Ready, set, go? Most health plans agree that migration to a new coding system--ICD-10--is a step in the right direction, but they fear a proposed 2010 deadline is too soon and could have costly effects on the industry.Key Points * Health plans say 2010 is too soon to migrate to a new billing and coding set. * Insurers have other migrations and conversions to accomplish before moving to ICD-10. * Health insurers and health-care providers face a huge undertaking in ICD-10 migration, including converting systems and extensive training. The clock is ticking ticking a coat color pigmentation pattern in which hairs of one color are distributed in small groups throughout the background color, e.g. Australian cattle dog. Called also speckling. on a deadline that health plans fear could cause numerous mistakes and insurmountable additional costs for the industry. In September, the U.S. House of Representatives passed the Health Information Technology Promotion Act of 2006, a health-care technology bill that contains a provision mandating a 2010 deadline for insurers and health-care providers to make the switch to a new billing and coding system Noun 1. coding system - a system of signals used to represent letters or numbers in transmitting messages code - a coding system used for transmitting messages requiring brevity or secrecy , ICD-10. While health plans support the move to ICD-10 and favor interoperability The capability of two or more hardware devices or two or more software routines to work harmoniously together. For example, in an Ethernet network, display adapters, hubs, switches and routers from different vendors must conform to the Ethernet standard and interoperate with each other. of systems, they fear the deadline is approaching too quickly. They say there's a host of other initiatives and conversions that need to be completed before they can delve into migrating to a new code set--a massive undertaking that involves not only revamping computer systems but also extensive education of providers and overhauling business processes. New Code Set The International Classification of Diseases and Related Health Problems--Version 10, better known as ICD-10, is a set of codes that translate the written description of a diagnosis into a coded format. While ICD-10 isn't new, it's now beginning to make a big impact on health plans. The World Health Organization oversees the International Classification of Diseases, which is the international standard diagnostic classification for all general epidemiological epidemiological emanating from or pertaining to epidemiology. epidemiological associations the associative relationships between the frequency of occurrence of a disease and its determinants, its predisposing and precipitating and many health management purposes. While ICD-10 was adopted in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. in 1999 for reporting mortality, ICD-9-CM ICD-9-CM International Classification of Disease, 9th edition, Clinical Modification A standardized classification of disease, injuries, and causes of death, by etiology and anatomic localization and codified into a 6-digit number, which allows (Clinical Modification) remains the U.S. data standard for reporting morbidity. Many believe the United States is lagging Lagging Strategy used by a firm to stall payments, normally in response to exchange rate projections. behind in migration to the national code set. Several countries, including Australia and the United Kingdom, recently moved to ICD-10. Making the Move The public health community and clinical researchers are strong proponents of ICD-10. Not only do they think the national code will offer better monitoring of health status, they also believe it's a critical answer to improving the monitoring of disease and potential biological threats in the United States. In general, many health plans also support moving to the new coding scheme. ICD-10 has the potential to improve interoperability between systems, provide greater specificity and granularity The degree of modularity of a system. More granularity implies more flexibility in customizing a system, because there are more, smaller increments (granules) from which to choose. to support medical/disease management programs, and reduce the number of miscoded claims. "The coding scheme also encompasses more medical advances in medical technology, processes and procedures since ICD-9 was published," said Michael Ubl, director, e-health and IT strategies, for Blue Cross and Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. of Minnesota. Health plans arc concerned, however, that moving to ICD-10 will be far front a menial MENIAL. This term is applied to servants who live under their master's roof Vide stat. 2 H. IV., c. 21. undertaking. In fact, David Boucher, assistant vice president of BlueCross BlueShield of South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. , places the "huge undertaking" on par with what insurers experienced in getting systems ready for Y2K See Y2K problem and Y2K compliant. Y2K - Year 2000 in the late 1990s. A significant increase in the number of codes adds to the burden. While ICD-9, used by inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay. in·pa·tient n. and outpatient providers for billing and reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. , includes 13,000 diagnosis codes, the proposed