Physicians preparing for next fall’s ICD-10 conversion need to be aware of a wild card that could potentially disrupt their coding and claims transition: The readiness level of data feeds from their hospital partners.

Most physician practices – and especially those that are hospital-based – rely on outbound hospital feeds for demographic and charge information. Others depend on hospitals for coding. These feeds can be presented as hardcopy, electronic copies of hardcopy or formatted electronic files. In all cases, the information is essential to producing a clean claim.

That means that if a hospital is delayed in transitioning its data to ICD-10 nomenclature -- or if they’re in the midst of a larger system conversion and are slow to establish the necessary electronic interfaces with partners -- groups will likely pay the price.

“Cash will stop,” said Theresa Gray, director of Information Technology for web2pro Business Performance Services. “This applies to practices that do their own billing as well as those that use a third-party vendor. You can do everything possible to be ready, but if the hospital data isn't there, nothing can be billed. And the revenue impact could be significant.”

Gray said web2pro is prepared to meet a range of contingencies once the new code activation occurs. Significantly, the company is storing both the ICD-9 and ICD-10 code sets in its system. That way, if a payer is delayed in adopting ICD-10, web2pro can continue to submit claims in ICD-9. Conversely, if some insurers start accepting ICD-10 before October 1, web2pro will be able to respond.

“We are locked and loaded. But what we can’t control are the data feeds,” Gray said. “So we need to know what the hospital’s plans are. Will they send us only ICD-10? Will they send us both ICD-9 and ICD-10? When will they make the change? What is the cut-off date? There are a host of issues that need to be ironed out. But it is challenging for us since we are one step removed from our clients’ hospital partners.”

Gray said another potentially significant issue will be hospital IT conversions underway or planned for the second half of 2015. Without ample lead time, she said, it will be difficult for any billing entity to complete the necessary interfaces and ensure uninterrupted data feeds.

To head off these problems, Gray said practices that bill in-house as well as those that outsource should reach out to their hospitals to learn more about the facility’s ICD-10 plans. In the case of web2pro clients, groups should also work to facilitate direct communication between the hospital and the web2pro client manager.

“Regardless of how you bill, you should engage with the hospitals to fully understand what their ICD-10 strategy is, and whether they plan to move ahead with any significant IT conversions or upgrades in 2015,” Gray stated. “We need to know how the hospital’s feeds will affect the data files that your practice depends on. Those that outsource should make the connection between the hospital and your vendor to help bridge the communication gap.”

Gray said unanticipated IT conversions and resulting problems with system interfaces could potentially represent the greatest threat to a smooth coding transition, due to the complexity of the task and the dwindling time available before the October deadline.  

“Groups can’t afford to turn a blind eye and assume somebody else is going to handle it, or wait until the last minute to figure out what their hospitals intend to do,” she said. “They need to begin now to make sure they’ll have the information they need to successfully file ICD-10 claims when the October deadline arrives.”


About the author

web2pro Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.