ICD -10. What does the Voice of the Customer say?
The October 1 transition to International Classification of Diseases and Conditions Volume 10 (ICD-10) is a big deal. But how do customers of radiology business management solutions actually feel about the switch on the eve of implementation?
Merge Healthcare used its 2015 client conference in San Diego as an opportunity to ask its customers just how concerned they really were about their ability to manage the switch to ICD-10 coding.
In an informal poll in one session, about half of the attendees indicated they were more than 80 percent ready for ICD-10. Another 40 percent felt they were 50 to 80 percent ready. Only 10 percent said they were less than half ready. Furthermore, no one thought another delay was likely at this point.
More than one Merge conference attendee predicted the concern about the change to ICD-10 might have a similar outcome to the concern about the Y2K computer bug in late 1999. In other words, although the concern is based on some legitimate possible problems, the industry may be erring on the side of over preparedness.
Among the Merge attendees, the main concern was not the switch itself, but rather the interim period following the switch where they will likely have to use both code sets for billing. Most payers will require ICD-10 codes for payment, but it is expected that a number of payers will still require ICD-9. This dual coding could take place for a long time, especially for the Merge customers who currently bill the four state Medicaid payers that were given an extension, or who deal with many workers compensation claims.
Dual coding adds complexity to the coding process, and requires a billing and financial system that can automate the workflow for applying the right code set to the right payer. When coders are entering charges in Merge Financials™
, for example, there is a system setting for each insurance plan that identifies the required code set. If they have patients with Medicaid in any of the states where ICD-10 implementation is delayed, they will be alerted when ICD-9 is required. The system works the same when submitting claims to entities not covered by the Health Insurance Portability and Accountability Act (HIPAA), such as worker’s compensation claims, which were not required to switch this year.
“Most people feel that, at this point, they are as prepared as they can be until they start seeing feedback from the submitted claims,” says Shannon Marshall, Solutions Manager for Radiology Workflow at Merge. “Our systems are prepared to handle the coding and are set up to output the correct information on the insurance claims, so our customers are comfortable with what they need to do.”
Another confidence-boosting factor was the CMS announcement to hold denials of any Part B billing based solely on ICD-10 coding errors, as long as the code indicated on the claim was in the right family of codes. Other payers may not be as lenient when it comes to coding errors the first year, but knowing that there is at least a grace period from CMS seemed to resonate with Merge customers.
Merge, a leading provider of innovative enterprise imaging, interoperability and clinical systems that seek to advance healthcare, is a long-time RBMA supporter and a 2015 Thought Leader sponsor. Learn more about Merge’s radiology business solutions
on its website.
This blog post was originally published on the RBMA “Let’s Talk” blog. Read the original blog post.