When payers and providers come to the negotiating table this year, they will do so during a pandemic or the tail end of it. Whether you are a novice or a seasoned negotiator, payer contracts can be complicated and difficult to interpret, even with an attorney or a consultant by…

EDITOR’S NOTE: During a recent Talk Ten Tuesday broadcast, listeners were asked “what percent of your claims are downgraded by third-party payers?” Downgrading by third-party payers occurs when the hospital-billed DRG is changed upon review by health insurance auditors to a lower-paying DRG. The majority of those who responded, over 51 percent,…

ICD-10 has been a non-event for clearinghouses, which are continuing to report little impact on their day-to-day business operations. Availity, one such entity, has encountered a few minor issues over the past month, primarily related to data not being submitted correctly by providers or payers having slightly different interpretations of…

Sherry Wilson Tina Greene As part of our efforts to track and help the industry respond to worker’s compensation challenges associated with the transition from ICD-9 to ICD-10, we will be penning a two-part series on the topic. This article is focused on the front end of post-implementation findings and…

ICD10monitor, as its name implies, will continue to monitor and report on the progress that all healthcare stakeholders are experiencing in their respective implementations of ICD-10.  Stakeholders include acute-care and post-acute care facilities, hospice and home health, physician practices, payers, durable medical equipment providers, clearinghouses, and vendors. 

The healthcare clearinghouse industry has not seen a substantial increase in call volume or cases related to the recent implementation of ICD-10, but as a group, the Cooperative Exchange anticipates that as activities ramp up over the next few weeks, this may change.  Clearinghouses are finding that their numbers are…

Notably, we are in a transition phase now as it pertains to ICD-10, and getting through that phase is going to take some time, perhaps even a few months.

Various industry agencies, organizations, payers, providers, and physicians are reporting that there has been a reasonably smooth start for such a gigantic undertaking as the recent implementation of ICD-10. Like all momentous challenges, there have been some hot spots, some notable failures, some minor toe-stubbing, and some smooth sailing. Keep…

EDITOR’S NOTE: The following is the final installment of a two-part series dealing with early signs of challenges facing physicians in their adoption of ICD-10. Many physicians are confused as to when to report the seventh-character extension. Physicians are confusing CPT® guidelines with ICD-10 guidelines. CPT and ICD-10 are two…

Efforts to fix what has been identified as the first significant issue to emerge under ICD-10 — medical necessity — appear to be underway with Medicare Administrative Contractor (MAC) NGS reporting that it will update its local coverage determination (LCD). The LCD issue surfaced earlier this week, when Laurie Johnson,…