Healthcare Providers Prepare for Major Billing Code Change
Medical providers are grappling with ideas and making plans for a major change to their bill coding system on October 1, when an upgrade from ICD-9 to ICD-10 will affect all diagnoses and inpatient procedures. Learning the code is like learning a foreign language, and they have to be fluent, says Annette Cox, Health Information Management Director for Lake Wales Medical Center (LWMC).
“It’s totally different from what we’ve been using,” she explains. “The goal was that we’d be able to share data… If everyone is using the same ABC system, they’ll be able to pull a lot more statistical information.”
The long-awaited change will mean up to seven digits in the code instead of just three to five, which will enable encoders to give more precise data to insurance companies, Medicare and Medicaid.
Upgrading the data system is probably the biggest change, says Cindy Sidoti, manager of Watson Clinic’s Outreach Department, which keeps people on top of changes in coding and reimbursement. “When you send out a claim form, you have to make sure your system is upgraded to adapt for two more fields,” she explains.
ICD-10 has been used in other countries since the late 1990s, so making the change will mean more comparable data. But Dr. Chris Pittman, chairman of the Florida Medical Association’s (FMA) Advisory Group on Health Information Technology, warns physicians should be prepared for cash flow problems for an indefinite period when the change is implemented. “All doctors are subject to this potential issue,” says Dr. Pittman, president-elect of FMA’s Political Action Committee.
“There’s no political reason for them to have it run smoothly,” says Dr. Pittman, president of the Hillsborough County Medical Association and medical director of Tampa’s Vein911. “Some businesses just make money on the float.” Dr. Pittman sees the change as “mostly political. The benefit accrues to payors. It’s also to help CMS (Centers for Medicare & Medicaid Services) ostensively rule out ‘fraud.’” The change will be affecting physicians, accounts receivable personnel, and all those involved in billing in medical offices, clinics, hospitals, and other medical facilities.
Dr. Arvind Soni, Polk County Medical Association (PCMA) president, says both physicians and coders will require training. “While ICD-10 was endorsed by the Forty-third World Health Assembly in May of 1990, many physicians and organizations do not feel they are ready for ICD-10,” he says. “A recent survey by EHR (electronic health records) vendor Vitera Healthcare Solutions demonstrated the concerns of the ICD-10 mandate by CMS. The chief concern is that it will take face time away from patients. Many practice administrators feel that extra resources will be required to implement the changes. In addition to coding, documentation will have to become more detailed. If charges are not properly coded and documented, practices will not get paid.”
When ICD-10 is implemented, ICD-11 won’t be far off. “The 11th revision (ICD-11) of the classification is already being developed and may be ready by 2015,” Dr. Soni adds.
At LWMC, owned by Community Health Systems, dual coding began January 1, as part of its training program. Cox says its five coders, who already have been training for a year, will be getting hands-on practice, enabling them to make the transition more easily. “When you actually get into the meat and potatoes… that’s when you really know whether you know it or not,” Cox says.
At Watson Clinic,the computer system will be upgraded in February to accommodate the extra digits, Sidoti says. That will enable the Lakeland-based clinic to enter the testing phase. “It’s not just something you can flip on overnight,” she says. “It’s going to be there but they’re not going to use it until it gets closer to the deadline.” Preparation began at the clinic two years ago, so the transition has been gradual. “I’m actually looking forward to ICD-10. I like specificity,” Sidoti says.
At the Florida Department of Health in Polk County, Revenue Administrator Jane Mikulecky says the staff is on schedule for the change.A pilot program is part of the preparations. “Preparing our staff for the level of documentation is going to be a challenge,” she concedes. “We’re ready for the October deadline. We know it’s coming.”
Mikulecky, who holds a Master’s of Science in Public Health, believes ICD-10 will benefit public health research and improve treatment when expertise is not readily available. “We’re just going to keep everyone informed,” she says.“I think it’s going to improve our level of care. I’m excited.”
Dr. Pittman, however, doesn’t believe all the detail is necessary.He suspects that ICD-10 will create an “obnoxious number of codes.” He elaborates, “We’re going from about 44,000 to over 150,000 codes. There’s already enough codes in medicine for just about every move that we make. To go to that number of codes essentially forces electronic medical record (EMR) adoption by physicians.”
Others are taking the change in stride. “It’s really just part of the culture anymore,” says Cox. “It’s really no different than anything else we continue to face . . . It’s the next step forward.” Cox believes the real question is compatibility.“We’re going to be ready for it. We will embrace it,” she says.
“ICD-9 is completely antiquated. It’s the thing of the past,” Sidoti says. “ICD-10, we’ve probably already outgrown it and we haven’t started to use it.”
She acknowledges some people don’t like change and are afraid of it. “The concept is still the same. It’s just tweaked a little bit,” Sidoti states.
It requires more time when the coding is being done, and being learned, but will help with payments.“In the back end, when bill is being paid, it saves time,” she says.
Here are some important steps you need to make to prepare your practice,suggested byRobert Tennant in ICD-10 Preparation Guide from Medical Group Management Association (MGMA).
- Check with software vendors to ascertain if they will provide the necessary software upgrades and how much it will cost. If necessary, make alternative plans. Find out how legacy data from ICD-9 will be accessed.
- Evaluate your current data collection process. Is the physician gathering sufficient data for ICD-10 coding purposes? Allow time to modify long-standing habits that need to be changed.
- Train affected employees well in advance of the deadline. You may want to partner with another practice to keep costs down.
The change comes at a time when the healthcare industry already is steeped in uncertainty because of the mandatory health insurance requirement in the Affordable Care Act. The government’s online insurance marketplace, Healthcare.gov, got off to arocky start in October when glitches plagued the system. Some who were insured previously received letters saying they may lose their coverage because they didn’t meet the new standards.
Meanwhile Mikulecky, based in Bartow, describes the ICD-10 transition as a “good challenge. My only advice is stay informed and participate in any training that is available,” she says.
As preparations are under way, Sidoti has this advice: “What’s the Boy Scout motto? Be prepared. Don’t panic,” she says. “Don’t wait until the last minute.”
story by CHERYL ROGERS