The Top 4 Coding Predictions You Need to Know in 2016

January 20th, 2016
ICD-10, Preparation

Well, folks, it’s probably safe to say that the transition to ICD-10 was a lot of bark and only a little bite. Roughly four months after the October 1 implementation deadline, most clinics are doing fine—but that doesn’t mean you’re done worrying about the coding change’s effect on your practice. In fact, 2016 brings with it several new coding challenges, both big and small. To help you prepare, we’ve put together a list of our top four coding predictions for the new year:

  1. According to the ICD-10 Monitor, 2016 will bring on more coding assessments, reviews, and audits. At this point, you’ve processed enough claims to start evaluating—and, hopefully, validating—your ICD-10 processes. If you uncover weaknesses, you’ll need to adjust your current best practices and metrics tracking processes—or establish new ones. What used to be “business as usual” for your clinic during the reign of ICD-9 may not be possible in the ICD-10 world. Not sure how to perform an ICD-10 assessment? Check out this how-to article from ICD-10 Monitor.
  1. Thanks to the above audit forecast, the experts at H.I.M. ON CALL, a health information and coding solutions company, believe we may experience nationwide auditor shortages. So, if you need to hire one, do so as soon as possible. You may even need to upgrade your technology to manage all those audits in a timely manner. Furthermore, these experts predict those audits will reveal accuracy rates 32% lower than pre-switch rates. If you find yourself facing a large drop in claims accuracy, it’s time to hit the books for a refresher course on ICD-10.
  1. Expect a comprehensive code update when the coding freeze thaws this fall. To help ensure a successful implementation, the US has held off on adding any new ICD-10-CM (and PCS) codes for the past four years. But that all changes on October 1, 2016—exactly one year after the mandatory transition to ICD-10. This update likely will be massive, so you should prepare for it in the same way you prepared for the transition itself. CMS may release more information as we get closer to update time, but for now, just know that you should expect new subcategories and tons of indexing changes.
  1. Big data isn’t just for big clinics. Thanks to ICD-10’s increased specificity, we have more—and better—data than ever before, and as this coding expert explains, we can “expect to see requests for detailed data increasingly utilized in smaller organizations.” We believe the push for data is a good thing, but it also can place a burden on coders who already have full plates—especially at smaller clinics where everyone wears multiple hats. So, make sure you provide your staff with the software training they need to meet new data demands.

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Like a high school graduate taking a gap year before entering college, the one year grace period from CMS allows you time to get a firm grip on ICD-10 and optimize your processes. But we’re already more than a quarter of the way through it, so there’s no time to waste. With these coding predictions in mind, you can start facing these coding challenges head-on—and make 2016 your best year yet.


3 Lessons Learned from the ICD-10 Switch

January 19th, 2016
ICD-10, Transition

This month, folks everywhere are making plans to get healthy in 2016. But, unlike many resolutions made in January, ICD-10 is here to stay. We’re already more than halfway through the month, and while gym-goers might start to slack, HIPAA-covered providers don’t have the option to drop the weight of ICD-10. Even if using a new code set isn’t exactly like a new year’s resolution, it’s definitely a new habit. And with any new habit comes a learning curve, and, inevitably, a few lessons learned. So, here’s what we’ve learned since the switch:  

1. Preparation pays.

You’ve probably read this—and, hopefully, experienced it for yourself: ample preparation across the healthcare continuum made the ICD-10 transition a success—so far. This ExecutiveInsight article highlights one piece of the puzzle: “The Centers for Medicare and Medicaid Services offered extensive education and testing services, while private payers and clearinghouses provided a framework for success.” But, it wasn’t just CMS, payers, and clearinghouses that worked hard to get ready for the switch. Providers, billers, and coders put in a tremendous amount of effort, too. They audited their processes, learned how to use the new code set, found solutions to coding and transitional challenges, and stayed on top of communicating with their vendors and payers. Hopefully, the healthcare community as a whole will remember this lesson as we come upon more changes—and challenges—in the future.

