Some 32 years after work began on developing the International Classification of Diseases 10th Revision of diagnostic and procedural codes, most providers, many with fingers crossed, jumped off the ICD-10 pier at midnight Thursday.
And by most accounts, the first 12 hours have gone off without a hitch.
“I think, by and large, at least the people we've worked with, they have done so much preparation that they're eager,” said Ed Hock, managing director and ICD-10 guru with the Advisory Board, a healthcare consultant. “I've yet to hear any horror stories.”
Health information technology cognoscenti predict most providers of size—large hospitals and health systems, large physician groups and large health plans—will swim right along in a sea of far more numerous, complex and very specific new codes.
If larger organizations experience cramps, they likely appear later as kinks in their cash flows caused by delays in reimbursements.
And after three government-induced delays totaling four years, most providers should have been ready.
The organizations most likely to have trouble, however, are smaller providers and health plans, which for several reasons lagged in implementing IT upgrades and training to handle the more robust ICD-10 codes.
Relative calm has defined the early atmosphere among several insurers. Debra Cotter, the ICD-10 project director at Highmark in Pittsburgh, said her company has been performing quality checks since midnight.
“All is going well,” Cotter said. “We have seen our first claims submitted in ICD-10, and we have finalized a couple claims already. So we're excited to see the years and years and years of work actually in practice.”
Highmark, a Blue Cross and Blue Shield plan with 5.3 million members, has prepared for the switch to ICD-10 since 2010 and has conducted routine testing of claims with providers for more than a year. Due to Highmark's large size—it processed more than 114 million healthcare claims last year—Cotter said it had to start thinking about ICD-10 early on.
But the new code set does not mean ICD-9 will be immediately buried in its grave. ICD-10 codes are required for all dates of service on or after Oct. 1, 2015. For people who saw their doctor or were admitted to a hospital more recently, like Sept. 30, those claims will still have the ICD-9 language.
Cotter said Highmark will be ready to juggle both coding systems at the same time. “We believe the industry is really ready and embracing the fact that ICD-10 is finally here,” she said.
Dr. J. Mario Molina, CEO of Molina Healthcare in Long Beach, Calif., a publicly traded insurer that mostly offers Medicaid managed-care plans, said claims operations at Molina have been status quo so far. Molina's business processes have been ready for ICD-10 for more than a year.
At Security Health Plan, a smaller 230,000-member payer owned by Marshfield Clinic in Wisconsin, the immediate impact of ICD-10 won't be felt until later Thursday night and next week. Security will receive its first claims files this evening for any services that were provided today, said Sara Foemmel, Security's claims operations director.
Few hiccups are expected. “We've tested a tremendous amount with all of the providers,” Foemmel said.
The same holds true at Blue Cross and Blue Shield of Louisiana. But insurers can't rule out potential delays in payment if codes aren't submitted properly.
The American Medical Association, numerous state medical societies, and other physician groups had fought the conversion for years, almost to the bitter end. The AMA didn't throw in the towel until July, cutting a deal with the CMS in which physicians were given one year's worth of wiggle room via a pledge by the agency not to bounce Medicare claims incorrectly coded.
According to Stanley Nachimson, the principal of Nachimson Advisors, a health IT consultancy, the ICD-10 brinksmanship has consequences. “A lot of docs are panicking at the last minute,” he said.
Nachimson said the first problems probably won't surface until Monday or Tuesday, when the nation's first round of rejected ICD-10 claims are processed.
“There was only a very small percentage of providers doing any testing” of their revenue-cycle software and processes leading up to Thursday's start date, so, for many of these providers, moving the claim even that far is a big unknown, he added.
After that, he said, another round of glitches could come from the payers—Medicare, Medicaid and commercial—which implemented their own software applications to handle the new codes.
The CMS insists its claims-processing contractors are ready.
“We've tested and retested our systems in anticipation of this day, and we're ready to accept properly coded ICD-10 claims,” Sean Cavanaugh, deputy administrator and director of the Center for Medicare and Medicaid Services, said in a blog post Thursday morning welcoming providers to ICD-10.
“ICD-10 will help move the nation's healthcare system to better, smarter care.”
But, according to Cavanaugh, even the CMS won't know for sure how well the transition to ICD-10 is going for a while.
“Most providers batch their claims and submit them every few days," he said.
Even after submission, Medicare claims take several days to be processed, and Medicare—by law—must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states.
Robert Tennant, policy director of Health Information Technology at the Medical Group Management Association, said his organization would survey its members in a few weeks on their experiences.
While many have said the ICD-10 conversion would be another Y2K, where Americans braced themselves for a technological meltdown at the turn of the century that never happened, this might have a more recent reference point.
“Remember the exchange site?” said Russ Branzell, president and CEO of the College of Healthcare Information Management Executives, a professional association of chief information officers, recalling the disastrous launch of Obamacare's enrollment website, Healthcare.gov. “It's not that it didn't work in concept, it was in volume. You may or may not know the issue is there until there are tens of thousands or maybe hundreds of thousands of claims not getting through.”
For Monique Fayad, CEO of ICDLogic in Harrison, N.Y., business is booming. Her nearly 3-year-old company developed a Web-based clinical documentation guide for physicians.
“I think that people have literally woken up in the last couple of days,” Fayad said. On Wednesday, ICD-10's eve, “The traffic to our website and the downloads to our demos increased 10 times the average for the quarter.”
Repeated delays of the ICD-10 launch have been a nightmare for Fayad. “For three years we've been waiting for this. It's been so long and drawn out,” she said. Now, it's like Valentine's Day at a chocolate shop.
Bob Herman and Maria Castellucci contributed to this report.
