The Six-Month Mark: An ICD-10 Status Update

Even after all of the pushback and panic, the transition to ICD-10 seems to have been a successful one. And over the last six months, pre-switch fears about denials, lost revenue, and reduced productivity have proven to be mostly unfounded.

Maybe that’s because providers worked hard to prepare for the transition—or maybe it’s that payers are being more lenient about their requirements (Medicare “grace period,” anyone?). Whatever the case may be, life in the ICD-10 world seems—for the most part, anyway—to be business as usual. In fact, according to a recent Physicians Practice survey:

  • 47.3% of the digital publication’s readers haven’t seen any changes in their denial rates;
  • 60% of practices haven’t seen any impact on monthly revenue; and
  • Denial rates are at a relative baseline, with less than 1% difference between ICD-9 and ICD-10.

The results of this survey seem promising, and news on the ICD-10 front remains fairly quiet. And as the old adage goes, “No news is good news.” Right? Not so fast.

The Silence

Just because we aren’t hearing about problems doesn’t mean they aren’t occurring. This ICD-10 Monitor article highlights a few of the biggest issues that could cause a ruckus:  

  • Medicare Administrative Contractors (MACs) are still working to correct and update local coverage policies. This might sound like a good thing—and it is. However, what MACs aren’t doing is automatically accepting the claims that Medicare wrongly denied (ugh). That means providers have to do the legwork to resubmit those claims.
  • Some EMRs automatically map ICD-9 codes to ICD-10 codes, which is causing costly coding mistakes. Furthermore, some software are just too burdensome to use, and that also has caused unnecessary coding mistakes and drops in provider productivity.
  • A number of the commercial plans that follow Medicare guidelines are incorrectly denying claims based on the NCD and LCD errors. That means—again—that providers are suffering the consequences of the payers’ mistakes.

So, if problems are occurring—but not yet garnering much attention—how do we know the true status of ICD-10? Furthermore, how will these problems affect the future of ICD-10 claim submission?

The Future

Despite the aforementioned issues, CMS is forging ahead with more ICD-10 changes. In fact, in 2017, a hefty crop of new ICD-10 codes will join the code set. “To date, there are 1,900 new ICD-10-CM codes proposed for the October 2017 release,” the AAPC announced. “Of that number, there are 313 deletions and 351 revised codes.” That means ICD-10’s future is looking more complicated than ever. Not only will providers need to account for new codes, but also payers are expected to tighten up their claim acceptance requirements this fall (after the conclusion of Medicare’s “grace period” is over). And once the rest of the major payers start becoming more strict with their coding rules, we’ll truly see whether providers have been coding specifically enough—or if they’ll need to work harder to ensure payment in the future.

The Work

Ultimately, to be successful in the age of ICD-10, providers need to put in the effort to code as accurately as possible. But, how do you know if your coding practices are up-to-snuff? One way practices can get a pulse on their coding know-how is to conduct internal audits. Once you have an idea of which codes are getting denied—and why—you might start seeing patterns. From there, you can work to correct common issues, and thus, reduce your denial rates.

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What news have you heard about ICD-10? Is your practice experiencing problems, or does it feel like nothing’s changed? Fill out the form below to tell us about your experience.