George Breen and Bethany Hills Discuss the Likely Results of ICD-10 Implementation with RevCycleIntelligence

George B. Breen/Bethany J. Hills: Training and work flow challenges associated with the ICD-10 transition will continue well past October. Existing reimbursement arrangements will be impacted and payment delays to providers will occur.

Note that while CMS’ recently announced a 12 month “grace period” - where neither quality penalties nor contractor claim denials will occur relative to physician or other practitioner claims under Part B – so long as a valid ICD-10 code is used from the right family – this does not apply to inpatient hospital services. Nor does it automatically translate to managed care.

Contracts with managed care entities may not sufficiently address the revenue impact. Many insurers are working to map ICD-9 to ICD-10 but there is unlikely to be a revenue neutral solution. As a result, we expect revenue challenges – translated as delays - involving both public and private payors.