Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

13M ICD-10 Claims “Successfully” Processed, But What’s Next?

By Jacqueline DiChiara

- As the first three weeks since ICD-10 implementation kicked off on October 1 unfold, alleged signs of positivity are being reported. Over 13 million institutional and physician ICD-10 claims valued at over $25 billion have “successfully” been processed since October 1, 2015, according to RelayHealth Financial. Such reported claims were processed among over 2,400 hospitals and 630,000 healthcare providers.

ICD-10 claims management RelayHealth

Gearing up for what comes next along the ICD-10 horizon is of utmost importance for industry-wide reimbursement survival. The next best step may be focusing on the art of accurate and expedient reimbursement matters. Says Joshua Berman, Director of ICD-10 at RelayHealth Financial, within a press release, “Claims are flowing successfully, and now the industry must be ready to tackle the next set of challenges: timely and correct reimbursement.”

As Berman predicted last year to EHRIntelligence.com, it was a “real possibility” for every claim submitted to be rejected on October 1, regardless of acceptance and rejection rates.

Berman pointed to the importance of collaboration among healthcare organizations and providers and transparency with trading partners to ensuring ICD-10 implementation success. No technology can easily crack the ICD-10 preparation code, said Berman.  “Think big and plan for the worst,” he advised, additionally maintaining the best defense is simply a strong one.

In light of this month's "successful" results, Berman maintains the Days to Final Bill piece of the ICD-10 puzzle is one specific area to monitor closely within the short term. Such indicates whether or not healthcare providers are effectively generating ICD-10 claims as was done prior to October. Berman maintains imperative focus on Days to Final Bill is required if this number drops without recovery.

Echoing these concepts, said Mike Hourigan, Director of Regulatory & Compliance at Cerner Corporation, to RevCycleIntelligence.com, everyone across the healthcare industry must work together with efficiency if revenue cycle goals are to be met and exceeded. The mitigation of physicians’ widespread payment delay anxiety comes down to evaluating and defining ICD-10’s overall impact throughout October, he maintained. Collaboration is essential to success, stated Hourigan, since ICD-10 will likely be a fairly perpetual entity instead of a more fleeting episode.

In light of RelayHealth’s data, it is perhaps still unknown how exactly payment issues among healthcare insurers are unfolding. According to RelayHealth's ICD10Central website, the number of days until final bill averages out to over 14 days since the start of October. Additionally, the reimbursement rate – the percent of total charges to be collected, excluding self-pay patients – from October 1 to October 20 is listed as over 28 percent.

Nonetheless, the majority of these claims were processed via the now antiquated ICD-9 system. As the life cycle of a medical claim contains many steps, many ICD-10 payment cycles have yet to finalize.

As the Healthcare Information & Management Systems Society (HIMSS) stated to RevCycleIntelligence.com last March, the healthcare industry needs to spend October operationalizing and making sure organizations and businesses continue to run smoothly post-October. Resultantly, ICD-10 will strengthen the fabric of the industry.

Said HIMSS, physicians will hopefully experience a decrease in the amount of documentation time required to process a claim. HIMSS predicted a streamlining of claims and a decrease in pending and rejected claims once a bit more time passes.

Focusing on your pending claim level within October, HIMSS stated, especially in terms of the past year or so, is imperative. Algorithms and the like can serve as useful predictors of what may come next around the ICD-10 bend.

Irregularities within reports require special focus with appropriate parties in October so such issues can be expediently resolved, HIMSS maintained. Catching abnormalities well before they become threats, said HIMSS, is perhaps one of the most promising goals at this stage of the ICD-10 game.

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