Everything seems fine on the surface with ICD-10 thus far, but is there a false sense of security?
Now that the ICD-10 coding system has been up and running for just over a month, we are starting to see some reports back from the trenches. And those reports are surprisingly good.
The sky did not fall in and the world did not come to an end. For most practices, denials did not go through the roof. Robert Tennant, senior policy advisor for the Medical Group Management Association, was at a Town Hall meeting a couple of weeks ago with Humana and Emdeon (a medical claims clearinghouse) and both organizations reported that they were seeing no great increase in denials and no big drop in the number of claims submitted.
As most experts anticipated, the key was preparation. Practices that had updated their EHRs as well as learned and tested the new codes are getting along just fine. Gary Hirshfield, an ophthalmologist in Queens, N.Y. said that the ICD-10 transition "is not effecting me one iota. Zero stress." He credits the EHR software he transitioned to a couple of years ago for taking the heat off. His system is practically fool proof, he said. "It talks you through it." Of course, Hirshfield, a self-described "terrible complainer about software," doesn't totally trust the system. He has between four and five closely spaced pages of the most commonly used codes, and he spot checks them. "If you use more general codes, you run the risk of having claims rejected," he explained.
Bonnie Dominick, billing manager at Associated Family Practice in Philadelphia, is experiencing the same success. "We haven't had a single denial yet," she said. Dominick credits her ICD-10 success to thorough preparation. She learned her codes well and made sure her doctors did.
Not every practice is having the same good experience, of course. "I know someone in another practice who is having a very hard time. She's an extremely organized, well-trained person, but she doesn't have an EHR," said Dominick. "She's overwhelmed- getting lots of denials."
So does the mostly bump-free ride mean that most folks have learned their codes and all is well? Maybe not. Tammie Olson of Management Resource Group, a firm offering financial management and support services for the healthcare community, is a little nervous about the good reports. "Don't let looks deceive you," she said. "It's going smoothly only because payers are allowing it to. Many providers are cheating right now. Some are still using their old encounters and just cross-walking the codes. That defeats the whole purpose of ICD-10. When the payers decide that practices have had enough time to transition, the payment crunch will be full on."
Tennant indicated something similar. "Humana and United both said at the town hall meeting that they had adopted a liberal approach to specificity as long as the codes made sense. Then they will begin outreach to move gradually toward more specific claims." The learning curve might not be steep, but it is coming. Just like the repeated delays gave many practices a false sense that they had unlimited time to prepare, this easing in to the specificity might be giving some practices the sense that they really don't have to understand and properly use the new codes.