2. Mistakes happen.

Prior to October 1, many providers were confused about when to submit ICD-10 codes—especially for those patients with cases spanning the transition date. And after the transition, confusion quickly gave way to mistakes. For example: “Some providers coded ICD-10 based on the calendar date thinking that they needed to use the new ICD-10 code set for claims submitted on or after October 1. ICD-10 requirements actually call for providers to code ICD-10 on claims with dates of service or discharge on or after October 1,” explains the same ExecutiveInsight article. Now that we’re several months into the transition, these mistakes are steadily waning. However, that doesn’t mean practices should coast until another coding change comes around. This Government Health IT article explains the importance of remaining vigilant in auditing processes: “Payers and providers will be well-served by instituting a program for ongoing analysis that specifically compares their assumptions about the effects of the transition against the real time activity they are observing as claims accumulate over the next 12 months.” In summation: providers need to pay close attention to detail if they want to avoid making simple—yet costly—mistakes.

3. Communication is key.

While we’re a long way from achieving total interoperability, making the switch to ICD-10 was a step in the right direction. That’s because interoperability relies heavily on communication, and ICD-10 allows providers a simpler, more accurate way to communicate detailed patient diagnoses to other parties. But, communication isn’t solely about providing accurate and complete diagnosis codes; providers also need to communicate with their payers and even their software vendors to prevent simple misunderstandings. Many practices did a good job of doing just that in the lead-up to the ICD-10 transition. As for those who didn’t? Many of them ended up making mistakes—and suffering delayed payments as a result. So, the lesson here is that communication pays—literally.

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Like a good—and sustainable—habit, ICD-10 has given providers plenty of positive takeaways. And for those practices that embrace the changes that lie ahead with a positive mindset and a willingness to put in some effort, the future looks bright for many new years to come. Have you learned any ICD-10 lessons? Fill out the form and tell us your story below.


How Soon Until the US Switches to ICD-11?

December 17th, 2015
ICD-10

First comes love; then comes ICD-10; then comes ICD-11 in, uh, a baby carriage? If only transitioning from code set to code set were so romantic. Unfortunately for us, such is not the case. And in the coming decades, we’re more likely to encounter opposition than the prompt adoption of a fresh-like-a-baby code set—at least in the US. And though some might argue that the recent transition to ICD-10 doesn’t look a whole lot like love, we’re married to the code set now; so, how long until we’re “due” for a transition to ICD-11 (get it)? Here’s what we’ve heard so far:

ICD-10: Less Than Comprehensive

Many healthcare professionals anticipated that the ICD-10 code set would include and account for nearly every single diagnosis and procedure under the sun. And it does—well, almost. Despite ICD-10’s massive list of 69,823 diagnosis codes, this Practice Fusion article explains that “CMS is already issuing corrections and adding new codes to to the ICD-10 set. Just last week, CMS approved additional diagnosis codes that were missing from osteopenia and its ICD-10-CM codes in subcategory M85.8-Other specified disorders of bone density and structure.” If corrections like this one are happening this early in the game, surely we can expect additional updates and expansions as we move forward.

The World Health Organization: Working on It

So, if ICD-10 truly is out of date, when will ICD-11 go into effect and resolve these issues? The short answer: Who knows? Well actually, WHO (The World Health Organization) does know what’s in store for the future of ICD-11. That’s because WHO has been working on its implementation for years. Even this past fall, as providers across the US were adopting ICD-10, ICD-11 was already undergoing updates, testing, and peer review.

And as far as the immediate future is concerned, the WHO has released its plans to present ICD-11 to the World Health Assembly in May of 2018 for endorsement. But, ICD-11 isn’t expected to be a huge transition like the one we experienced with ICD-10. So, for the sake of improvement, maybe another change isn’t so bad, as this HealthcareDIVE article emphasizes: “the good news is the next iteration won’t be coming for awhile, and the change should be significantly less complex.”

ICD-11: The Timeline

In terms of an ICD-11 release timeline, the WHO has formed a plan for ICD-11 that spans from 2015 to 2018. Here’s what’s in store for the next few years, as adapted from this document:

Testing and Peer Review Process

  • January to March 2016: Executive Board update with ICD-10 review
  • April to June 2016: World Health Assembly (WHA) update, including revision process and ICD-10 review
  • September 2016: Revisions conference (hosted in Japan)
  • October to December 2016: Consolidation period with testing and peer review

Testing Strategy and Updates

  • January to March 2017: ICD-11 full testing strategy begins
  • April to June 2017: World Health Assembly update, including revision process and strategies for ICD-10 improvement; testing continues
  • July to September 2017: Full testing strategy finalized

