There’s been much written to help doctors prepare for the ICD-10 deadline coming this fall, including upgrading your software, tracking your most common diagnosis codes, training your staff, monitoring your processes, checking your systems, etc.  The purpose of this article is not to repeat the laundry list but to add an important consideration that most experts are leaving out–practices need to prepare financially for delays they may see in insurance payments.

The implementation of ICD-10 means the entire medical industry and all its partners will participate in a gigantic systemized dance that must be perfectly synchronized to succeed.  The last time we saw this happen was the 5010 conversion of ANSI claim files in 2012, which created havoc in the industry and delays in claim payments for months.   ICD-10 has the potential to be even more problematic because of the gigantic scale of this massive overhaul.  Every doctor, staff member, software vendor, clearinghouse, and insurance company must be ready simultaneously and have done their due diligence in preparation, testing, and correcting any missteps before the deadline hits. If one fails, at least that part of the system crashes.

Hopefully, the insurance industry learned some important lessons in 2012–start earlier, test more thoroughly, have system backups and personnel ready to meet the challenge.  However, to be safe, doctors would be wise to lay back a cash reserve to help carry them through the transition if we see similar issues that delayed the transmission and processing of claims.

Here’s the good news for our clients, however.  Optometric Billing Solutions weathered 5010 very well, and we expect to do the same with ICD-10.  While we can’t control the preparation done by your office, software vendors, clearinghouses, or insurance payers, we have the processes and staff in place to ensure every claim gets paid as quickly as the system allows and that none get lost in the electronic chaos.  Because they had us as a safety buffer in 2012, most of our practices were not even aware of the turmoil that affected their colleagues, and we are already planning to make ICD-10 go as smoothly!

4/15/15  Update:  Last night the Senate passed the bill already approved by the House that prevents a 21% reduction in payments to Medicare doctors.  President Obama is expected to sign the bill into law.  Therefore, we are sending out all Medicare claims today.  They should now process correctly, and you should receive payment by month’s end.

4/3/15  Notice to our Clinics:  OBS is temporarily holding your Medicare claims from April 1 forward while Congress considers legislation to forestall a mandatory 21% decrease to Medicare doctors. Medicare’s sustainable growth rate formula has threatened automatic payment cuts to Medicare physicians for more than a decade. In the past, Congress has approved temporary patches to prevent these reductions from taking effect and is looking at similar legislation once again. Any Medicare claims filed after March 31 will process incorrectly if Congress acts to override payment reductions.  According to Congressional reports, we can expect to hear something by April 11th.  We will keep you posted on pertinent updates and file your Medicare claims once the situation is resolved.