Medicare has offered providers a boon in the battle to ICD-10 readiness. In an agreement made through the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS) says that claims will be paid for a year following the October 1, 2015 ICD-10 deadline if the coding applied to procedures is within an appropriate family. That means providers don't have to hit the coding bulls eye on every claim during what many expect will be a steep learning curve on the new code set.
Accommodations Help Stem Revenue Losses
The accommodations from Medicare are likely to help providers mitigate revenue and productivity losses associated with the ICD-10 roll-out. Though providers have known about the upcoming deadline for a while, most are still not fully prepared. Technical resources and vendors are doing what they can to minimize coding issues when the transition occurs, but doctors and staff still have to apply coding correctly. For many, that means more specific and accurate clinical notes and the ability of coding staff to understand those notes and convert them to the more specific diagnosis codes required by ICD-10.
At least at first, many organizations are expecting a loss in productivity as clinicians and administrative staff get used to new procedures. With Medicare reducing the number of claim denials it hands down based on inaccurate coding, providers will have to worry less about increases in denial management work and decreases in cash flow.
Other Payers Not Yet Following Suit
The news from Medicare is good for almost all providers, and especially for those that deal with a high volume of Medicare patients. But private insurance companies and state Medicaid programs haven't officially weighed in on the accommodations, which means the harsh impact of the ICD-10 transition on revenue might still exist for organizations. Healthcare media reporters reached out to several private payers, including giants such as Blue Cross, asking about possible accommodations but the response was mostly crickets.
One revenue cycle expert says it's unlikely the larger private payers will hold provider feet to the fire in the first months of the ICD-10 transition. It's bad business for insurance companies if providers can't get claims paid at all, and the expert says most payers are probably going to offer concessions and assistance for at least six months. The fact that insurance companies aren't making official announcements about such concessions just means they want providers as ready as possible for the change. Constantly announcing concessions just encourages providers to put off preparations that should have been going on for the past few years.
Accommodations Don't Abolish ICD-10 Pain Points
Even with accommodations from Medicare--and possible concessions from other payers--the ICD-10 transition is still likely to cause pain points for providers. In addition to temporary reductions in productivity and increases in claims denials, providers might experience hiring challenges as they look for employees familiar with new coding sets. Provider offices might also see temporary dips in morale as administrative staff struggle to integrate new code sets into procedures that have become second nature for them.
With the October deadline looming, providers of all specialities should have already been preparing for ICD-10 transitions. Providers who are just getting started can take heart that accommodations are available, but they should also encourage training and transition work be done quickly and thoroughly since not all payers are on board with concessions.