A little more than a year ago, tensions were high as the healthcare industry prepared for the transition from ICD-9 to ICD-10. After all, the threat of delayed—and denied—reimbursements was real. While Medicare committed to a one-year grace period during which it wouldn’t penalize providers for not using the most specific diagnostic codes available—as long as those codes fell into the correct code family—no one knew exactly how private payers were going to process the new codes (not to mention how providers and billers themselves were going to handle using such an enormous code set). Well, it turns out things went pretty well all the way around. Now, that’s something to celebrate. Here are some of the highlights from ICD-10’s first year:
More than 13 million ICD-10 claims were successfully processed in the first month.
According to this RevCycle Intelligence article, RelayHealth Financial reported that it had successfully processed more than 13 million ICD-10 claims—worth more than $25 billion—in the first 19 days of the transition alone. While there were some dips in productivity and a few workflow hiccups—a survey conducted in June by the American Health Information Management Association (AHIMA) found that overall coding productivity decreased by 14% and accuracy decreased by .65% after the transition—most providers reported that the “implementation process went smoother than expected.” This Healthcare Dive article echoes that sentiment. Michael Munger—a family physician with Saint Luke’s Medical Group in Overland Park, Kansas, and president-elect of the American Academy of Family Physicians (AAFP)—said, “The fear that this was really going to impact us financially because of the potential inability to process the new codes really never transpired.” Apparently, the AAFP tracks error rates, and it found that the error rate after the transition was the same as it was for ICD-9: 10%.
However, some EHRs weren’t holding their own.
Some providers did run into challenges with their EHRs. In the above-cited Healthcare Dive article, Richard Bruno—AAFP board member and resident in a joint family and preventative medicine program in Baltimore—said: “The challenge has been with the transition, especially within the medical records system, using the electronic health record and making sure that it’s searchable and that the right codes are associated with the right people, as these are tied to payment.” Munger’s practice actually had to upgrade its EHR recently in order to adapt to the greater level of coding specificity required after October 1, 2016. According to Healthcare Dive, Bruno believes that one of the major issues with the new code set is that it is “still tied to a fee-for-service billing structure that rewards [providers] for getting more detailed in their diagnoses.” He hopes that the move to more value-centric care and payment structures will help the entire process, because these new structures won’t hinge as much on “getting accurate diagnostic codes.”
And causation coding proved difficult.
While the challenges inherent to causation coding aren’t new—they existed in ICD-9 as well—many providers are finding it difficult to get the desired level of specificity in ICD-10 because they simply don’t have the necessary information. According to Barbie Hays—a coding and compliance strategist for the AAFP—“You can code out to it happened in a ranch style home or a split level…and there are some insurance companies that have started wanting that, but most are not.” She goes on to explain that there are opportunities for the Centers for Disease Control and Prevention (CDC)—and the ICD-10 governing committee—to provide additional guidance around the use of causation codes. However, it doesn’t appear to be high on their priority list right now, as they’re still focused on the codes for the injuries and illnesses themselves.
That being said, the AMA agrees that the transition went well overall.
The same Healthcare Dive article also reported that the American Medical Association—the organization that pushed CMS to institute the one-year grace period—believes the transition went well, as there was “no major uptick in Medicare claims rejections.” However, the AMA plans to continue monitoring the process now that the flexibility period has ended—as there’s still the possibility for “potential disruptions and changes that could result when more specific coding is required.”
How did your clinic fare in the transition to ICD-10? Are you celebrating a successful year—or a challenging one? Tell us your experience in the comment section below.