As of October 1, 2015, the long-awaited switch to ICD-10 diagnostic and procedural coding is finally taking effect after considerable delays and concerns. Billions of dollars in medical claims will be affected every day. Ready or not, the U.S. healthcare industry will soon need to use ICD-10 codes when they calculate and bill for healthcare services every day. The chances of another last-minute reprieve are extremely remote. There have already been three such delays of the ICD-10 start date, and experts do not predict a fourth.
While many large hospitals, health systems and large physician groups have been ready for ICD-10 coding for a while now, some smaller providers are more likely not to be as prepared. A May-June survey conducted by AHIMA (American Health Information Management Association) reports that 68% of large hospitals are fully ready for implementation, having already completed external testing with payers and clearinghouses. But, as of July, only 20% of physician offices/groups had done such testing. What’s more, many physicians are nowhere near being able to conduct external ICD-10 compliance testing. For instance, a recent MGMA survey found that 9.2% of physician groups were still using an electronic data transmission format incapable of carrying the new ICD-10 codes.
One thing experts warn large and small healthcare providers about is the impact switching to ICD-10 coding will have on their cash flow. Because of ICD-10 related payment delays, hospitals and providers who do not have cash crunch plans in place could experience significant hardships. Particularly vulnerable to cash-flow crunches, doctors aren’t able to hold large cash reserves because of federal tax rules. A Texas Medical Association survey released in August concluded that payment delays linked to ICD-10 could force some physician practices to close or push older physicians into retirement.
“Yes! It’s finally going to happen,” says David J. Duncan, PhD, FACHE, FACMPE, President/CEO of UPMC Altoona Regional Health Services. “After numerous delays, ICD-10 is going to go into effect on October 1, 2015. We’re ready for it; we’ve been preparing and planning.”
UPMC Altoona Regional Health Services is a multispecialty group practice of seventy-seven physicians. They are part of UPMC Altoona (www.upmcaltoona.org), which is part of UPMC Pittsburgh (www.upmc.com). UPMC stands for University of Pittsburgh Medical Center.
“Years ago, when the move toward ICD-10 first started, UPMC identified a system-wide approach toward implementation,” explains Duncan. The approach included mandatory provider education focusing on specificity of clinical documentation to support ICD-10 codes, development of a diagnosis code search tool, coder education including anatomy and physiology refresher courses as well as 34 specialty-based clinical educational training modules, other staff training according to role to include ICD-10 general awareness or ICD-10 advanced education.
Education has been a key component of UPMC’s ICD-10 preparation. Physicians were required to complete the mandatory training assignments. Non-compliance continues to be tracked by UPMC’s Human Resources and Ethics/Compliance departments and potential sanctions were identified for non-compliance. In addition to clinical education regarding specificity of documentation to support ICD-10 code assignment, all software applications have updated processes in place to support the transition to ICD-10. Additional education (online, self-based tutorials) for all providers and staff was provided for the various applications. UPMC also conducts an ongoing series of conference calls across all business units to provide communication needed to achieve a seamless transition to ICD-10.
Every Health Insurance Portability and Accountability Act-covered entity, literally hundreds of thousands of providers, payers and claims handlers, will need to switch from ICD-9 to ICD-10 codes. Used to authorize and calculate trillions of dollars in payments from Medicare, Medicaid, commercial insurers, Tricare and the Veterans Health Administration to hospitals, physicians and other providers, the codes provide important documentation about diagnosis, procedures, treatment and more.
Replacing ICD-9, which has been in place since the 1970s, ICD-10 is a much more complex and detailed coding system. For example, ICD-10 has about 68,000 diagnostic codes under the new ICD-10-CM (clinical modification) codes—five times more than under ICD-9-CM. There is an even more complex matrix of 87,000 new codes for hospital-based procedures in the ICD-10-PCS (procedural coding system)—29 times more codes than in ICD-9.
While the CMS (Centers for Medicare and Medicaid Services) has been monitoring state Medicaid programs regarding their ICD-10 readiness, it has not released its findings. Nevertheless, the signs are not encouraging. For example, CMS has granted permission to California, Louisiana, Maryland and Montana to use a type of workaround, called a crosswalk system. Rather than fully converting to ICD-10, these four state Medicaid systems will take claims coded in ICD-10, convert them into ICD-9 codes, and use the older system to calculate payments to providers. There are some inherent problems with this system, however. Because there will be newer codes that don’t exactly match up to older codes, claims could be rejected.
How prepared is your facility or office for ICD-10 codes? Have you been part of any testing with ICD-10? We’d love to hear your thoughts!