by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
For those who think Obamacare is a fist-clenching, jaw-tightening, eye-rolling daily dosage of headline news, an even bigger non-Obamacare headache is about to fall on medical providers.
Physicians may need their share of blood pressure pills come October 2015, as they will be required to upgrade to the ICD-10 medical coding system — formally known as the International Classification of Diseases (ICD). The ICD is the most widely used index of medical diseases and injuries, dating back to the late 1890’s.
For over 30 years, third-party payers have used the (ICD-9) — the 9th edition- to reimburse medical providers. The coding system also serves as a key communication mechanism within the medical community, as researchers use it to track disease patterns for certain demographics, outcomes, and health care cost-effectiveness.
The 10th edition has been established by the World Health Organization for more than a decade and still awaits full implementation in the U.S. The Centers for Medicare and Medicaid Services(CMS) and the Obama crew fully support this massive transition, claiming that the new coding system will be more sophisticated and efficient for the medical community – sophisticated and efficient meaning that codes will be more descriptive and further subdivided based on the severity of a diagnosis.
Thus, a more detailed coding system is intended to grant providers access to a more accurate index of diagnoses before submitting claims to the government or other third-party payer. Sometimes ICD-9 can cause frustrations for providers if their diagnosis description does not properly fit under a specific code.
So a more descriptive system ultimately means more codes — as in loads, scads, and heaps more. The number of codes will exponentially increase to 155,000 from 17,000 under the current ICD-9. Wow. An exorbitant number of codes also means more room for error. And more errors means more delayed reimbursement for providers, as claims may not be initially processed as "clean."
Now, new codes certainly are necessary due to medical innovation and discovery. But after reading Stephen Hayes’s "Code Chaos" in the Weekly Standard, some are just laughable. Others make you wonder why they even made the book:
Ever considered suicide by jellyfish? Have you ended up in the hospital after being injured during the forced landing of your spacecraft? Or been hurt when you were sucked into the engine of an airplane or when your horse-drawn carriage collided with a trolley?
Chances are slim.
But should any of these unfortunate injuries befall you after October 1, 2015, your doctor, courtesy of the federal government, will have a code to record it.
Pushing aside this hilarity, what will it take for providers to make the monumental switch? According to CMS and other medical IT sources, providers are warned to set aside 6-12 months of reserves in the event of a catastrophic rollout resulting in lengthy payment delays. Making the momentous switch will certainly cost time and money upfront as well. The Weekly Standard further explains:
A 2008 study on the costs of implementing ICD-10 from the health care IT firm Nachimson Advisors warned that "significant changes in reimbursement patterns will disrupt provider cash flow for a considerable period of time." The study projected that the total cost of the ICD-10 implementation would be $83,290 for a small practice (3 physicians and 2 administrative staffers), $285,195 for a medium practice (10 providers, 1 professional coder, and 6 administrative staffers), and $2.7 million for a large practice (100 providers, 10 full-time coding staffers, and 54 medical records staffers).
Who knows how long it will take for a predicted tech glitch to be resolved. Perhaps North Carolina along with the rest of the nation is enduring the most disastrous few years in the history of medical economics and technology. The ICD-10 rollout could complete a terrible trilogy in combination with healthcare.gov and NC Tracks, North Carolina’s Medicaid billing system.
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