ICD-10 diagnosis code set calls for more than 120,000 codes. ICD-9 procedure codes, which are used only by inpatient providers, number nearly 11,000, while ICD-10 procedure codes total about 87,000. For example, ICD-9 has four codes for sprained and strained ankles; the number climbs to 72 such codes under the ICD-10 set. Most payers' systems will have to be changed because they're currently piggybacked on ICD-9 codes The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain. ICD abbr. codes built into their logic. Going through all these systems and changing to ICD-10 will be complicated. For example, [payers] will have to decide if they'll pay different payments for each code." However, payers won't take the biggest hit. While they'll face an enormous undertaking, Fox said physicians and health-care providers will bear the biggest brunt brunt n. 1. The main impact or force, as of an attack. 2. The main burden: bore the brunt of the household chores. because they'll be the ones responsible for coding data. Is the Time Right? The bill passed by the House calls for an Oct. 1, 2010, deadline for the industry to migrate to the new code set. Many health insurers and providers fear it will take several more years to make the switch. The Blues association, along with a coalition of physicians, labs and other providers and insurers, now are urging Congress to change the deadline and make ICD-10 compliance required no sooner than Oct. 1, 2012. "The 2010 deadline isn't workable because not only is ICD-10 a massive and costly undertaking that places a huge burden on physicians and other health-care providers, but rushing its implementation would also put Medicare at great risk of delayed and improper payments," said Fox. America's Health Insurance Plans also fears an expedited schedule could have a detrimental effect on health plans. "Everyone at the table is in agreement with the intent of ICD-10, but it's just a question of how much of a burden do you place on physicians, hospitals and health plans to get there too soon," said Mohit Ghose, a spokesman with the association. A recent report by IBM (International Business Machines Corporation, Armonk, NY, www.ibm.com) The world's largest computer company. IBM's product lines include the S/390 mainframes (zSeries), AS/400 midrange business systems (iSeries), RS/6000 workstations and servers (pSeries), Intel-based servers (xSeries) Corp., commissioned by AHIP AHIP America’s Health Insurance Plans AHIP Army Helicopter Improvement Program AHIP Academy of Health Information Professionals AHIP Association of Hearing Instrument Practitioners (Ontario, Canada) AHIP ARPANET Host-IMP Protocol , recommended that the period for implementing ICD-10 code sets be three years, so health plans could assess their needs, prepare detailed project plans for business areas to define their requirements and identify how their business processes will change. It also said the activities should be preceded by six to 18 months for healthcare organizations to plan and budget resources for the work--both human resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees. and financial. But there are several things that first need to be done before the industry can tackle the ICD-10 conversion issue. "Industry and government need to take a look at the broader spectrum of other regulations out there that also need to be implemented," said Blue Cross and Blue Shield of Minnesota's Ubl. "Capital and resources in the health-care industry are limited. There needs to be a comprehensive plan developed that identifies the value proposition of the various regulatory initiatives on the table. To some extent, value should drive the priority of activities." One of the huge undertakings includes the adoption of the next generation of the Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. According to the Centers for Medicare and Medicaid Services (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when of 1996 transactions (ANSI (American National Standards Institute, New York, www.ansi.org) A membership organization founded in 1918 that coordinates the development of U.S. voluntary national standards in both the private and public sectors. It is the U.S. member body to ISO and IEC. X12 version 5010). The "5010" is a prerequisite for ICD-10 implementation, and health plans estimate it will take at least another two years to complete. The Blues association believes a 2012 deadline is feasible for ICD-10 conversion because it would allow three years for "5010" adoption, said Fox. Health plans are also in the throes throe n. 1. A severe pang or spasm of pain, as in childbirth. See Synonyms at pain. 2. throes A condition of agonizing struggle or trouble: a country in the throes of economic collapse. of trying to implement the National Provider Indicator. In 2004, the Secretary of Health and Human Services Noun 1. Secretary of Health and Human Services - the person who holds the secretaryship of the Department of Health and Human Services; "the first Secretary of Health and Human Services was Patricia Roberts Harris who was appointed by Carter" published a Final Rule that adopts the NPI NPI National Provider Identifier, see there its the standard unique health identifier for health-care providers. When implemented, covered entities will use the NPI as their primary identification number to identify health-care providers in all