ICD-10: The Sky That Never Fell


Many physicians and medical billing experts predicted that the sky would fall on October 1, 2015, when the United States began using the newest version of the International Classification of Diseases, or ICD-10.

The Department of Health and Human Services first issued a regulation proposing the transition to classification scale in August 2008. After nearly a decade of trying and three delays, clinics and other medical institutions in the United States begrudgingly switched to the new coding system to report medical diagnoses and procedures on October 1, 2015.

Paging Chicken Little

Many physicians and medical groups panicked at the mere thought of transitioning to the new codes. Workgroup for Electronic Data Interchange (WEDI), for example, expressed their concerns about the level of industry preparedness in a March 2015 letter to the Health and Human Services Secretary, Sylvia Burwell. WEDI worried that many organizations had not taken full advantage of the extra time afforded by the March 2014 delay. In that letter, Devin Jopp, Ed.D, president and CEO of WEDI said that, “unless all industry segments make a dedicated and aggressive effort to move forward with their implementation efforts in the next few months, there will be significant disruption to industry claims processing on Oct 1, 2015.”

In July of 2015, the Texas Medical Association (TMA) surveyed physicians in the state regarding their practice’s readiness for "the transition." Ninety-seven of the 936 respondents treated patients in active medical practices and 42 percent were solo practitioners.

Eighty-three percent of respondents said they expected delayed or denied claim payments resulting from the transition to ICD 10. Understandably, physicians facing possible delayed or denied claim payments worried about cash flow problems within the practice. When asked how they would handle cash flow stoppage, 36 percent said they would draw funds from their personal accounts to keep their practice open. An astonishing 30 percent said they simply retire early and 17 percent said they would close or sell their practice. Others said they would reduce employees, curb employee hours or limit benefits. All of these alternatives would hurt the local workforce and reduce patient access to care.

Most of the respondents in the Texas survey – 65 percent – said that they had “little to no confidence” that their practice would be ready at the deadline. Only 10 percent of the respondents said they were “very confident” in the readiness of their practice.

Two surveys   in March 2015 and another in September 2015, show physicians are gaining confidence in ICD-10 preparedness. In response to the question of how the new classification system might affect their business’ finances, nearly a third of the respondents said “very negatively” in March but only 4 percent held that view in September. This means positive expectations have tripled in just six months.

Physicians are also more confident when it comes to rejected claims. In the March survey, 65 percent of respondents said they were “very concerned” about rejected claims immediately after the transition, whereas only 42 percent reported feeling that way in September.

But the ICD-10 Sky Never Fell

Despite eight years of handwringing, the transition to ICD 10 came and went with barely a hiccup for most practices. The Centers for Medicare and Medicaid Services (CMS) issued a statement on October 29, 2015, detailing Medicare Fee-for-Service claims from the first of that month to the 27th. These metrics showed that the number of total claims submitted remained the same at 4.6 million per day and that the total claims rejected due to incomplete or invalid information stayed at 2.0 percent of all claims submitted. The number of claims rejected due to invalid codes dropped and the total number of claims denied increased by only 0.1 percent in October 2015 compared with the historic baseline.

Most certainly, individual physicians, practices and hospitals struggled with the transition, especially in the first few days of October, as practitioners and employees made a mad dash to finish training, upgrade systems and familiarize themselves with the new codes. In some rare cases, clinicians and clinics stayed with ICD-9 and eventually had difficulty providing tests and other necessities of patient care.

In most cases, however, physicians and offices prepared for the transition and have been comfortably using ICD 10 in the weeks since its implementation. Chicken Little can now rest easy - ICD-10 did not make the sky fall.

Sources: wedi.org; texmed.org; cms.gov

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