ICD-10: Providers brace for disruptions from physicians, payers

Friday, September 18, 2015

YARMOUTH, Maine - About half of the respondents to a recent HME NewsPoll (55%) say they’re ready for the transition to ICD-10 on Oct. 1. The bigger question: Are physicians and payers?

A whopping 70% of respondents say they expect some disruption in cash flow as physicians and payers navigate the new code set.

“(The transition) won’t disrupt cash flow through our fault, but who knows what will happen at the insurance companies,” said Janet Tersoff, billing supervisor at New Hampshire Pharmacy in Washington D.C. “I am concerned about some Medicaid HMOs, which already have problems paying at the right rate and recognizing the right modifiers.”

ICD-10 has 68,000 codes compared to 13,000 under ICD-9, as well as expanded alphanumeric code sets to identify disease etiology, anatomic site and severity.

Respondents like Stanley Saellam say physicians have been dragging their feet on ICD-10 implementation, operating under the assumption that time is on their side.

“They all say they don’t have to worry about it until Oct. 1, so they aren’t helping,” said Saellam, director of WellSpan Medical Equipment in Ephrata, Penn.

In a proactive move, respondent Dionne Franklin has been educating physicians on ICD-10 and asking them to use the new codes.

“I began issuing letters to the physicians for conversion of ICD-9 codes to ICD-10 codes about two months ago for capped-rental items and patients that we have seen in the last six months,” said Franklin, who works at Mobility & More in Loveland, Colo. “Also, I have had the physicians, nurse practitioners and physician assistants put both ICD-9 and ICD-10 codes on all prescriptions for the last two months.”