ICD-10 at 6 months: Providers and payers have yet to reach the bottom

The healthcare industry appears to have successfully withstood the transition from ICD-9 to ICD-10. But are the sighs of relief premature? Is another shoe waiting to drop?
By John Andrews
08:18 AM
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The mass worrying about healthcare coming to a grinding halt on the Oct. 1, 2015 ICD-10 compliance deadline did not materialize. The transition went so well, rather, that it even has some healthcare professionals uneasy.

Various health IT experts credited awareness, preparation and education, as well as different technologies for facilitating the transition, as reasons it has gone so smoothly, thus far.

There were hiccups, of course, but for the most part they were minor. Not surprisingly, the physician sector experienced the most difficulty at crunch time, with some practices struggling to make the conversion.

Broadly speaking, however, the transition was not as hard as many people expected it to be," said  Mary Jean Sage, president and founder of The Sage Associates, an expert consultant in billing and coding for the Cooperative of American Physicians, Inc.

For Jose Rivera, vice president of physician solutions development at Santa Rosa, Calif.-based VisiQuate, the key to success was two and a half years of preparation.


This article is part of a Special Report on ICD-10. Other stories include a look at how the code set is poised to usher in a new generation of younger, more tech-savvy medical coders and one data scientist’s view that providers can recoup millions of dollars by running advanced analytics against denied claims datasets. 


"Initially we had a little difficulty, maybe a 15 percent increase in claims that were held back for coding reviews because certain physicians took a little longer to choose the right ICD-10 codes, but within a month it was back to normal and overall it was a success," he said.

To be sure, the extra year made a difference for a lot of healthcare organizations, said Pauline O'Dowd, senior director with Chicago-based Huron Healthcare.

"People woke up on Oct. 2 and found that all was well," she said. "From a clinical documentation perspective, we found that people were well prepared. We really haven't seen any revenue drops ― there were the usual denials, but nothing directly related to ICD-10."

While it’s tempting to think that the healthcare industry pretty much aced the ICD-10 deadline, and those worries have been put to rest, the 6-month mark is a good time to ask if such concerns really have been settled?

The one-year span between Oct. 1, 2015 and Oct. 1, 2016, after all, is something of a grace period during which the Centers for Medicare and Medicaid Services and commercial payers are offering more latitude on claims details.

"The bottom hasn't been reached yet because CMS came along and said it wouldn't be as hard on physicians for 12 months after the deadline,” Sage said. “There haven't been too many denials yet, but that could change. So we may not have seen things that we will see after Oct. 1, 2016.”

At least this far in the fears of massive claims rejections, crashing cash flows and full-blown chaos were largely unfounded. And after a mounting pre-deadline build-up and "sky is falling" admonishments ― coupled with head-in-the-sand physician denial ― it's no wonder that those fears existed in the first place.

Huron Healthcare’s O'Dowd said preparation, pragmatism, and prioritization helped a lot of entities withstand the storm: "The organizations that succeeded built a strong relationship with their teams ― specifically the clinical documentation specialists, physicians and coding professionals."

But as the relaxation period winds down, providers will have to get more specific with their codes, said Matthew Ketterman, director of product and portfolio analysis at Availity.

"Providers understand that ICD-10 is life now," he said. "There may be some bumps and issues with the system upgrades where no more ICD-9 codes are supported by vendors."

October 1, 2016 just might turn out to be the real ICD-10 compliance deadline.

"There is a lot of change to come,” said Allison Gilmore, principal data scientist for healthcare with Menlo Park, California-based Ayasdi. “And we have yet to see the other shoe drop.” 

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