Ask the Experts: ICD-10 Transition
Now that the ICD-10 conversion deadline has passed, what are the top issues that providers are seeing? Are there any national payer trends or issues?
Answer 1: From my perspective at an 11-hospital health system in Virginia, we have not yet seen any issues. Most of our physicians had already started using ICD-10 codes prior to the Oct. 1, 2015, conversion deadline as we were getting orders with both ICD-9 and ICD-10 on them, so from a registration point of view, things have been very smooth.
This question was answered by: Brenda Loper, director of patient registration services, Sentara Healthcare, and a member of the Virginia-Washington D.C. Chapter.
Answer 2: My issues have been coder productivity and some system interface delays, which have mostly been resolved.
This question was answered by: Caswell Samms, network CFO, Lincoln Medical Center and Harlem Hospital, NYC Public Health System.
Answer 3: Here is an update from a conference I attended. It’s specific to Georgia but could apply to other states.
Several issues were identified though some are state specific: Georgia Medicaid is denying all claims with unspecified codes. They are going to revisit this and add back the list of unspecified codes they accepted under ICD-9 but there is still a significant amount of unspecified codes that will have to be researched and re-coded prior to the claim going out, so this will impact Medicaid claims submission. The other issue was the number of claims that Medicare suspended. The Centers for Medicare and Medicaid Services responded that this is typical whenever there is a major conversion. It is not ICD-10 specific and once they review and make sure the system is working the claims will be released. I checked with one of our Illinois clients and they said the same thing happened there, but claims are now being released for payment.
The only other issue identified was commercial payers that could not accept ICD-9 codes for procedures that occurred in September but the discharge date was in October. Most are requesting split bills, but once all these claims are cleared this shouldn’t be an issue.
This question was answered by: Suzanne Lestina, vice president, client innovation, Avadyne Health, and a member of HFMA’s First Illinois Chapter.
Answer 4: We are not seeing anything major yet, but it might be too early to tell for some of the minor payers.
This question was answered by: Kelly McGinnis, director of revenue cycle, HealthAlliance of the Hudson Valley, and a member of HFMA’s Hudson Valley New York Chapter.
Answer 5: I was most worried about coder productivity and therefore delays in billing, but so far they have done well. All other issues, as expected, were not a problem due to interface and payer testing. Claims are getting out and getting paid—both physician and hospital.
This question was answered by: Ruth Lande, senior vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s New York Metropolitan Chapter.
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