standard electronic transactions. Large health plans are required to use only the NPI to identify covered health-care providers in standard transactions by May 2007; small health plans must use the NPI by May 2008. Health plans are also busy working with Medicare, which is in the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?" midmost of the largest contracting change in its 50-year history. Medicare is currently consolidating more than 50 local contractors into 15 Medicare administrative contractors. Dire Effects "We're supportive of moving to ICD-10, but the time frame is unworkable," said Valerie Rosenhoch, vice president of legislative and regulatory policy for Excellus BlueCross BlueShield. "If you look at the costs associated with it, it's not just our costs but also that of physician practices and hospitals who will be looking to insurers to increase reimbursement. So it's a ripple effect ripple effect Epidemiology See Signal event. , and ultimately comes back to the government, businesses and consumers who are voluntarily purchasing health care." The financial burden of early implementation will only add to the already costly endeavor the industry will endure in making the move to ICD-10. "Not only will systems and business processes need to be redesigned to handle the new codes, health plans will have to offer extensive training of clinical and administrative personnel at an estimated price tag of $14 billion, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. a 2003 report compiled by Robert E. Nolan Co. Inc." said Fox. That estimate is at the high end of a 2003 cost projection by the Blues association. In 2003, management consulting Noun 1. management consulting - a service industry that provides advice to those in charge of running a business service industry - an industry that provides services rather than tangible objects firm Robert E. Nolan Co. conducted a cost/benefit analysis of the transition to ICD-10 for the association. The estimated cost for the industry was between $6 billion and $14 billion to migrate systems. Nolan projected the per-entity cost for multiregional health plans could be $10 million to $20 million, and for larger hospitals, between $1.5 million and $5 million. Some insurers aren't sure the benefits of a new national code set will outweigh out·weigh tr.v. out·weighed, out·weigh·ing, out·weighs 1. To weigh more than. 2. To be more significant than; exceed in value or importance: The benefits outweigh the risks. the costs. "You really don't make health care more affordable by making it more expensive" said Rosenhoch. "Our real focus now is on expanding access. As the number of uninsured continues to climb, we need to keep focused on that and not be taken away from doing it too quickly. Part of the problem with the new coding is the timing and complexity of it, which would make it a far more onerous on·er·ous adj. 1. Troublesome or oppressive; burdensome. See Synonyms at burdensome. 2. Law Entailing obligations that exceed advantages. undertaking than it could be." Fox said cost to plans isn't the only issue of concern to the association. "The real problem with speeding up the deadline is how we will educate physicians and get them to code properly. If physicians don't, plans could end up getting poor data." She said plans also fear possible backlashes from a rushed deadline. Physicians have their own uncertainties. "Their biggest concern is that this will take time away from treating patients," said Fox. Physicians will also lose administrative support that they have with HIPAA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191) Also known as the "Kennedy-Kassebaum Act," this U.S. law protects employees' health insurance coverage when they change or lose their jobs (Title I) and provides standards for patient health, . "One way that many practices, especially smaller ones, meet requirements is by working with clearinghouses that put noncompliant claims into a HIPAA format and send to payers. But that strategy won't be available to physicians with ICD-10 because you need medical records to determine proper codes and clearinghouses don't have access to patient records," said Joel Slackman, managing director of policy for the Blues association. For doctors to make a successful transition to ICD-10, he said, they'll have to do it themselves and work with new vendors. "We feel strongly that the industry will move to ICD-10 but it has to be done in a smart way," said Fox. Otherwise, "a doctor who is extremely unhappy about the ICD-10 mandate may be less inclined to embrace new technologies" and that could mean lower rates of health IT adoption. Moving Ahead Some health plans have begun to prepare for ICD-10. "We've done some high-level assessments at this point, but not a lot in-depth work," said Blue Cross Blue Shield of Minnesota's Ubl. "We've taken a look [at how] the breadth and depth of our business applications and areas would be impacted, and frankly, we found it's rather significant. But we haven't yet drilled down to a numbers level and determined how much time it will take and how much it will cost." He said the company plans to put together what he calls a "plan for the plan" this fall to outline a fully developed strategy of what the company hopes to accomplish in 2007 to prepare for ICD-10 migration. Merit Smith, vice president of Nolan's health-care practice, believes