Electronic Health Records

Policy & Regulation News

ICD-10 Implementation Smooth for Larger, Private Insurers

By Sara Heath

Despite considerable apprehension prior to ICD-10 implementation, many larger insurers are experiencing a relatively smooth transition to the new medical code set. A variety of news outlets and industry sources are reporting little disruption for payers, which may be a hopeful sign for providers worried about the financial impact of the ICD-10 switch.

According to a Forbes article written by Bruce Japsen, many large, private insurers are seeing steady submissions of claims that are mostly accurate.

The article describes the transitions for major, private health insurers such as UnitedHealth and Humana, both of which report that the transition is going successfully. According to the insurers, the multiple implementation delays have been a considerable help.

Humana said very few calls have actually been made to the insurer regarding coding questions. Japsen reports that “only 0.03 % of all calls from providers regarding benefits, claim status, spanning date of service, and authorization.” Furthermore, Japsen reports, the insurer is seeing success with claims submissions.

“We are about ten days into this and already have 50% of our claims coming in. Almost everyone who is submitting claims is getting it right,” said Humana’s ICD-10 implementation team head Sid Hebert.

The ICD-10 transition is going almost as well at UnitedHealth, Japsen reports. According to UnitedHealth’s vice president of regulatory implementation Ross Lippincott, the insurer is receiving its usual number of claims. However, not all of these claims are correct, Japsen reports. UnitedHealth is experiencing a “slight uptick” in denials in the wake of ICD-10.

However, Japsen added that perhaps no news is good news with regard to potential ICD-10 catastrophes. According to the Medical Group Management Association’s (MGMA’s) health IT policy director Robert Tennant, it would be clear by now if larger insurers such as Humana and UnitedHealth were not ready. Therefore, the fact that no large news stories have cropped up may indicate that insurers aren’t facing any notable challenges.

Despite larger insurers’ successes with ICD-10 implementation, small practices have been reporting mixed reviews. According to a Crestview News Bulletin article written by Brian Hughes, many physicians and coders report that ICD-10 is a major hindrance on their practice. Coders report that the added specificity of the code set requires a cumbersome amount of extra work.

“It requires so much extra work. If my doctor treated someone for rheumatoid arthritis, there’s hundreds of codes. It’s got to be specific,” Betty Jordan, the manager of physician practice for Abdul Mir, MD, told the Crestview News Bulletin.

However, practices in Maine are experiencing more luck with the transition. According to an article from the Bangor Daily News written by Jen Lynds, healthcare professionals have used the multiple delays as time to perfect their ICD-10 transition approach. Lynds reports that many practices have seen a smooth transition, but are prepared for a decrease in productivity due to the new code set.

Other practices, like the ones in Southern Illinois, are seeing a smooth transition, but are feeling its negative effects financially. An article from The Southern Illinoisan written by Nick Mariano explains that Illinois hospitals have put hefty financial investments into their ICD-10 implementation success.

“The change has meant a roughly $2 million investment for Southern Illinois Healthcare, covering the cost of software updates, training, added staff and outsourcing to comply, said Marcia Matthias, corporate director of health information management for SIH,” Mariano reported.

Mariano also reported that SIH is concerned for productivity changes, as well.

Many practices may also feel the financial impact due to delays in payment. According to a SERMO poll conducted prior to the October 1 ICD-10 deadline, 93 percent of physicians feared major payment delays as a result of the transition. Although there are scarce reports regarding payment delays, the end of a billing cycle may soon confirm whether those fears were justified.




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