Navigating the early days of ICD-10

Navigating the early days of ICD-10

Posted on: October 8th, 2015 by claimsworks

How the ICD-10 transition is impacting your healthcare world likely depends on two things – what type of organization you’re part of, or own, and the steps taken by you and your team, as well as your payers, billers, and EHR vendor to prepare for the changeover.

Early reports indicate that many private practices and small groups, who are quite dependent on the preparations of EHR vendors, billers, and payers, have done everything possible to prepare by training everyone involved in documenting, coding, and billing (if they’re doing billing in-house). Many providers have also created financial buffers to mitigate any slowing of payments and diminished cash-flow.

We’ll be getting more feedback this week at the IPMA Conference – and will be sure to post updates next week about what we hear from DPMs and their teams.

While CMS has established a one-year grace period that ensures claims will be processed for payment as long as the codes are in the correct category (originally “family”), the commercial payers may not be as “gracious”. Early reports do indicate that some major payers are indeed having problems with some ICD-10 related claims. How widespread this will become, and what impact it will have on your practice’s cash-flow remains to be seen.

Here’s a few action steps to consider that can help move your practice quickly through any transition bumps while minimizing negative impact on your operations:


  1. Prepare for reduced cash-flow and slower reimbursements – most likely you’ve got that in place.
  2. Make sure you have increased focus and review of your claims denials – spotting any troubling trends that will help you resolve the most critical issues now so they don’t grow into significant problems. At a minimum, keep a sharp eye on:
                  a) Denial rates (by payer)
                  b) Reimbursements vs. contract rates
                  c) Days in Accounts Receivable (by payer)
                  d) Amounts denied (by payer)
  3. Be prepared for to quickly respond to an increase in requests for additional documentation.

While there are several key ICD-10 issues that physician practices can manage effectively, there are a few external dependencies, such as billing service providers and EHR systems, which may require quick action. If you see early indications that your EHR software or billing services provider aren’t managing the change effectively, then you’ll need to decide if it’s time to make a change or stick with them as they get their ICD-10 house in order.

Our EHR system has been ICD-10 Ready since 2013, so contact us if you’d like to learn more or arrange a demonstration. We can also provide a Free Practice Analysis to help you identify opportunities to improve your practice’s profitability and streamline workflows.