Right
now we would be launching the long-anticipated shift from ICD-9 to ICD-10 scheduled
to commence October 1, 2014—that is, until CMS was ordered to make yet another
change to the deadline. The newest deadline is October 1, 2015. The inevitable
is put off for another year. Delaying implementation of ICD-10 is a relief for
some, but grinding for others. Without a doubt, continued delays significantly impact
costs and benefits for the healthcare system.
Delayed rollout
According
to Michele Hibbert-Iacobacci, CMCO, CCSP, Vice President of Information
Management and Support at Mitchell International, “On March 31, 2014 the ICD-10-CM/PCS (International
Classification of Diseases-10th Revision, Clinical Modification and Procedural
Coding System) implementation was delayed in the United States due to the
Senate approved a bill (H.R. 4302). This update to the obsolete ICD-9-CM/PCS
was a requirement in the Health Insurance Portability and Accountability Act
(HIPAA) for all covered entities. Workers’ compensation has been excluded as an
industry that is not covered under HIPAA (non-covered entity); however, the
providers submitting the medical bills to workers’ compensation payers are
covered entities. By proxy, the workers’ compensation industry needed to
prepare to accept ICD-10-CM/PCS by the implementation date of October 1st 2014
and the majority of payers and vendors were ready to process bills by that
date.”
Benefits
of ICD-10
The
move from ICD-9 to ICD-10 reflects substantial advances in medicine that have
occurred during the last three decades. ICD-9 includes 17,000 diagnostic codes
whereas the ICD-10 has 155,000 codes, reflecting much more detail and
differentiation in diagnoses.
The
result of the expanded and updated coding will enhance disease and injury
definition with more accurate payment specificity. Yet, continued delays have
placed a burden on billers, suppliers, and payers. The rollout delay means both
time and cost burdens throughout the healthcare and insurance industries.
Costs of delay
“Scores
of provider, supplier, payer, education and training organizations have spent
millions of dollars preparing for the expected medical coding upgrade.”[1] The delay can be translated to measureable lost
costs when you consider turnover of trained personnel and training refreshers
needed for others.
Cross-walk
One challenge
that will be encountered is sporadic or uneven use of ICD-10 codes before and
after the deadline requiring handling both sets of codes. There will be those
who begin using the new coding early and those who never believed the day would
come. The latter group could lag long.
Accommodation
will be made for old coding and dual coding. Bills will be submitted using either
and both. Therefore, decisions must be made regarding payment. Will the payment
organization assume the task of converting the codes? Should reimbursement be denied those not in
code compliance? Systems will need to accommodate both to navigate the
transition.
Inevitable
The
drop-dead date for ICD-10 will come, whether it occurs October, 2015 or some
later time. When that happens, procrastinating further will not fly.
Reimbursement will depend on accurate and timely coding.
The positive side
Frustration
and exasperation notwithstanding, there are those who are thankful for the
delay because they were not ready for October, 2014. They now have time to meet
the new deadline. Those who were ready for the launch can now perfect the
processes they created.
Bite the bullet
Many,
if not most organizations were ready for the 2014 deadline. The test for them
is to sustain sharp readiness for another year. That is costly, and it is also
tiring.
Karen
Wolfe is the founder and President of MedMetrics®, LLC, a
Workers’ Compensation medical analytics and technology services company.
MedMetrics offers online apps that super-charge medical management by linking
analytics to operations, thereby making them actionable. karenwolfe@medmetrics.org
[1] Barlow, R. Coders teeter on tightrope
of relief and tension. Health Management Technology. September, 2014. www.healthmgttech.com.
