Smooth transition to ICD-10, but some rocky areas revealed: 6 observations

Industry stakeholders still express concern about potential increased government audits and provider productivity associated with ICD-10, according to Bloomberg BNA.

Here are six observations:

1. Providers must ensure their claims have adequate detail to support the ICD-10 code.

2. The industry should also be ready to deal with private and public payer audits.

3. Providers should consider using the CMS one-year grace period as a time to establish effective audit protocols. Although the CMS won't deny claims in compliance with a correct ICD-10 code, it is unclear whether it will be as lenient with nonspecific ICD-10 claims resulting in overpayments.

4. In addition to the smooth transition process to ICD-10, the new codes offer enhanced data and the ability to compare health globally. Since the United States became the last industrialized country to transition to ICD-10, it has the capability to match up its population health outcomes against other countries.

5. As providers become more comfortable with ICD-10, there may be less productivity.

6. Some Medicare Advantage Contractors have rejected patient screening claims, due to poor local coverage determination system edits.

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