If, like me, you spent way too much time searching “ICD-10 Launch” on the internet yesterday… you probably (also like me) saw a lot of panic-inciting and/or fear-inducing blogs and opinion articles that made it sound as if yesterday’s transition to ICD-10 in the United States was going to be the medical coding equivalent of the apocalypse.
Today, I am happy to report that the U.S. ICD-10 transition has been about as “apocalyptic” as the Y2K panic was back in 2000 (which, as most of you probably remember, was not an apocalypse).
Yesterday’s ICD-10 launch didn’t go 100% perfectly, of course… and I don’t think anyone really expected that it would. There were some minor glitches, but nothing too serious from what I can tell. If anything, it went far more smoothly than many people thought it would. Anytime a systemic change as large as this occurs, there are naturally going to be problems. However, for the ICD-10 launch, those problems have been fairly uncomplicated.
There was a report of at least one system of hospitals that ran into problems when their ICD-10 coding solution crashed (that solution was not NexCode, just to be clear).
There were multiple reports, mostly in the Northeastern parts of the country, of reimbursement denials being caused by doctors who were still coding with ICD-9 (which shouldn’t be happening). This was attributed to a glitch in their own systems that was automatically rejecting all ICD-9 submissions, instead of allowing them to pass through in order to be manually converted to ICD-10 later (which sounds very inefficient).
The real winners yesterday were the people who made good use of the last four years of delays and prepared for ICD-10 in advance -- training for it, acquiring ICD-10 solutions, updating computers, and developing compliant payment systems. To be honest, the vast majority of the big problems that were experienced by healthcare providers yesterday -- mostly denied reimbursements -- were experienced by those who waited until the last minute and were not prepared for it. For example, payers with outdated computers requiring manual conversion (resulting in backlogs) and/or providers who failed to update their payer contracts to make sure they would be compliant with ICD-10.
Of course, some of the blame probably rests on the shoulders of certain insurance companies. I ran across more than a few online rants when I got on my computer this morning from both physicians and administrators who found themselves engaged in phone arguments with insurance reps regarding whether the codes they were using were correct or appropriately specific (to avoid exposing our readers to profanity, I have chosen not to provide links to said rants).
To be clear -- these sorts of rejections should NOT be happening yet.
Back in July, the CMS announced a one year grace period (from 10/1/15 to 10/1/16) intended to prevent health insurance companies and other payers from gratuitously rejecting ICD-10 claims on the grounds that they weren’t accurate/specific enough. The idea was to give everyone time to adjust to the new system and to minimize any negative financial impacts for healthcare providers.
Therefore, specificity should be a non-issue for ICD-10 reimbursement claims for now. Do not let anyone, especially an insurance company rep, try to tell you differently. Until next year, payers are bound by law to accept ICD-10 submissions long as they are generally accurate.
If you find that a payer is consistently rejecting your ICD-10 claims due to specificity, you may want to consider sending them a copy of this CMS document and (if things get really bad) perhaps even consider (or at least mention the possibility of) legal action.
While the ICD-10 launch went relatively well, it’s only been a day. There are some who still expect more problems to come to light over the coming weeks. This may be true… maybe not. No matter what happens, however, one thing is certain -- the better prepared you are the better off your practice will be. If you aren’t already prepared, it’s time to get on it. There’s just no more room for procrastination.
Luckily, yesterday did not turn out to be the end of the world… just the end of ICD-9, meaning some folks had to cancel that End of the World party they were planning.