Endorsement Process

  • September to October  2017: Full report on ICD-11 process released; future management approach and endorsement of final products prepared for Executive Board approval
  • November to December 2017: WHO endorses final products and future management approach; WHO readies health information development strategy to present at WHA
  • January to May 2018: Endorsement of final products, future management, and health information strategy
  • May 2018: WHA includes a full report on ICD-11 and endorsement of final products, future management, and health information development strategy

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Like I said before, there’s a lot for the WHO to accomplish before 2018. But, even if all of these plans come to fruition, it’ll likely be at least a decade before the US adopts ICD-11. And that means that—just like we had time to adjust to the idea of ICD-10—we still have some time to fall in love with ICD-11. You know—before the wedding bells start ringing (again).


An ICD-10 Ode to Rudolph

December 11th, 2015
Codes, ICD-10

Your old favorite, with a new twist.

Rudolph the Red-Nosed Reindeer (W55.31XA Bitten by other hoof stock, initial encounter),
Had a very shiny nose (Q30.8, Other congenital malformations of nose).
And if you ever saw it (H53.60, Unspecified night blindness),
You would even say it glows (T67.9XXA, Effect of heat and light, unspecified, initial encounter).

All of the other reindeer (W55.89XA, Other contact with other mammals, initial encounter)
Used to laugh and call him names (R45.81, Low self-esteem).
They never let poor Rudolph
Join in any reindeer games (Z60.4, Social exclusion and rejection).

Then one foggy Christmas Eve (T69.9XXA, Effect of reduced temperature, unspecified, initial encounter),
Santa came to say (R47.81, Slurred speech),
“Rudolph, with your nose so bright,
Won’t you guide my sleigh tonight (V80.791A, Occupant of animal-drawn vehicle injured in collision with other nonmotor vehicles, initial encounter)?”

Then how all the reindeer loved him (R00.2, Palpitations),
As they shouted out with glee (H93.13, Tinnitus, bilateral),
“Rudolph the Red-Nosed Reindeer,
You’ll go down in history (Z86.59, Personal history of other mental and behavioral disorders).”


ICD-10 Holiday Gift Guide

December 8th, 2015
ICD-10

You’ve made your shopping list and checked it twice. But, lo and behold, you’ve got some healthcare professionals—whether they’re your clinic’s staff, your peers, or your doctorly family and friends—on your list, and you don’t have a clue as to what to get them. Fear not, my head-scratching shoppers! Healthcare professionals went through the biggest change since the Affordable Care Act this past October. It wasn’t an easy switch, but they got through it. Thus, it’s perfectly fitting—and funny—for you to gift them some ICD-10 merch this holiday season. Behold: the ICD-10 Holiday Gift Guide, crafted with care to help you find the perfect gift for every healthcare professional and medical biller/coder in your life.

ICD-10 Coffee Mugs

From an “ICD-10 Survivor” mug to an array of cups featuring specific codes (like struck by balls, burn due to water-skis on fire, and struck by turtle), there are many options out there for all the caffeine-guzzling docs and therapists in your life.   

ICD-10 Apparel

Nothing makes for a great conversation starter like a bizarre medical diagnosis code illustrated on a comfy t-shirt. Check out these ones from Zazzle: other superficial bite (i.e., vampires), walked into a lamppost, and bitten by squirrel. Want something warmer for those chilly winter months? Go for a spacecraft crash pullover.

ICD-10 Art and Games

ICD-10 Illustrated—the brilliant folks behind Struck by Orca—is an amazing website whose team has been working to add some levity to the otherwise super-serious diagnosis coding transition. They’ve created several items that are perfect for gift-giving:

ICD-10 Wall Art
Image from ICD10illustrated.com

The Packaging

Once you’ve nabbed your ICD-10 gift, it’s time to wrap it—and what better way to encapsulate your present than with bitten by squirrel wrapping paper. Once you’ve sealed the gift and tied it with a bow, add one final touch: an ICD-10 holiday greeting card.

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Ta-da! You now have a wealth of gift ideas for every medical professional on your holiday shopping list. Now, you just need to worry about your enigmatic great aunt.


How is CMS Resolving ICD-10 Issues?

