Doctors shift focus to compliance as ICD-10 deadline set

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Fri Sep 14 14:37:48 PDT 2012


 
September 10, 2012
 
Doctors shift focus to compliance as ICD-10 deadline set

American Medical News

By Jennifer Lubell
On Aug. 24, the Centers for Medicare & Medicaid Services issued a final rule that effectively changed the date for complying with the new ICD-10 medical data code sets to Oct. 1, 2014.
The agency decided to pursue the one-year delay in lieu of other alternatives, such as keeping the original 2013 deadline, or bypassing ICD-10 altogether and waiting to adopt ICD-11. “We believe a delay in the ICD-10 compliance date will increase the readiness of the industry at large, and thus avoid a large disruption in health care claim payments,” the final rule stated.
But even with the extra time, learning all of the new codes that ICD-10 will require a physician practice to submit on claims will be extremely cumbersome, said Michael Speer, MD, president of the Texas Medical Assn. “For example, there are 480 codes for a fractured kneecap alone — up from a grand total of two in the current system.”
Physicians will be dealing with adopting the new coding sets on top of numerous other Medicare incentive programs, said Steven J. Stack, MD, chair of the AMA Board of Trustees. ICD-10 alone “requires physicians and their office staff to contend with 68,000 codes — a fivefold increase from the current 13,000 codes,” he said.
The AMA had requested at least a two-year delay in the ICD-10 adoption deadline, asking CMS in a May 10 letter to conduct a cost-benefit analysis first to see what the financial and administrative implications would be of transitioning to ICD-10. Practices working to familiarize themselves with a much larger coding system may have to provide additional training to physicians and office staff as well as upgrade their health information technology to comply.
But doctors will have to be ready for this transition, because private health plans and government payers, already ahead of the game on implementation, “are going to force the issue,” said Greg DeBor, a managing director at Manatt Health Solutions, a national policy and strategic business advisory group. Payers have a simpler route to transition to ICD-10. All they have to do is accept the codes “and enforce their business rules against them. They don’t have to worry about how the claim is coded the way the physicians and hospitals do. They’ll have it ready to go by the deadline and will be saying to doctors, ‘If you want to get paid, you better give me your claims’ ” using ICD-10, he said.
Fred Ralston Jr., MD, an internist in Fayetteville, Tenn., and past president of the American College of Physicians, said his practice should “be able to attach an ICD-10 code of some sort to most of our diagnoses by the deadline. We are making sure that physicians are aware that every code needs to be addressed, and this will take significant physician time and involvement.” He said his practice could have done a much more careful job of transitioning to the new system had CMS granted the AMA’s request for a two-year delay.
Per-physician, the uncompensated costs of compliance with ICD-10 could be in the thousands of dollars “and countless additional hours of work for existing physicians and staff,” Dr. Ralston said. The AMA has estimated that total compliance costs could run as high as $2.7 million for large practices.
Hospitals that treat a wide variety of patients in their emergency departments as well as inpatient and outpatient settings probably face the biggest implementation burdens, although many facilities already have started work on this, DeBor said. By comparison, solo and primary care physicians “have a lot of similarly coded types of visits,” so the burden shouldn’t be as great in terms of training staff and changing conding systems, he said.
DeBor said larger group specialty practices that are involved in a wide variety of diagnoses but haven’t yet started their prep work on ICD-10 are likely to benefit the most from the one-year delay.
The American Health Information Management Assn. says the coding upgrade is long overdue. Physicians and hospitals currently use the ICD-9 system for billing medical services, which uses far fewer codes that don’t allow for as much specificity in listing patient diagnoses. AHIMA maintains that the new ICD-10 system would be more conducive to national payment and quality reforms.
Still, some doctors questioned the merits of a more diverse coding system. It provides the opportunity to collect more details on patients, but “I’m not sure how ICD-10 provides any better care” to patients, said Gary McWilliams, MD, executive vice president and chief ambulatory services officer at University Health System in San Antonio.
Dr. Stack said the AMA would work with federal regulators in the coming months to reduce the burdens associated with ICD-10 compliance, freeing up more time for doctors to interact with their patients. “This is not the final action on this issue,” he said. 




Bryan Sloane
Deputy Editor, CAL/AAEM News Service
 
Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

For more articles, visit our archives. 

To unsubscribe from this list, visit our mail server.

Copyright (C) 2012. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM). http://www.calaaem.org. All rights reserved.

CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.

Follow CAL/AAEM on Facebook and Twitter:
 
     
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://maillists.uci.edu/mailman/public/calaaem/attachments/20120914/5aea99a5/attachment-0001.html 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image007.jpg
Type: image/jpeg
Size: 19903 bytes
Desc: not available
Url : http://maillists.uci.edu/mailman/public/calaaem/attachments/20120914/5aea99a5/attachment-0003.jpg 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image008.jpg
Type: image/jpeg
Size: 941 bytes
Desc: not available
Url : http://maillists.uci.edu/mailman/public/calaaem/attachments/20120914/5aea99a5/attachment-0004.jpg 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image009.jpg
Type: image/jpeg
Size: 885 bytes
Desc: not available
Url : http://maillists.uci.edu/mailman/public/calaaem/attachments/20120914/5aea99a5/attachment-0005.jpg 


More information about the CALAAEM mailing list