some of the minimal efforts around ICD-10 until this point are due to a continued lack of awareness by many constituents. "We're not hearing a lot about ICD-10 from our clients and from state professional organizations. Similar to what we saw with HIPAA privacy a few years ago, only up until the last few months, there was very little awareness of what's out there on this issue ... it's almost like having a tsunami coming toward the beach again." Instead, Smith deems the updated code set as a more political "Beltway issue." The Unknown "We don't know Don't know (DK, DKed) "Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. what will come out of the legislation, so it's hard to start preparing on an 'if-come' basis when you don't know how it will end up," said Excellus' Rosenhoch. "It's still very much a moving target." BlueCross BlueShield of South Carolina's short-term plan is to focus much of its resources on NPI, said Boucher. "After that we'll start delving down a bit more deeply into what ICD-10's impacts will be, such as to our software, reimbursement and contracting with providers, statistical and reporting systems, treatment policies for how we process claims, and internal and external training with providers." But a few things are still necessary before insurers can fully immerse im·merse tr.v. im·mersed, im·mers·ing, im·mers·es 1. To cover completely in a liquid; submerge. 2. To baptize by submerging in water. 3. themselves in ICD-10, said Fox, of the Blues association. "We know we'll have to change systems and our logic to determine payment and detect fraud and other things, but we don't know how extensive these changes will be until the government has finalized See finalization. the ICD-10 diagnosis code and completed and tested a crosswalk between ICD-9 and ICD-10, and the industry and providers move to HIPAA version 5010." Learn More Blue Cross and Blue Shield of Minnesota A.M. Best Company # 60077 Distribution: Internal agents, independent agents, direct Blue Cross Blue Shield of South Carolina A.M. Best Company # 01727 Distribution: Independent agents, brokers, consultants, direct sales reps, direct Excellus Health Plan Inc. A.M. Best Company # 60082 Distribution: Direct sales, brokers For ratings and other financial strength information about these companies, visit www.ambest.com RELATED ARTICLE: Technology trauma. Migration to the ICD-10 billing and coding system is "an enormous technical hit to the industry," said Valerie Rosenhoch, vice president of legislative and regulatory policy for Excellus BlueCross BlueShield. Like lessons learned with Y2K, HIPAA and other major conversions, Rosenhoch said, "each time we learn that it's more complicated than people imagine up front and it takes a toll on internal operations and both internal and external communication." One technological change is that insurers and health-care providers will have to purchase or upgrade software that can accommodate up to the seven characters required in ICD-10, as opposed to ICD-9's three- to five-character length. Also any field that requires a code number will need to accept an alphanumeric code
In general, in computing, an alphanumeric code is a series of letters and numbers (hence the name) which are written in a form that can be processed by a computer. found in ICD-10, rather than just a numeric numeric see numerical. numeric cluster see ten-key pad. code of ICD-9. In addition, data field sizes that accommodate the description of codes may need to be revamped because code titles are much more descriptive and longer in ICD-10-CM ICD-10-CM International Classification of Diseases, 10th revision, Clinical Modification than in ICD-9. Added to the price tag is the cost to train new coders and other personnel. Some health plans said they'll possibly have to hire additional information systems personnel to help with the migration. Diagnosis Codes For Sprained and Strained Ankles ICD-9 845.00 845.01 845.02 845.03 ICD-10 S93.401A S93.491A S93.401D S93.491D S93.401Q S93.491Q S93.402A S93.492A S93.402D S93.492D S93.402Q S93.492Q S93.409A S93.499A S93.409D S93.499D S93.409Q S93.499Q S93.411A S96.211A S93.411D S96.211D S93.411Q S96.211Q S93.412A S96.212A S93.412D S96.212D S93.412Q S96.212Q S93.419A S96.219A S93.419D S96.219D S93.419Q S96.219Q S93.421A S96.811A S93.421D S96.811D S93.421Q S96.811Q S93.422A S96.812A S93.422D S96.812D S93.422Q S96.812Q S93.429A S96.819A S93.429D S96.819D S93.429Q S96.819Q S93.431A S96.911A S93.431D S96.911D S93.431Q S96.911Q S93.432A S96.912A S93.432D S96.912D S93.432Q S96.912Q S93.439A S96.919A S93.439D S96.919D S93.439Q S96.919Q ICD-10 Is More Complex Than ICD-9 Diagnosis Codes ICD-9 13,000 ICD-10 120,000 ICD diagnosis codes are used by inpatient and outpatient providers for billing and reimbursement. Procedure Codes ICD-9 11,000 ICD-10 87,000 ICD procedure codes are used by only inpatient providers for billing and reimbursement. Source: Blue Cross and Blue Shield Assoc. Note: Table made from bar graph. U.S. ICD-10 Classification System Is More Complex Than in Other Countries ICD-10 Diagnosis Codes Australia 16,013 Canada 30,000 United States * 120,000 * Proposed 2003 version ICD-10 Procedure Codes Australia 6,055 Canada 18,000 United States ** 87,000 ** Final version Source: Blue Cross and Blue Shield Assoc. Note: Table made from bar graph. |
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