December 7th, 2015
ICD-10, Insurance

The Centers for Medicare & Medicaid Services (CMS) recently announced that the transition to ICD-10 caused barely a blip on its radar. As it turns out, though, that optimism doesn’t outweigh the fact that there have indeed been issues on Medicare’s end—and they’ve caused more than a blip in providers’ workflows. Here’s what we know so far:

NCDs and LCDs

The “isolated” issues surround National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). This AACE document defines these terms as follows: “NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers.” Translation: NCDs and LCDs outline allowable diagnosis codes for payment—which means that when there’s an issue affecting these policies, claims don’t get paid.

NCDs

In the case of NCDs, claims have been inappropriately rejected or denied. CMS has indicated it is committed to resolving these issues quickly. Specifically, the organization is:

  • automatically reprocessing wrongly rejected or denied claims (in most cases), without requiring any action or additional fees from the affected providers;
  • providing further clarification on, and refinement of, NCDs;
  • creating a permanent system to resolve issues by January 4, 2016; and
  • making information available on Medicare Administrative Contractors (MAC) websites.

LCDs

Some MACs failed to update certain LCD criteria, which resulted in additional errors. CMS is postponing processing these claims until the updates are complete. In the future, if any claims come in with these same errors, CMS will pause processing until the MACs make the required updates. If providers have any questions, they should contact the appropriate MAC.

Ready…

Before October 1, CMS made it a point to announce its ICD-10 readiness. Even back in July, the testing results touted success: “the agency stated that its last test run resulted in an 87 percent claims acceptance rate of the 29,286 tests the agency received. The rejection rate for ICD-10 errors was 1.8 percent and the rejection rate for ICD-9 errors was 2.6 percent.” Furthermore, CMS repeatedly assured providers that they had enough resources and staff to effectively handle the transition. In essence, CMS appeared to be totally prepared to tackle the transition.

Or Not

Now, it appears that CMS wasn’t as prepared as we’d all hoped—and believed. Plus, as this Healthcare Payer News article points out, “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.” Ouch. But, CMS isn’t the only entity that could encounter problems. This Healthcare Finance article also gives a grim forecast for providers: “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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As explained here, “CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible, and reprocessing claims to minimize impact on providers.” That may be reassuring, but we’ve yet to see whether providers themselves were truly ready for the transition.

 


So, You Switched to ICD-10. Now What?

December 3rd, 2015
ICD-10, Transition

On September 30, 2015, healthcare providers all over the US were partying like it was 1999, but October 1 came and went—and for most folks, nearly nothing bad happened. We’re still in the early stages of the switch, so we can’t say for sure that it’s smooth sailing ahead, but if you felt like the transition to ICD-10 was more “calm waters” than “catastrophe,” you’re certainly not alone. PR Newswire announced this week that 79% of 298 organizations surveyed on November 9, 2015, by the tax, audit, and advisory firm KPMG LLP said the transition “has proceeded smoothly.” Here’s a more detailed breakdown of those responses:

  • 28% indicated they experienced a completely smooth transition.
  • 51% indicated they experienced a few technical issues, but were successful overall.

However, it wasn’t all clean claims and speedy payments, as 11% of respondents indicated their ICD-10 transition was a total failure.

Growing Pains

While it’s certainly a far cry from the doom and gloom many providers predicted, if you’re one of the 11%, you’re probably feeling a bit doomy and gloomy, thanks to some—or all—of the transition’s biggest challenges, including:

  • Rejected medical claims
  • Clinical documentation
  • Physician education
  • Reduced revenue from coding delays
  • Information technology fixes

But the transition to ICD-10 doesn’t have to be a death knell for your practice. After all, other clinics are hitting it out of the park—and you can, too. So, now what?

Moving Forward

According to this recent Managed Healthcare Executive article, the keys to success moving forward are:

  • tracking your key financial and operational performance indicators;
  • making timely, decisive actions;
  • keeping a pulse on the morale of your most impacted employees;
  • showing leadership and support; and
  • focusing on communication.

Furthermore, “providers will need to dedicate more attention to the quality and specificity of clinical documentation to reduce rejected medical insurance claims.” But that doesn’t tell you anything you don’t already know, right? There are several ways to handle this post-switch period, so what’s your first priority? Well, like 46% of survey respondents, you can tackle auditing your internal processes and systems, including:

  • Clinical documentation
  • Revenue cycle management
  • IT systems
  • Electronic health record system

That last system, in particular, plays a huge role in your ICD-10 transition—for better or for worse. As one provider reminds us in this Medical Economics article, “You learned ICD-9; you can learn 10 and with technology it is easier.” Another provider echoed that sentiment, advising healthcare professionals that “there are better tools available for dealing with these codes” and telling them to “ask your [EMR] vendor whether they can provide them.” My advice? If your vendor can’t offer what you need to be successful, find one that can.

