December 17, 2015

Physicians Coping with ICD-10 Denials: It’s a Matter of Time


So, how are we physicians coping with denials? 

Despite the many apocalyptic predictions regarding the ICD-10 transition, for healthcare organizations and the nation, ICD-10 has moved along rather swiftly to date. By now, most of us have seen the Centers for Medicare & Medicaid Services (CMS) October statement, which noted 4.6 million daily claims, 0.09 percent of which were  rejected due to invalid ICD-10 codes, with a 10.1-percent total overall denial rate (which was on par with historical data).

In California, where I am licensed to practice medicine, last month the medical board reported a few issues with providers having claims rejected, but nothing on a large scale. The California Department of Health Care Services indicated that it rejected a minimal amount of claims due to ICD-10, determining that less than 1 percent are being rejected for ICD-10-related errors.

Also in November, Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians (AAFP), reported hearing some problems, but nothing widespread, noting that “physicians (were) only taking an extra two or three minutes per patient (for paperwork) since the transition.”  We have heard these same remarks regarding minutes per patient from physicians around the nation, outside of family practice, in conversation, on blogs, and in social media online. Two or three minutes per patient adds up quickly, and at the end of the day that’s another 1-1.5 hours of time away – not only away from my patients, but away from my son’s karate practice, or away from dinner with the family this evening. It is hard to separate out ICD-10 from the overall negative feelings towards healthcare that many providers in the U.S. currently hold.

Although everyone in the healthcare system worked extremely hard to get everything ready for Oct. 1, and billers and coders are eager to continue processing clinical documentation to help produce the correct codes, ultimately yet again we are witnessing the physician’s reluctant commitment to their duty to continue to move things along with minimal impact on denial rate (and at the expense of further sacrifice on time).

Coming from a family of four physicians, including my father, I think it’s telling when out of the three siblings, I practice the least, yet I am the only one who would still encourage their child to become a doctor in the future. In fact, according to last year’s physician foundation survey of 20,000 physicians, only 42 percent of physician practice owners would recommend medicine as a career to their children.

So to answer the initial question on how we physicians are coping with ICD-10 and denials, my answer is this: along with many other initiatives in healthcare, we are coping by sacrificing more time

Although KPMG in November reported smooth sailing from 80 percent of healthcare organizations they surveyed, even during a smooth sail you are bound to encounter some choppy waters, and for those of you who remember Gilligan’s Island, there is always a risk of total catastrophe. 

I don’t believe the expectation should be that most of our work for ICD-10 is done, and we can now shift our focus to PQRS, antibiotic stewardship, addressing the alarmingly high rates of diagnostic and peri-operative medication errors, and recouping those 2-3 minutes of wasted time per patient. 

Fine-tuning will need to take place during the remaining part of this year as organizations begin to realize how the selection of billable ICD-10 codes in your electronic health record (EHR) can still lead to incorrect codes, unexpected DRG shifts, and a failure to realize the promise of producing higher-quality data instead of just more data.


Andres Jimenez, MD

Andres Jemenez, MD, is the founder & CEO of ImplementHIT, a physician and PhD Candidate in adult education, and his company's training software is used by hundreds of hospitals to train physicians on ICD-10 and their EHR.

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