firms to measure the impact that the change has had on the industry. For Part 1 of this two-part piece, HCI talked to executives from three consulting companies about what they’re seeing and hearing from their provider clients regarding the transition. Below are excerpts of interviews with: Ed Hock, managing director at Washington, D.C.-based The Advisory Board Company; Ingrid Moyer, senior advisor at Impact Advisors (Naperville, Ill.); and Scott Griffin, vice president, consulting services at Culbert Healthcare Solutions, a Woburn, Mass.-based firm.
What are the main things you are hearing from your clients so far regarding ICD-10?
Hock: First, let’s talk about the obvious—the sky did not fall on Oct. 1. On the IT side of things, it has gone incredibly smoothly with the here-and-there small instances of problems or glitches being quickly fixed. The flow of data within hospitals and to payers has been really successful, most recently denoted by CMS’s percentage of rejected claims being right around historical averages. That’s great news.
Griffin: The many CFOs we deal with are saying the transition was a non-event. There were minor glitches with the systems, and most of the early issues have been IT-related. There was really no way to ultimately test for things such as clean interfaces. You do verifications with the payers and ask them if they are ready, and you kind of have to take them for their word. You can only do so much testing. Those IT fixes have been resolved once Oct. 1 passed, though. There have been really no major issues that we have seen, and we have clients of all shapes and sizes.
Moyer: The implementation has gone well for our client site [the site, unnamed, has six hospitals and approximately 100 physician offices, says Moyer]. We set some different work queues set up since we wanted to monitor the go-live in multiple ways. We had a referrals authorization queue set up. Then there was another queue where we monitored claims that might have gone out with an ICD-9 code to see if those were going through. We found that in some of the areas, Medicare was paying some claims but not others. We found out in one area that there were some FTE [full-time equivalent] issues, and had we not been monitoring this, we wouldn’t be aware of these issues. Overall though, it did feel like a non-event.
Hock: What we are watching—and encouraging providers to watch—are other [things] that are popping up, such as the documentation of those sent claims. Just because we could get paid claims out the door doesn’t necessarily mean that the claim was documented sufficiently as it should have been. We expect that to be a troublesome part of ICD-10. Physician documentation is one of the areas hospitals have been working to prepare for most. It’s still too early to see the impact of that, but we have seen some examples of anecdotal evidence that would be troublesome for some organizations across the country.
What specifically about the documentation piece of this is so troubling?
Hock: Because of increased granularity, ICD-10 requires physicians to be more specific in their documentation so coders can code with the highest degree of accuracy, and so hospitals get paid for that. If that doesn’t happen, either providers won’t get paid like they should be because the true complexity of the procedure was not captured, or the claim will be rejected later in the process. Services could be deemed not-medically-necessary by payers because the full documentation wasn’t there.