Tag: ICD-10

More ICD-10 Codes to be Added Next Month

The Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention will add about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the ICD-10 coding system for healthcare claims in fiscal year 2017, the agencies announced.

According to a statement from the American Hospital Association (AHA), the large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on Oct. 1, 2015. Both new and revised PCS codes are available at www.cms.gov. The new diagnosis codes will be included in the hospital inpatient prospective payment system proposed rule for FY 2017, expected next month.

With the transition to ICD-10, healthcare professionals were already having to learn many new codes compared to the previous coding set, ICD-9. Nonetheless, in a Feb. 24 blog post, Andy Slavitt, CMS Acting Administrator, reflected on the lessons learned from the healthcare industry’s conversion to the ICD-10 coding set last fall. Slavitt himself noted that it was being compared to Y2K, a transition with the potential to create chaos in the healthcare system.

However, Slavitt pointed to the transition as an overall success. He wrote, “The ICD-10 implementation had all the hallmarks of how CMS could drive a successful implementation and aim for excellence.” The approach that CMS took which the agency says as “become its doctrine for getting things done,” had four major elements, per Slavitt: be customer focused, be highly collaborative, be responsible and accountable, and be driven by metrics.

 

ICD-10 Claims Denial Rate at 1.6 percent, RelayHealth Reports

Denial rates for ICD-10 claims are at about 1.6 percent, according to a report by RelayHealth Financial.

Out of about 262 million claims processed between Oct. 1, 2015, and Feb. 15, 2016, which totaled $810 billion, 1.6 percent were denied, according to an announcement from the revenue cycle management solutions organization.

The numbers show there has not been a “marked increase” in rates for claim denials, Marcy Tatsch, RelayHealth Financial’s vice president and general manager of reimbursement solutions, says in the announcement.

However, she adds that “as many as 1 in 5 claims is still denied or delayed–which can mean a dip of as much as 3 percent in a hospital or health system’s revenue stream.”

The Centers for Medicaid & Medicare Services, in a recent blog post by Acting Administrator Andy Slavitt, posted 2015 ICD-10 claims rejections, based on estimates from testing. CMS found that an average of 9.9 percent of claims were denied; the RelayHealth Financial’s reported rate of 1.6 percent shows actual rates may be lower than those averages.

Slavitt says in the post that while CMS is continually improving and won’t “declare victory,” the fears surrounding implementation of ICD-10 never materialized.

The implementation had been delayed three times, including once by Congress, before it was finally official last fall.

CMS Issues First Claims Metrics Since ICD-10 Implementation

At the start of October, the healthcare industry transitioned from the old ICD-9 code sets to ICD-10. Although it was a highly anticipated transition that caused many industry stakeholders distress throughout the preparation process, many reports have come in stating that ICD-10 is going well.

According to a public statement, the Centers for Medicare & Medicaid Services (CMS) has issued metrics for Medicare fee-for-service payments throughout the first few weeks of ICD-10, substantiating claims that the transition has been successful.

Since the October 1 roll-out date, CMS has received 4.6 million Medicare fee-for-service claims per day. In total, 10.1 percent of claims processed have been denied. Approximately 2 percent of these denials were due to incomplete or invalid information, 0.09 percent were due to invalid ICD-10 codes, and 0.11 percent were due to invalid ICD-9 codes.

CMS reiterated their timeline for processing Medicare and Medicaid claims, stating that it will take several more pay cycles to have a full understanding of how the transition went. Medicare claims take two weeks to process, and by federal law, CMS cannot issue payment until 30 days after claim submittal. Medicaid claims can take up to 30 days to process after having been received by the states.

Provided all of this, CMS states that it will continue to monitor the transition.

ICD-10 Success for Large Practices, Problematic for Small

Several weeks following the implementation of the ICD-10 code set, the progress of the transition appears to vary according to size of the practice. While many large practices are reporting success with the transition, some smaller ones are reporting difficulty.

According to a blog post by the Coalition for ICD-10, many of the group’s members — which happen to be larger healthcare providers — are reporting great success with the transition. Many, like Centegra Health System, credit this success to the ample time for preparation they received.

“Centegra Health System was prepared for a smooth ICD-10 transition after two years of careful planning. Our information technology systems have been updated and our educational plans were deployed to help with the initial roll-out,” said Centegra’s Executive Vice President, Chief Financial Officer, and Chief Information Officer David Tomlinson.

Additionally, some coalition members stated that their success on October 1st is due in large part to their early implementation of the code set.

“Northwest Community Healthcare’s transition to ICD-10 has been smooth. This is due, in part, to our early clinical rollout of ICD-10 with our Epic Go-Live date of May 1, 2015,” said President and Chief Executive Officer of Northwest Community Healthcare Stephen Scogna.

Other members of the coalition, such as insurer Blue Cross Blue Shield of Michigan, reported a few bumps in the road amidst a generally smooth transition.

““BCBSM’s ICD-10 implementation went very smoothly. Call center volumes and overall inquiries are very low. Professional and facility claims are processing as expected. A few issues noted, which we are resolving, but nothing major to report,” the insurer said.

