March 7, 2016

Latest Results: HBMA’s ICD-10 Benchmark Survey: Three Rev Cycle Companies Shuttered


In February, the Healthcare Billing and Management Association (HBMA) surveyed its members seeking information on current claims statuses as well as their experiences with ICD-10 implementation. Many responses were as predicted, some were consistent with other industry reporting, some confirmed what we already knew, and there were some surprises. This was not a statistically valid survey. However, we believe the survey is a valid snapshot of the revenue cycle industry. Thirty-eight billing companies responded; on average, that represents 13 to more than 15 million claims per year. Consistent with past discussions with key industry stakeholders, not all companies were able to answer all questions at the time of the survey. Regarding coding questions in particular, not all revenue cycle companies provide coding services.

Furthermore, our survey did not mirror other stakeholder reports by indicating that no problems were encountered with ICD-10 implementation. In fact, 22 companies reported that they experienced up to a 10-percent increase in denied claims from pre- implementation. Only eight companies reported no increase in denials.

While 12 companies reported no change in pending claims adjudication, 17 reported up to a 10-percent increase in such claims. Seven companies reported an increase of greater than 10 percent. In addition, 15 companies reported increased requests for medical records, but 12 reported no increases. There was essentially a tie between companies reporting no change in the number of days from claim submission to adjudication (14) and the number of companies reporting delays of 1-14 days (13). 

Specialties appear to have had significantly different experiences to date. Specific to the issues identified above, anesthesia, primary care, and radiology experienced more problems than oncology, which reported none, or emergency medicine and pathology. Five companies reported issues with surgical specialties. Half of the companies responding reported issues with a variety of other specialties. Given the known issues with errors in national coverage determinations, some specialties have had significantly more issues with Medicare claims than others. Our companies reported a very wide scope of commercial payors with issues. In addition, various Medicaid plans were reported as having adjudication problems. 

Twenty-two companies reported that coding productivity is still up to 25 percent beneath levels recorded prior to ICD-10 implementation. Seven companies reported no decreased productivity. Seventeen companies made no changes in coding, five hired more coders, seven outsourced coding, and nine added automated coding tools. Fourteen companies reported that coding accuracy was the same as pre-implementation. Eleven reported that it is more accurate, seven reported that it was somewhat less accurate, and two companies reported a significant increase in coding errors.

Nine companies reported issues with various payors denying unspecified diagnosis codes. Eighteen companies reported an increase of up to 10 percent in coding error denials. A dozen companies reported no increase, and two companies reported a decrease in coding error denials. 

Five companies reported that a code assist product failed successful implementation. Four companies reported electronic medical record/electronic health record (EMR/EHR) failure, two reported outsourced vendor failure, two reported billing software failures, and three reported clearinghouse issues. Nineteen companies reported no such issues. Sadly, it was reported that three revenue cycle companies went out of business due to an inability to master ICD-10 implementation.

Provider coding errors reportedly resulted in increased denials for 10 companies, but there were no provider coding error denial increases reported by 19 companies. Consistent with this response, nine companies also reported that provider documentation deficiencies have resulted in increased denials, although 17 companies reported they have not experienced this issue.

HBMA plans to repeat this benchmarking survey later this year. We are hopeful that we will see resolution of issues and positive progress toward our new “normal.”

Holly Louie, RN, CHBME

Holly is the Compliance Officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho.  Holly is the 2016 President of the Healthcare Billing and Management Association (HBMA) and previously chaired the ICD-10 Committee.  Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing and regulatory compliance.  She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.

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