The ICD-10 transition was feared and fought—and for many, it was fraught with concern over lost productivity and revenue. And that was all for good reason: the transition to ICD-10 was the biggest change most healthcare providers have had to face in their careers.
With so many unknowns, there was bound to be some kind of negative impact, right? That’s the mindset many members of the medical community carried into the transition, and it’s the reason healthcare systems, providers, and payers all over the US braced themselves for the potentially devastating ICD-10 earthquake by preparing, planning—and planning some more. And all of that preparation must have lessened the blow, because it’s already November, and we’re hardly feeling an aftershock. Some organizations have even described coding in ICD-10 as “business as usual.” Case in point: CMS announced on October 30 that they’re “pleased to report that claims are processing normally.” So with total mayhem averted, what does ICD-10 look like today?
Thanks to the millions of ICD-10 claims submitted every day, we already have some definitive data points regarding the number of denials and rejections—and the reasons behind them. Here’s what CMS has found so far:
|Total claims submitted||4.6 million per day||4.6 million per day|
|Total claims rejected due to incomplete or invalid information||2.0% of total claims submitted||2.0% of total claims submitted|
|Total claims rejected due to invalid ICD-10 codes||0.09% of total claims submitted||0.17% of total claims submitted|
|Total claims rejected due to invalid ICD-9 codes||0.11% of total claims submitted||0.17% of total claims submitted|
|Total claims denied||10.1% of total claims processed||10% of total claims processed|
Nothing too shocking, right? Actually, the numbers seem pretty average compared to the historical baselines. But, can we really call the switch a smashing success this early in the transition?
The Waiting Game
Although the initial numbers look promising, some payers take up to 30 days to receive and process claims. That means we still have some time before we’ll know how the transition really went. In addition to the typical payer delays, Medicaid fee-for-service programs in California, Louisiana, Maryland, and Montana announced that they weren’t prepared for ICD-10—period. In this article, Charlotte Bohnett explains that “to work around this issue, those payers are accepting claims with ICD-10 codes, but then crosswalking the codes to ICD-9 in order to calculate reimbursements.” We’ve yet to see what kind of payment delays or inaccuracies will result from this messy workaround. But while we wait for the full payment picture to reveal itself, there are some things you can do in your own clinic to keep things running smoothly:
- Make sure your staff members—including your front office employees, therapists, and billers—are communicating openly.
- Figure out the reasons behind any incoming denials; then, work to prevent those types of denials in the future.
- Audit and adjust your processes to improve productivity.
The Payment Delay Defense
When you focus on improving productivity and accuracy within your practice, your claims stand a better chance of getting paid—and paid quickly. But, how do you measure productivity within your own practice? “One suggestion to measure where your productivity is now is to look at your productivity by coder and/or type of coding from October 2014 through October 2015 to identify if any productivity loss exists, and if so, the percentage of loss,” explains this ICD10monitor article. “This should be a report that you run each month for the next 12 months, looking to make strides to get productivity back to what it was in 2014.” So, you need to not only evaluate your current claim denials, but also keep an eye on your productivity levels throughout the next year. This way, you’ll have a clear understanding of what delays and/or mistakes are holding up your revenue.
So, what does ICD-10 look like for you today? Are you seeing dips in productivity? How about denials? Did the transition leave you running for the nearest door jamb, or did you feel barely a tremble? Send us an email using the form below to share your experience.