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

Policy & Regulation News

93% of Docs Expect ICD-10 Payment Delay Despite Grace Period

By Jacqueline DiChiara

- With ICD-10 implementation kicking off tomorrow, October 1, 2015, the upcoming transition is generating severe physician trepidation about the possibility of payment delay, according to this week’s SERMO poll. Ninety-three percent of over 500 surveyed physicians confirm delays in payment later this week – despite an announcement of an ICD-10 grace period – according to yesterday’s email correspondence with SERMO. Sixty-seven percent of over 300 responding physicians confirm they have taken out a line of credit to prepare for possible ICD-10 based payment delays, said SERMO. Additionally, a reported 91 percent of physicians expect payment delays following the end of the ICD-10 grace period. 

Ninety-three percent of 500+ surveyed physicians confirm delays in payment later this week – despite an announcement of a grace period – says SERMO.

To dive deeper into the significance and greater implications tied to SERMO's ICD-10 implementation results via a physician's perspective, chatted yesterday via email with Linda Girgis, MD, FAAFP, physician and SEMO member. Says Girgis, everyone has no choice but to be officially caught up to ICD-10 speed. How do physicians generally perceive ICD-10 implementation?

Dr. Linda Girgis: Most doctors do not see the benefit of switching over to ICD-10. There is no evidence that it will improve patient outcomes or serve any clinical advantage. In fact, it will take time away from direct patient care time as we try to spend time coding the encounter visit correctly. It stands as a big detriment in patient care. Commercial and governmental insurance companies now have a means of capturing data on patients. Do we really want this?

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  • Based on poll data, payment delays are highly anticipated across the healthcare industry. What do you anticipate happening once October 1 hits in terms of the impact of revenue cycle?

    LG: I truly hope payments go smoothly. I have been ICD-10 ready for months. However, some insurance companies are working out glitches in their systems. In order for payments not to be delayed, there needs to be a smooth work-flow between practice management software, clearinghouses, and insurance company sites. These all need to map correctly for the billing process to work.

    We are going to see many mapping errors in the first few weeks, which will delay billing. Once we work out the problems in the interoperability process, then we have to be sure we are billing codes that are covered by the insurance companies. There is a lot of room here to deny claims, especially as we are all on the learning curve. My prediction is we won't see global delays in payment but only isolated cases, whether with specific insurance companies or through IT deficiencies. I don't expect revenue to be delayed longer than a few weeks, if at all. What are the greater implications of physicians taking out lines of credit to finance their practices? Generally speaking, is this an intelligent move or a setup for failure?

    LG: It is not a bad idea to take out a line of credit, but it should only be drawn on in case of true emergency. As overhead costs soar and reimbursements decrease or stagnate, a doctor who digs him/herself into a hole will have a very hard time digging his or her way back out. However, a line of credit often has a lower interest rate than taking out a loan to pay for a piece of equipment or leasing.

    If a doctor is purchasing an expensive piece of equipment, it would be helpful to compare interest rates so having a line of credit can save on interest payments. I have had a line of credit at my bank for more than 10 years. I have never borrowed from it. But, it is there if I ever need it and I won't be stuck taking out a high interest loan if an urgent need ever arises in the practice. What do you think will happen once the grace period has ended? Will the industry be caught up by then?

    LG: Once the grace period has ended, everyone has no choice to be caught up to speed. Everyone will be billing ICD-10 and learning how to do it the right way whether we like it or not. I do know a few doctors changing to DPC (Direct Patient Care) models just so they don't have to deal with ICD-10 and insurance companies anymore and we will see a great increase in this. I think the industry will be caught up but not so sure the practitioners will be. 


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