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The MedMetrics blog provides comments and insights regarding the world of Workers’ Compensation, principally, issues that are medically-related. The blog offers viewpoints regarding issues affecting the industry written by persons who have long experience in the industry. Our intent is to offer additional fabric, perspective, and hopefully, inspiration to our readers.

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Monday, September 29, 2014

ICD-10 Delay Fatigue

by Karen Wolfe

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.

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.

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.

Monday, September 15, 2014

MedMetrics Claim Risk Score is Now Available

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Karen Wolfe, President/CEO
MedMetrics, LLC
Workers’ Compensation Medical Analytics
541-390-1680 (v)
541-388-1422 (f)