WEDI-Con: Physician practices encountering some hurdles during ICD-10 transition

While the first month of the ICD-10 transition has gone relatively smoothly, per both an update from the Centers for Medicare & Medicaid Services released Oct. 29, and hospital and payer stakeholders speaking at a conference a day earlier, physician practices have run into a few issues, according to Robert Tennant, director of health information technology policy at the Medical Group Management Association.

Through Oct. 27, according to CMS, total claims submitted remain consistent with the historical baseline at 4.6 million per day. Total claims denied are up slightly (10.1 percent of total claims processed vs. 10 percent of total claims processed).

Other statistics from CMS include:

  • Total claims rejected due to incomplete or invalid information: 2 percent of total claims submitted
  • Total claims rejected due to invalid ICD-10 codes: 0.09 percent of total claims submitted
  • Total claims rejected due to invalid ICD-9 codes: 0.11 percent of total claims submitted

Speaking at the Workgroup for Electronic Data Interchange's annual conference in Reston, Virginia, Oct. 28, Tennant, along with several other provider, payer and vendor representatives, outlined implementation progress, to date. Tennant said he's cautiously optimistic, but there also have been challenges.

"I don't think we're quite there yet in terms of our knowledge base, certainly on the adjudication side," he said.

Tennant (pictured left) said he's heard that some of the ICD-9 codes on claims for dates of service prior to Oct. 1 were getting rejected, sort of a "hard edit" coming in from some of the health plans. "I think generally, we've heard that there have been very few problems on the commercial side of insurance," he said. "It's really more on the [Medicare Administrative Contractors] side, and I'm guessing perhaps some on the Medicaid side."

He also noted there have been some challenges related to screening services such as colonoscopies that are coming in with generic codes and being rejected. Tennant said those are being recognized by not all, but some MACs, and practices are being told those claims need to be resubmitted.

Additionally, he said he's heard about some problems with nonpayable diagnosis codes.

"We're hearing that there are some delays in payments," Tennant said. "Some MACs are holding the claims beyond 14 days," although he noted that in some states, law allows claims to be held for 30 days.

Conversely, Ross Lippincott, vice president of provider regulatory programs at UnitedHealthcare, and Laurie Darst of the Mayo Clinic, both said they've experienced a minimal number of hiccups, and nothing that could not be dealt with same day.

"It's really been a nonevent so far," Darst said, although she added that it will take another month or two for the dust to settle.