What To Do If Your Payer Does Not Comply With The ICD-10 Switchover Deadline

dr_EHR / February 4, 2016

ICD-10 is fully in place October 1, 2015. It will include approximately 80,000 diagnostic codes, unlike the 14,000 in ICD-9. This new system needs a lot more specific coding when documenting patient visits. It will affect both commercial and public third-party payers to either:

  • Revise payments
  • Deny claims
  • Consider the claims

The American Medical Association (AMA) and 99 specialty and state societies made clear their concerns about the ICD-10 to the CMS (Centers for Medicare and Medicaid Services). Their concerns say there could be a multi-billion dollar disruption as there are inadequate contingency measures in place. They are also afraid patients will suffer care issues during the transition.

Readiness continues to be slow as many physicians feel the government will delay implementing the plan again.

It has been delayed once already and many are not too concerned with training staff as they feel it will only get delayed once more. Doctors can receive immediate benefits by learning how to document for ICD-10 now instead of waiting. Improved documentation benefits physicians now in the ICD-9 environment. It will increase their reimbursement and reflect in their outcome and quality metrics.

If there are problems with the testing in September it could cause disasters in October when it goes live.

Two things to help keep revenue flowing are to:

  • Have all doctors keep great notes.
  • Ensure coders are coding correctly.

These two steps alone could slow down or stop revenue if not implemented. If your system gets stuck it could turn normal revenue turnover times from 65 days to 95 days. The worst thing that can hold paperwork up is when you find a coding error in the matrix after you think everything is finished.

Some of your payers may not be able to make the switch over to ICD-10 by October 1, 2015. You will have an option open to you for those payers. On the Practice Default screen there is a setting at Payer level that will replace Practice Defaults setting. From the Insurance Management screen you will be able to set coding for either ICD-9 or ICD-10 for different payers. If you have some that are not ready on October 1st you will have this option for those certain payers.

Make sure you are ready

You should have your EHR ready to begin processing new codes as well as your practice management and billing software company. You should have your payers identified and know if any are not going to be ready so you can make the indication of the Practice Default screen. Being prepared and ready will keep your ENT practice running smoothly throughout the changeover.