3 ICD-10 Implementation Concentrations for Healthcare Payers
By - As healthcare payers adjust their business models to more cleanly align with the continuously evolving ICD-10 landscape, immediate concern is being placed upon where payers should be focusing next as the healthcare industry now sprints towards the finish line. As providers expect to struggle collecting reimbursement from payers, payers must be able to address and rectify claims management challenges as they pop up come October. Here are three needed areas healthcare payers should consider as the approximate one-month ICD-10 countdown begins.
Specificity and physician penalization
As ICD-10 codes multiply to 68,000 from ICD-9’s 13,000, a projected spike in claims denials is anticipated. The greater specificity of ICD-10’s codes is perhaps most evident in the clearly explicit detail some codes imply – an injury while watching a great opera singer: Y92.253; an injury while playing kickball at a summer camp for children: Y93:6A; clumsily spilling hot olive oil on yourself while cooking pasta: X10.2XXA; injuring yourself while milking a goat: Y93.K2; sudden unexpected injury while sending a loved one an email: Y93.C1.
Greater specification breeds a new set of challenges for healthcare payers. ICD-10 implementation may mean healthcare payers may become entangled in penalization aftermath. Payers and providers, nonetheless, need to collaborate effectively to ensure a smooth ICD-10 transition. As EHRIntelligence.com says, maintaining payer engagement via a fresh focus on technology or requesting translation work are simple means to keep overall satisfaction levels high come October.
Said President of the American Medical Association, Robert M. Wah, to RevCycleIntelligence.com, “[Healthcare payers] may use the conversion to ICD-10 to change their policies on the level of code specificity required on the claim. Since greater specificity of information is a touted benefit of ICD-10, payers may penalize physicians for using more general codes.” The healthcare industry must ensure there are adequate contingency plans in place to prevent large-scale interruptions in claims processing and reimbursement when ICD-10 implementation goes into effect on October 1, 2015, Wah stated.
Payment matters before patient matters
It is possible that substantial increases in payer concern for the remainder of this year will mean high quality healthcare simply falls to the wayside. Healthcare providers will likely be focused on hurrying up and waiting as the claims and denial process begins.
As RevCycleIntelligence.com reported, payer resources are available on behalf of the Centers for Medicare & Medicaid Services (CMS), including an ICD-10 payer directory to help bridge gaps healthcare payers have regarding ICD-10 testing questions and concerns. Payers will be responding to healthcare claims much differently than they did to ICD-9 efforts given the new specificity ICD-10 entails and simply keeping up is key. CMS advises payers to test the most commonly used ICD-10 codes (perhaps in contrast to the brief list of those mentioned beforehand, that is).
Address gaps in ICD-10 support and preparation levels
Regarding such testing trials and tribulations, as EHRIntelligence.com reported, healthcare payers should especially ask themselves the following questions:
• Who will be my primary contact at your organization for the ICD-10 transition?
• Can we set up regular check-in meetings to keep our progress on track?
• When will you be ready to accept test transactions from my practice?
• What will we need to test with you?
• Do you anticipate any changes in policies or delays in payments to result from the switch to ICD-10?
Such questions are significant, as healthcare payers are unlikely to offer hospitals support during the ICD-10 transition, according to a RelayHealth report, Seventy-four percent of nearly 550 surveyed payers in 2013 stated they had yet to identify what types of ICD-10 testing they will allow. Sixty-seven percent of payers confirmed they did not have a timeline in place for when they would begin ICD-10 testing. A small percentage of payers – 3 percent – claimed they planned to offer unlimited testing to all of their healthcare providers. A lack of people as well as a lack of system resources were to blame for slowing down the ICD-10 preparation process.
Healthcare providers struggle to collect full reimbursement from payers, as EHRIntelligence.com confirmed – 6 out of 138 payers returned correct copay information less than half of the time, leaving providers unsure of what to expect with regard to ICD-10 implementation.
It is hopeful payer efforts can effectively be translated and executed come October as ICD-10 swings into full gear and that claims can be processed without a buildup of disastrous glitches.
