Electronic Health Records

Policy & Regulation News

93% of Healthcare Professionals Fear ICD-10 Payment Delays

By Sara Heath

As ICD-10 implementation draws nearer and nearer, a resounding majority of physicians are expecting payment delays, according to a recent poll conducted by the physician social media group SERMO.

icd-10 causes some physicians to expect payment delays

SERMO found that 93 percent of 537 respondents anticipate a delay in payment despite the Centers for Medicare & Medicaid Services’ (CMS) ICD-10 grace period. Furthermore, the poll found that 91 percent of respondents anticipate payment delays even after the 1-year grace period has ended. In preparation for those expected delays, SERMO reports that nearly two thirds of respondents have taken out a credit line.

SERMO also reported some mixed opinions from healthcare professionals in various specialties. Some believe payment delays will stem from private payors in addition to CMS.

“The point, though, is that I think the private payors will use this as an excuse to delay payment, even if you think you billed it correctly with your green triangle and everything,” one neurologist says.

Others believe that ICD-10 is simply an unfeasible transition for the average practitioner.

“The whole thing is doomed to fail,” says one allergist/immunologist. “The average clinician doesn’t have the time to wait for the computer to process all these extra codes.”

However, SERMO reports that other healthcare professionals are approaching the transition with a little more optimism, acknowledging that much of ICD-10’s success will depend on clinician cooperation.

“There is no question this will be a difficult transition for some, especially those who really don’t want to make it,” says one radiologist. “Yes, there will be glitches, theirs or ours, that will cause some problems. The idea is to help overcome those problems… Guerilla actions by the medical community will only make things worse. We should be committed to making the transition and make it as painless as possible.”

According to a recent question and answer conference call hosted by CMS, the agency is ready and willing to cooperate with and act as support for physicians during this transition period. Specifically, CMS is confident in its support staff and Medicare administrative contractors. Additionally, the agency has appointed an ombudsman, William Rogers, MD, to deal with any serious concerns.

However, CMS reports that it will not know how ICD-10 is going until approximately one month into the transition because it takes several weeks to process claims. After the approximate one month mark, practitioners should be able to determine how long claims will take to be processed, whether or not there will be delays, and how the process will work with dealing with errors and other issues.

Furthermore, CMS reports readiness on the part of practices. According to a July report, approximately 87 percent of ICD-10 test claims were accepted by the agency. CMS also reported that a majority of the rejected claims were due to issues other than ICD-10 coding. However, because this test only included a sample of 1,200 providers, it does not provide a good look into what the payment delays process may work out.

Continue to site...