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

Policy & Regulation News

86% of Physicians Say ICD-10 Diverts Focus from Patient Care

By Jacqueline DiChiara

- With ICD-10 – the tenth edition of the International Classification of Diseases – implementation now a tangible reality as the healthcare industry enters mid-October, questions about ICD-10’s detrimental patient impact are beginning to emerge.

icd-10 codes reimbursement payment patient care

As reported, technical difficulties, coding snafus, and payment snags stemming from ICD-10 implementation aftermath may now be causing physicians to divert much needed focus away from patient care and onto more trivial, vapid matters, such as spending valuable time waiting to get someone on the phone only to still have questions unanswered and time spent keeping a patient waiting while trying to sort through correct codes.

Eighty-six percent of 200 surveyed physicians confirm ICD-10 implementation is negatively impacting patient care, says a SERMO poll. To help more clearly understand what is not working to hopefully shed more light onto what may work in the future, here is a brief collection of what some physicians have said regarding their primary ICD-10 implementation struggles in regard to maintaining high care quality.

Physicians claim loss of time, heightened confusion

A three-hour wait time to get through to an insurance company “is not unusual,” says one surveyed physician. Once insurance companies are reached, they are unable to answer ICD-10 related inquiries, says another. The solution is simply “submit and we will see.”

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Says a physician in allergy and immunology, “It wastes too much time, decreasing the number of patients I can see a day. I am now having to schedule some return visits farther out than is ideal as a result. Waiting time for new patient appointments is longer.” 

Says a pediatrician, “I recently saw a young man as a follow up from a car accident. Under the old [ICD-9] I would type ['motor vehicle'] and get the choices, ['passenger'] and ['driver.'] With the [ICD-10,] I typed ['motor vehicle,'] the first 20 choices were 3 wheeled vehicles and all different descriptions. I took a couple of minutes to find the right code." According to this individual, there has been no perceived improvement in care quality.

Technology glitches still require ironing out

Payer sites were inaccessible merely because “they were updating,” confirms one physician. Another says technical difficulties caused a local Medicare carrier to shut its doors for an entire week. A third surveyed physician says referrals for his or her largest payer were unable to be completed because the online referral system continues to reject ICD-10 codes. 

Paperwork and charge entry too cumbersome, the payment game continues

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Says one physician, “I used to enter my own charges. I quit on October 1st and now my biller is doing it. I used to bill every day [and] we are now 3 days behind.”

Says another physician, “It takes a gazillion [hours] to fill out the lab requisition forms looking up new and useless codes.”

Says a third physician in family medicine, “Right now it’s about an extra 60-80 minutes per 12 hour ER shift. Each diagnosis that used to be in the chart from past encounters can't be 'checked off', it has to be re-translated to ICD-10 by the person making the first post 10/1 encounter, which for the next few months will oftentimes be the ER physician. 2-3 sets of multiply nested boxes to filter through per patient, 15-30 times a shift.”

Says a fourth physician, “I expect the [third] parties and government to reduce our reimbursements using [ICD-10] and citing quality measures (which they will set to maximize their own profits).” 

Considering the flip side and the remaining 14 percent

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What about the 14 percent of surveyed physicians who are experiencing smooth sailing of sorts post ICD-10 implementation? As reported, larger healthcare practices may be outperforming the smaller ones as the former generally have a larger coding and billing staff.

According to yesterday’s report from Forbes, post October-1st ICD-10 aftermath has resulted in a “smooth rollout” for medical coders and health insurers. An abundance of time has perhaps proven beneficial. Others point to the simple fact that “almost everyone” submitting claims is doing so without a hiccup.

In light of this news, four state Medicaid agencies – California, Louisiana, Maryland, and Montana – confirmed last month they are simply not prepared for ICD-10 implementation, as reported. Predictions swirl that others may soon follow in their ICD-10 crosswalk footsteps.

Nonetheless, the greater implications of the SERMO survey perhaps merely provide an isolated snapshot of what is yet to come. Although it may still be a tad too early to adequately assess ICD-10 aftermath, will continue to stay a step ahead of the curve as October, November, and beyond unfold.


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