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CA Providers Report Smooth Transition to ICD-10

By Doug Desjardins  
   November 10, 2015

The primary concern had been that providers would have multiple claims bounced back from insurers due to errors or unspecified codes. And while that's happened to some degree, it hasn't created widespread problems.

This article originally appeared in California Healthfax.

California providers reported few problems with the transition to ICD-10 in October and a minimal number of claim denials linked to coding errors.

"We've heard about a few issues with providers having claims rejected but nothing on a large scale," said Molly Weedn, associate vice president of public affairs for the California Medical Association. "And the few instances we've heard about where there are coding issues, they've been resolved pretty easily between the physicians and insurers."

There were a number of concerns in the run-up to ICD-10 and its more detailed system of codes. The primary concern was that providers would have multiple claims bounced back from insurers due to errors or unspecified codes. And while that's happened to some degree, it hasn't created widespread problems.

One the state's largest medical groups, Brown & Toland Physicians, said there was "nothing really to report" in terms of problems with ICD-10 coding. "We did a lot of education with our doctors—more than a year's worth—and the doctors on our EHR system had less to worry about since the system was updated to ICD-10 codes," said Richard Angeloni, director of integrated marketing and communications for San Francisco-based Brown & Toland.

Other states are also having a smooth transition into ICD-10. Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians (AAFP), said she's heard about some problems but nothing widespread.

"We're not hearing about any catastrophes," said Hays. "We're hearing about some claims being rejected because they're missing vital information or because they listed a condition as unspecified."

Hays said concerns about the new coding system being too labor intensive for clinicians and physicians have been justified to some degree. "Before the launch of ICD-10, physicians were worried that they'd be up until 2 a.m. doing paperwork," said Hays. "But from what we're hearing, physicians are only taking an extra two or three minutes per patient [for paperwork]."

Hays added that some coding problems appear to be linked to certain electronic medical record systems. "We're hearing that some EMR systems are not doing as well as others and that the whole claims process is taking longer," said Hays.

Both the CMA and AAFP credit a yearlong program of training and testing leading up to the rollout of ICD-10 for the smooth transition. "We did a lot of work with our members leading up to the transition and that work seems to have paid off," said Weedn.

The Centers for Medicare & Medicaid Services (CMS) reported that only 10.1% of Medicare and Medicaid claims were denied during the first four weeks of October, just slightly more than the average rate of 10% of claims denied in a typical month.

"CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally," CMS said in a statement. "During the first four weeks of October, 2% of all claims were rejected due to incomplete or invalid information and less than 1% were rejected due to invalid ICD-10 coding."

The California Department of Health Care Services (DHCS) said it's rejected a minimal amount of claims due to ICD errors since October 1. "DHCS has determined that an average of less than 1% of claims are being rejected for ICD-10-related errors," said DHCS spokesperson Carol Sloan. "The errors on the rejected claims are due to providers billing by using an incorrect code set or an incorrect ICD-10 indicator." She added that provider calls and questions regarding claims in October "have been consistent with historical baseline data."

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