Life Under ICD-10: Smooth Sailing in the Short-Term


October ushered in the ICD-10 era with a whimper not a bang. As with the much-ballyhooed non-disaster that was Y2K, the nation’s healthcare system neither collapsed nor stumbled under the weight of the expansive new code.

That does not mean the ICD-10 doomsday soothsayers were completely wrong. It may simply be too soon to tell. In a CMS blog published on the day of the transition, CMS Deputy Administrator and Director Sean Cavanaugh noted that it will take several weeks before we have a full picture of the impact because most healthcare providers batch claims and submit them every few days.

“Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states,” he wrote. “Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle.”

An article from the Healthcare Financial Management Association (HFMA) indicates that it has been business-as-usual for many. In the three weeks following the transition, Navicure reported an ICD-10 denial rate of just 1.5% after processing 77% of its clients’ 1 million daily claims. Denials peaked at 2.24% on Oct. 15, 2015 before settling back down to the high end of the normal range. RelayHealth Financial reported denial rates of 1.7% after processing more than $25 billion in claims, and found no apparent change over the previous three months in days-to-final payment, days-to-payment and reimbursement rates.

These results led some to conclude that clearinghouse edits were catching many of the ICD-10 issues before they made it to payer systems. It’s an assumption supported by Navicure’s clearinghouse, where rejected claims reached 4% on Oct. 6 before dropping to 3.6%. That compares to a normal reject rate of 2.5% to 2.9%.

While the immediate aftermath of the transition has been calm, providers are not out of the woods yet. As indicated by CMS’s Cavanaugh, the first real transition pains won’t be felt until payers begin issuing payments. Days-to-bill will also creep up as coders and billers labor under the voluminous new code set, struggling to recapture their ICD-9 speed and efficiency. It’s a change that could spell disaster for practices without the financial wherewithal to withstand even temporary cash flow disruptions.

There are, however, ways to off-set revenue disruptions. One of the most effective is an innovative payment processing system that taps into the power and immediacy of text messaging to rapidly increase cash flow, speed collections and reduce/eliminate appointment no-shows, saving even small practices hundreds of thousands of dollars every year.

The move to ICD-10 will mean a short-term revenue hit for even the most-prepared physician groups and hospitals. Innovative provider organizations can lessen the blow by partnering with vendors that possess the kind of “one-click” mentality that results in relevant solutions designed to mitigate the impact of the new code set on cash flow and create a symbiotic patient-provider relationship.

swerve_health_registeredSwervePay is a cloud based software focused on mitigating many of the issues facing the healthcare industry. Their “one-click” mentality makes the software relevant and easy to not only the providers, but also the patients making for a symbiotic relationship in an industry that has been historically contentious.

SwervePay Health offers cloud-based payment applications that leverage the security of the cloud and the ubiquity of text and email to immediately notify patients of outstanding balances and provide one-click access to an online payment portal. Applications also enable automated payment plans that improve practice profitability and reduce bad debt, as well as electronic statements which help eliminate the cost of collections.