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Okay, so that’s a good place to start, but keep in mind there’s a lot more to the ICD-10 transition than just optimizing your processes: there’s much to learn—and unlearn—and that’s no simple task. It’ll take time and effort, but your practice can make a full recovery from the transition to ICD-10. You’ll be back on your feet—and in the black—faster than you can say ICD-11. (Too soon?)


How Are Providers Handling the Switch?

November 20th, 2015
ICD-10, Insurance, Transition

So far, ICD-10 has arrived on the healthcare scene with very little fanfare. And we haven’t witnessed any major roadblocks or negative impacts on payers, claims, or payments. So with that in mind, how are providers handling the switch?

Productivity

One of the biggest fears providers had going into the ICD-10 transition was the potential for a huge loss in productivity. So far, though, providers haven’t reported any massive interruptions to their daily workflows. But, could that be because their claims haven’t been denied yet? As this Politico New York article explains, we’ve yet to see ICD-10’s true impact across the board: “One month into the transition to a new, expansive coding system for diseases and health problems, health care providers say it’s still too early to know what sort of repercussions the new system will have on their operations.” As more data comes in about claims and payments—or denials—providers will have a better sense of whether their productivity will suffer moving forward (i.e., how much time they’ll spend correcting and resubmitting claims).

Process

One aspect of ICD-10 that providers worked hard to prepare for was the inevitable change in their coding process. Because the new code set is much more specific, they had to adjust their coding habits to code more accurately. And in these beginning stages, it looks like their efforts are paying off—at least according to this RevCycle Intelligence article: “Nearly 1,000,000 ICD-10 claims were successfully processed the first time around within the first three weeks of October.”

But, to keep this momentum going, providers can’t kick back and get comfortable with their current habits. This Modern Medicine Network article stresses the importance of constant attention to detail and evaluation of processes: “Providers will continue to require coaching on documenting to ICD-10 level specificity and the importance of providing it from the time care is being authorized, all the way through the patient’s treatment plan.”

Potential

Even if there is a chance providers could suffer productivity loss in the future, they still stand to gain advantages from the ICD-10 switch. Because the new code set allows for more specificity, claims can be paid more easily—without the time-consuming back-and-forth communication between payers and providers. This Healthcare Informatics article explains that ICD-10 cuts down on “the ‘gigantic paper chase’ for providers, as historically commercial payers have frequently asked for more information or additional details about a procedure when providers submit claims.” So, as long as the transition continues as it has thus far, providers might find that ICD-10 offers more potential than it does pain.

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How’s the transition going for you? Are you seeing a drop in productivity? Or has your preparedness helped you take on this transition with ease? Fill out the form below and tell us about your experience, and keep an eye on the blog for more ICD-10 news as information is released.


Thanksgiving Leftovers: ICD-10 Style

November 17th, 2015
ICD-10

What comes to mind when you think of the day after Thanksgiving? Sales? Crazed shoppers fighting over the cheapest television? Furbys? I’ll tell you what I think about: sandwiches. I’m talkin’ awesome turkey-stuffed stacks, complete with Miracle Whip-slathered bread, buttery stuffing, and tart cranberry sauce—served with a heaping side of cold mashed potatoes. Because who really has the time to heat up yesterday’s potatoes when you’ve got a delightful sandwich waiting for you? Amirite? So, what do my day-after-Thanksgiving habits look like in the language of ICD-10? I’m glad you asked. It might look a little something like this:

The Aches

First, I’d probably get a bad case of R14.0, Abdominal distension (gaseous). All that turkey, Miracle Whip, cranberry sauce, and stuffing has to do some damage, right? But to me, a little bloating is a small price to pay for sandwich heaven.

The Pains

A few hours later—after my good ol’ stack has digested—I’m guaranteed to have some wicked heartburn, or R10.13, Epigastric pain. But that’s okay, because by this time, the turkey’s tryptophan is kicking in.

