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How Practices Are Faring with ICD-10 at Six Months

How Practices Are Faring with ICD-10 at Six Months

It took 23 years for ICD-10 to come to the U.S. healthcare system, from its publication by the World Health Organization in 1992 to its mandatory implementation date last year, with multiple delays, a good amount of pushback from high-level doctor groups, and lots of stress for physicians crammed in between.

Just like Y2K, ICD-10's impending deadline came with a lot of trepidation and hype. A survey of more than 300 physician practices, released by the Workgroup for Electronic Data Interchange in the summer of 2015 found that less than half said they were ready for the change. While it's been only six months, experts say just like Y2K the trepidation and hype were just that. The fear of denials, lost revenue, and work flow is nowhere to be seen.

"For the most part, it has been successful. By that, I mean we really haven't seen many decreases in revenue, which everyone predicted. The AMA was predicting as much as a 25 percent hit for private practice. We have not seen that," says Scott Griffin, vice president of consulting services for Culbert Healthcare, a Woburn, Mass.-based consultancy.

A Physicians Practice survey revealed that 47.3 percent of readers say they are having no problems with the ICD-10 transition and claims are being rejected at the usual rate (see related sidebar). Another survey, from Navicure, a claims management company based in Duluth, Ga., found that 60 percent of practices said they have not seen an impact on monthly revenue.

Moreover, Mike Denison, senior director of regulatory compliance programs with Change Healthcare (formerly, Emdeon), a clearinghouse firm from Brentwood, Tenn. that processes ICD-10 claims for payers and providers, says there has been barely any variance in denials. "Overall, the rejection rates from both a clearinghouse and payer perspective were very close to baseline. From a payment and denial perspective, when you compare Q3 2015 to Q4 2015, we see very little variance in the average paid amount from a claim as well as the average denial percentage. If you look at commercial Blue Cross Blue Shield payers, for example … there was a less than 1 percent variance," says Denison, who notes the problems are similarly quiet coming from Medicare as well.


For Joshua Bock, a Mesa, Ariz.-based chiropractor and managing partner of a 24-doc practice, ICD-10 was a matter of preparation. He had to reassure the other doctors at the practice that ICD-10 was not a mystical creature each time it got postponed. In early 2015, the practice began preparing for the transition. They educated themselves with ICD-10 books, conversion charts, and invested in software that converted the codes from ICD-10 for them automatically.


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