For the past several years, the nation’s providers have been neck-deep in efforts to implement ICD-10 billing codes and be ready to get health claims out the door once the switch flips. With six months to go until these codes are law, the biggest concern is becoming what will happen once the new-era claims leave the house.
Experts say there’s a two-part drama that includes such players as practice management system vendors, claims clearinghouses, private-sector payers and the Centers for Medicare & Medicaid Services. The first act has the claims coursing through multiple checkpoints to their destinations without a glitch; the second is about achieving a paid claim rather than one that’s denied or put aside for more information.
“In terms of readiness, all of the statistics would suggest that we are in a very good place,” says Pamela Jodock, senior director for health business solutions at the Healthcare Information and Management Systems Society. Surveys of hospitals, physician practices and practice management vendors report a high degree of readiness.
An American Hospital Association survey fielded in January and February found that 93 percent of hospitals are moderately to very confident of reporting under ICD-10 by the Oct. 1 transition date. The Healthcare Administrative Technology Association, a practice management vendor trade group, conducted a survey concluding that by April, 80 percent of responding vendors will have ICD-10 services and software available to customers and will start testing with external sources. Another 20 percent said they will be at that point by mid-year. And a survey by clearinghouse Navicure found that 81 percent of practices are confident they will be ready in time, though only 21 percent said they were on track as of February.
Successful processing of claims is less certain. CMS has reported an 81 percent success rate in tests of incoming claims, but the American Medical Association has led an organized physician outcry declaring that a 19 percent failure rate would be ruinous to many practices.
However, that failure rate included problems with misidentified providers, invalid places of service and other simple errors that happen with current claims, says Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association. “When you focus on the fact that only 3 percent of the rejected claims … had to do with ICD-10 problems, that’s pretty good,” she says. Private payers say they are doing extensive testing and it’s going equally well if not better than it is with Medicare, Bowman says.
Testing responsibility ultimately rests with each practice, said Charles Christian, chief information officer of St. Francis Hospital, Columbus, Ga., and the hospital’s point person with owned and affiliated groups. Doctors at a local practice recently told him that their systems were ready. “My response to them was, ‘Great, have you tested it?’ The answer was, ‘No, sir.’ I said, ‘Let me know when you get the testing done next week.’ ”