The Gains

All of that brings me to my next diagnosis: I’m showing symptoms of R46.4, Slowness and poor responsiveness. Inevitably, my general grogginess will lead to an afternoon nap. Score! I’m headed straight to snoozeville. Hopefully, I won’t experience F51.5, Nightmare disorder, upon my arrival.

After waking up, maybe I’ll watch some sort of holiday-themed movie for the first time this season—at least I thought it was the first time. Turns out, I’ve had The Grinch on repeat since the end of October. I guess that means I’ve got a mean case of F22, Delusional disorders.

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So, is it all worth it? I think experiencing some bloating, heartburn, and grogginess is a small price to pay for an afternoon spent blissfully devouring leftovers while simultaneously avoiding Black Friday sales. But, this year won’t be the first year I’ve indulged in a post-Turkey Day sandwich (or two). So, let’s hope I don’t end up developing K90.0, Celiac disease (e.g., a gluten allergy) come 2016.

Happy Thanksgiving!


ICD-10 News: Payers, and Clearinghouses, and Reimbursements—Oh, My!

November 11th, 2015
ICD-10, Insurance, Transition

“Business as usual” isn’t exactly what most providers expected to hear from The Centers for Medicare & Medicaid Services just a few short weeks after October 1. But, according to CMS, the transition to ICD-10 was just that: successful with nothing out of the ordinary. Of the estimated 4.6 million Medicare claims submitted every day, only 10.1% of those processed between October 1 and October 27 were denied. That’s just 0.1% more than the historical baseline number. But, even with numbers like these, has enough time passed for us to really gauge the transition’s success? Or are our assumptions a bit premature? Here’s the latest news:

Commercial

Emdeon, one of the largest claim clearinghouses, recently explained in an ICD-10 Watch article that “claims coded in ICD-9 for services before October are still coming in, but 86 percent of claims now being received at Emdeon are ICD-10.” So, even though the majority of claims contain ICD-10 codes, it might be too early to judge the situation with commercial payer reimbursements, because there are still ICD-9 claims lingering in many payers’ backlogs.

To add to the uncertainty, this Medscape Article reveals that some commercial payers took a page from Medicare’s “grace period” book and have been more lenient with denials based on code specificity alone. But how long will this leniency last? The article goes on to warn that “physicians and their billing staffs need to closely monitor the number and causes of denied claims going forward. Commercial insurers, after all, aren’t obliged to overlook specificity mistakes on matters like location and laterality as Medicare is doing.” So, there are no guarantees that payers will forgive specificity mistakes. And it may take weeks or even months to get a pulse on just how unforgiving these commercial payers truly are when it comes to denials.

Medicare

“Grace period” aside, Medicare payments are coming in at lower-than-average rates. That said, there’s no evidence that connects recent Medicare payment decreases with the transition to ICD-10. Health Data Management recently released an article that explains why: “Medicare payments on average are 7 percent less, but that is due to October payment policy changes.”

Even if these lower payments aren’t due to ICD-10, some providers might be experiencing other problems with Medicare and ICD-10. If that’s the case, CMS urges providers to:

Medicaid

If things seem to be going well for Medicare, the same must be true for Medicaid, right? Unfortunately, this is not a guarantee. Because Medicaid claims can take up to 30 days to be submitted and processed, we have very little information on whether these claims have been successfully submitted, denied, or paid. CMS has even announced they won’t have further news on Medicaid statistics until later this month, at the earliest. But, Mike Denison, senior director of regulatory compliance programs at Emdeon, says that that organization’s initial Medicaid claim data shows that the “average paid amount is 12 percent higher but denied payments—for several reasons that include a claim not meeting contractual policy or a subscriber is not recognized, among others—are down 9.6 percent.” Typically, Medicaid has the highest number of denials. So, why now are payment percentages up and denial percentages down? Maybe the grace period is making its mark in the Medicaid world. We won’t have a definitive answer until more time has passed and more claims have been submitted.

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Where does all of this information leave us? Analysis from RemitData found that “year-over-year data reveals that when you compare October 2014 claims processing figures to October 2015, only 24 percent of the anticipated claims volume has been processed for the month of October.” So, that means we still haven’t seen the full ICD-10 picture. However, I don’t think that means providers need to give up hope about seeing the fruits of their labor and preparedness; they just need to be patient. That’s because within the next 60 to 90 days, we might find that ICD-10 implementation is truly “business as usual.”