The first two weeks of ICD-10 implementation has thrown up lot more questions than expected. Despite years of preparation, most healthcare practices are still lagging behind with regard to ICD-10 preparedness. Furthermore, sudden and unexpected glitches is making ICD-10 implementation anything but seamless. Experts apprehend that lot more glitches may emerge as we move into the third and fourth week of October.

With this in mind let’s take a look at some of the most glaring disruptions that we have witnessed during the first few weeks of ICD-10 implementation.

1. Lack of Clarity About Specificity

CMS had earlier revealed that it will accept ICD-10 claims as long as the code is in the “right family” during the initial 365 days. But there is still confusion whether private insurers will follow the same directive, as there is no assurance that they won’t require higher degree of specificity for reimbursements. To be on the safer side, healthcare providers are required to follow the highest level of specificity right from the beginning. And this is no easy task, say experts.

2. More Demanding Clearinghouses

Clearinghouses that earlier used to accept unspecified codes have completely revamped their structure. They seem to have thrown out all unspecified codes and have stopped submitting them to insurance carrier altogether. This has put many healthcare practices in complete soup.

3. Difficulty in Carrying Out Eligibility Checks

Several insurance websites went off the grid for the first few days of this month. What this means is that numerous healthcare delivery professionals had to provide care without checking the eligibility of patients.

4. Lack of Training

The focus to gear up IT systems for ICD-10 transition has been so strong, that most healthcare practices have overlooked the need to train their staff to cope with the changes. A majority of the healthcare representatives were unable to answer basic questions related to ICD-10. It appeared they were submitting claims to test the waters. Additionally, problems in submitting patient referrals and the waiting time to reach appropriate insurance providers were some of the other key challenges that dominated the first few days of ICD-10 implementation.

To be fair, most of these disruptions have already been fixed and a few are in the process of being ironed out in the coming weeks. However, the main concern related to reimbursement still persists and will only be answered when the first claims is adjudicated in a few weeks from now.


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