Claims Management News

Claims Processing Found Successful after ICD-10 Transition

"As far as ICD-10 itself... I doubt it will have much value in clinical practice but it may help public health data miners in the future."

By Vera Gruessner

- Now that the ICD-10 transition has taken place across the country over the last month, the number of diagnosis codes has grown tremendously and many are wondering whether healthcare providers and payers will be able to successfully file claims and transfer payments due to the complex, new coding system.

ICD-10 Coding System

The ICD-10 transition has affected a wide section of the healthcare industry including billers, payers, and providers. However, the benefits to patient care and stronger healthcare administration is significant.

Advantages of ICD-10 for Patient Care

The Coalition for ICD-10 issued a statement on October 1, 2015 that mentioned the importance of the new coding system including improved administrative processes, better health outcomes, and lower medical costs.

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  • “The long-awaited US transition to ICD-10 on October 1st is a historic moment for U.S. healthcare and a major milestone in the evolving transformation of our 21st century healthcare delivery system. As a result of the replacement of the obsolete ICD-9-CM with the more modern ICD-10-CM and ICD-10-PCS code sets, patients can look forward to complete, accurate, up-to-date diagnostic and procedural data necessary to achieve significant advances in the quality of care and more efficient healthcare administrative processes,” the Coalition for ICD-10 stated.

    Successful Billing Expected to Continue

    RevCycleIntelligence.com reported on the successes found over the last several weeks regarding the ICD-10 transition period. Approximately, one million ICD-10 claims were processed without any issues in the first 21 days of October. The expectation is that first-time claims using ICD-10 codes will continue to be processed quickly and effectively without major problems.

    “We fully expect calendar year 2015 to end the same way for our clients as did 2014: with no less than a 99% success rate on their first attempt clearinghouse claims," stated David Barzillai, President of Advanced Data Systems Corporation.

    These results are actually better than the expectations of the Centers for Medicare & Medicaid Services (CMS) after the August ICD-10 end-to-end testing. The numbers are also higher than CMS acknowledgement testing results.

    To learn more about the system changes and billing successes of medical practices, HealthPayerIntelligence.com interviewed Dr. David R. Beckwith, M.D., a family practice physician from Susanville, California.

    HealthPayerIntelligence.com: What are some positive outcomes that came from adopting a new system for ICD-10 coding?

    David Beckwith: I've been using drchrono [an EHR system] since well before the ICD 10 switch. drchrono took care of everything almost flawlessly. There were a couple of minor glitches that were fixed within two or three days. The two small glitches I found had an easy workaround that I was able to figure out myself. As far as ICD-10 itself, only time will tell. I doubt it will have much value in clinical practice but it may help public health data miners in the future.

    HPI.com: Have you experienced any reimbursement delays or other setbacks since the ICD-10 transition deadline passed?

    DB: I had no reimbursement delays or setbacks. Medicare was a little slower in paying but that was their problem, not the fault of drchrono. None of my billings have been rejected for ICD-10 related issues.

    HPI.com: What are the biggest challenges your medical practice had to face when transitioning to ICD-10 coding?

    DB: I experienced no problems. We just sat back knowing that drchrono would put a good system in place as they promised.

    HPI.com: What backup plans and securities have you incorporated in case of payment delays due to ICD-10 codes?

    DB: I didn't see the need for any backup plans or securities and so put none in place. This worked out beautifully using the drchrono system.