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Insurers anticipate early ICD-10 billing problems

Delays in claims processing expected with shift to new medical codes

As today begins the transition to the new ICD-10 medical codes, health insurance companies are anticipating potential billing problems as a result of the transition, reports Forbes.

That's because an estimated one in four physician practices in the U.S. is not ready for the transition to ICD-10, which will require doctors to convert to 140,000 new codes when they bill government and private insurers, according to the article. After two years of delays, the Centers for Medicare & Medicaid Services is mandating providers use the new codes beginning today.

Insurers anticipate that mistakes on insurance claims will pose major headaches for patients and companies. In fact, one survey found 20 percent or more of physician practices have not received the billing system updates needed for ICD-10, the article added. 

While some physician practices are ill-prepared for the conversion, it has also been a massive and expensive undertaking for insurers that will also use the new codes in claims processing and paying providers. Benefits experts told Forbes that health plan enrollees could see a delay in authorization for certain tests and procedures if physicians don't correctly code the services and that insurance claims could be denied.

Employee benefits consultant Aon Hewitt told Forbes that physicians and hospitals may use outdated codes and potentially bill patients for services that may be covered by their insurance. 

While Medicare announced in July that it reached an agreement with the American Medical Association that it won't deny or audit claims based solely on the specificity of diagnosis codes for the first year after ICD-10 use, it's not clear whether private insurers have established similar accommodation periods, as FierceHealthPayer previously reported.

To learn more:
- read the Forbes article

Related Articles:
Have insurers established ICD-10 accommodation periods?
Despite ICD-10 challenges, many providers optimistic they'll meet deadline
Most physician practices not ready for ICD-10
Docs far behind hospitals in ICD-10 implementation
Congress members propose ICD-10 dual-coding bill
CMS announces one-year ICD-10 grace period
AMA on board with CMS plan to ease ICD-10 transition