ICD-10 key effects on providers, reimbursements and payers

Z23 is the ICD-10 billing code that is used for an immunization encounter. This is the mere code that stumped the team at Arlington, Virginia-based Privia Health, a national medical group.

Maureen Clancy, vice president of revenue cycle management at Privia Health claims, “It is very usual code”. What was reason of such hype and noise? Everyone considered that an ICD-10 code should have more digits in contrast to ICD-9 code. But Z23 has contains only 3 characters.

Along with other healthcare providers and payers – Privia health - founded the issue when claims were getting rejected, she states.

Yet, Clancy asserts that the issue was fixed within few days. Subsequently, the expected melodrama that was ICD-10 was really a “non-event.”

Clancy contends that it took many years and hard work for her billing team to get ready for ICD-10. They entire team spent several weeks to learn out the ICD-10 Guidelines code set, and 9 months giving one-on-one, specialty-specific training for the medical group’s more than 600 physicians. The whole administrative staff at Privia Health also took much time to get trained.

On the day of October 1, 2015, the transformation to ICD-10, the medical group made available a hotline phone number for contributors to deal any queries. Clancy elaborated that the manned 12 hours a day for a couple of weeks; the hotline got very few calls.

On the other hand, Privia Health is primarily a primary-care group; it involves neurologists, cardiologists, endocrinologists, and OB/GYNs. “Few specialties were hit harder [by ICD-10] in contrast to others,” claims Amy Waller, coding education and audit manager.

Health policies and ICD-10

It was very similar experience for major health policies, huge hospitals, and integrated delivery networks throughout the West Coast to get transition to ICD-10, states Stephen Linesch, senior vice president of administration and development at CAPG, a trade association for physician agencies around the country.

At a recent quarterly meeting, he inquired over their experience with ICD-10. Their reaction? The entire experience has been “operationally very smooth,” which means that there have been no interruptions, operational setbacks, or delays because of the migration to the latest code set.

Many respondents compared the whole experience of transition with the “Y2K moment,” when everyone thought that the technology mishaps would appear when the year switched from the time period of 1999 to 2000, asserts Linesch. There were no major impacts—with Y2K or with the transformation to ICD-10 instead of much stress and preparations.

Several payer and provider agencies made key investments in training, IT systems, and auditing within the Privia Health, says Linesch, further adding that those investments might be what made the transformation to ICD-10 a very smooth one so far.

Reimbursement assumptions

It is still very vague how the upcoming years will play out with claims and ICD-10. Waller ensures that she checks claims on routine basis and has seen no key affects within the new code set.
Payers discussed about their experience with the ICD-10 agree.

The senior director at Aetna, Stacie J. Watson, cautions tolerance and patience as we wait to analyze how the transition will impact the industry. “It is too early to completely understand what affect, if any, the transformation to ICD-10 may have,” she states. “To monitor any such impacts, we’ll be using operational and financial reporting.”

The experience at the organization of Cigna has been similar. “No major impact on reimbursement has been observed yet, but it is too early to tell. We are still in the position of assessing and will know more later this year,” claims Mark Slitt, a spokesperson for the payer.