BCBSM also reported that it was the first private insurer to reimburse the hospitals it serves.

“Received kudos from our hospitals stating that BCBSM was the first payer to pay ICD-10 claims and these claims are paying as expected. Hospitals are not reporting any major issues. Other Payers (Priority, Cigna, Aetna) are reporting the same experience in that they are not seeing any major issues.”

However, this success is in contrast to what some other smaller providers are reporting. The impact of ICD-10 on smaller providers is a little bit more weary as these providers have fewer resources to work with.

For example, Linda Girgis, MD, FAAFP, told EHRIntelligence.com that due to how small her practice is — she and her husband are the only physicians in the family practice — its workload has grown much larger. This work includes changing patient problem lists from ICD-9 codes to ICD-10.

“The doctors are doing it right now,” she says. “I’m doing it as I come across different patients, but definitely it’s adding time on to the workday.”

Smaller practices are especially affected by ICD-10 troubles because much of their revenue comes from the Centers for Medicare & Medicaid Services (CMS), and the agency has been reportedly unreachable throughout the transition.

“My biller tries to call every day. Since October 1, they have messaged that they are down due to technical difficulties so it’s impossible to get through to any person there,” Girgis said.

Not receiving CMS payment is problematic for small practices like Girgis’ because those payments may amount to almost 30 percent of hospital revenue. While a larger hospital, like those mentioned above, may be able to do without 30 percent of its revenue for a month or two, this kind of issue could be potentially detrimental for a practice like Girgis’.

“Big organizations, hospitals, and groups can go a few months without 30 percent of their reimbursement coming in. But for small practices, that can be devastating,” argues Girgis.

CMS set a timeline for rolling out ICD-10 payments, stating that those claims would be reimbursed within the first 30 days of the new code set. As that 30-day timeline draws to a close, small practices will be waiting to see if their claims are reimbursed.

Many Physicians Reporting a Downside to ICD-10 Transition

A vast majority of physicians report that the ICD-10 transition is having a tangible effect on patient care, according to the social media network for doctors SERMO.

Out of 200 members surveyed, 86 percent indicated ICD-10 having an impact on patient care with the remainder reporting no effect whatsoever.

Individual physician responses highlight the most immediate impact coming in the form of time spent adapting to how the ICD-10 code set works. On the whole, the prevailing criticism of ICD-10 compliance to date from a physician’s perspectiv is a decline in productivity and physicians are worried that added time spent conforming to the new code set will impact patient engagement and the number of patient visits.

One pediatrician decried the ICD-10 transition’s effect on time spent engaging with a patient during a relatively simple encounter:

I recently saw a young man as a follow up from a car accident. Under the old ICD 9 I would type motor vehicle, and get the choices, passenger and driver. With the ICD 10, I typed motor vehicle, the first 20 choices were 3 wheeled vehicles and all different descriptions. I took a couple of minutes to find the right code. All the time taken from the patient. [A] real waste and no improvement in quality of care.

Another physician, a family medicine practitioner, determined the impact of the ICD-10 use to have added an additional hour to his time in the emergency room:

Right now it’s about an extra 60-80 minutes per 12 hour ER shift. Each diagnosis that used to be in the chart from past encounters can’t be ‘checked off’, it has to be re-translated to ICD-10 by the person making the first post 10/1 encounter, which for the next few months will oftentimes be the ER physician. 2-3 sets of multiply nested boxes to filter through per patient, 15-30 times a shift…

The impact of the ICD-10 transition is likewise reported to have affected how many patients another physician has been able to see:

ICD-10 is one more impediment to good medicine for the patient. It wastes too much time, decreasing the number of patients I can see a day. I am now having to schedule some return visits farther out than is ideal as a result. Waiting time for new patient appointments is longer.

The most glaring of negative ICD-10 transition experiences comes a primary care provider who provided this rather lengthy breakdown of events:

It has added boatloads of time.

1. We are not able to do referrals because the online referral system will not accept ICD10 codes (for our biggest payer).

2. Wait times to get thru to insurance company now is hours (3 hours is not unusual)

3. The personnel at the insurance companies do not know how to answer any ICD10 related questions: the answer is, submit and we will see.

4. We were locked off the sites of several of our payers because they were updating

5. Our local Medicare carrier closed for the last week because of technical difficulties

6. And now the wait game to see if we will be paid

7. And when all that is ironed out, I expect the 3rd parties and government to reduce our reimbursements using ICD10 and citing quality measures (which they will set to maximize their own profits).

8. I used to enter my own charges. I quit on October 1st and now my biller is doing it. I used to bill every day…..we are now 3 days behind.

9. It takes a gazillion of hours to fill out the lab requisition forms looking up new and useless codes.

and on and on and on…

and no one is listening…

More to come as ICD-10 enters its second full week in use.

Oct
02
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TAMPA, Fla. – October 2, 2015 – In line with the healthcare industry’s transition to the ICD-10 coding system, Doctors Administrative Solutions (DAS) today announced that it has acquired the revenue cycle management (RCM) business of Spectra Healthcare. Based in Tampa Bay, Spectra has oper...


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