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Your Stories: Local Dr.'s office says insurance not paying

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Brighton, N.Y. - A local doctor's office says they're not getting paid by some insurance companies after a required upgrade to the coding system.

On October 1, the new ICD-10 coding system took effect. Doctors’ offices across the country worked to upgrade their systems and learn the new codes to meet this deadline.

Retina Associates of Western New York, P.C. in Brighton made sure they were ready to comply, which is why business manager Lori Kiser was surprised when they started to get claim rejections.

“I've never seen anything come through like this,” said Kiser who pointed out a stack of dozens of envelopes from Excellus Blue Cross Blue Shield. “They all say please resubmit with the correct diagnosis code, and all the claims have the correct diagnosis code on them.”

According to a post on Excellus Blue Cross Blue Shield’s website, providers are asked to hold claims containing new ICD-10 Codes. It states:

We are currently updating our claims processing system to accept the new ICD-10 codes implemented on October 1, 2016. At this time, our system is unable to process electronic and paper claims containing these codes. We anticipate being ready to accept claims containing the new ICD-10 codes on October 19. Please hold your claims submissions until this date.

Which means a lot of lost money in the meantime, for practices like Retina Associates.

“In a week, it's well over $100,000,” said Kiser. “There should have not been any kind of hiccup here because it means loss revenue for us. We'll eventually retrieve it, but it's lost right now.”


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