The health care industry is “not progressing at a suitable pace” to be ready for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the insurance billing process, a new analysis shows.
Though the conversion to 140,000 new codes that medical-care providers will use in order to bill government and private insurers doesn’t occur until Oct. 1, 2014, last month’s analysis by the Workgroup for Electronic Data Interchange, or WEDI, is important because it will take months for hospitals and doctors to get their systems in place and test.
WEDI is an industry group that closely follows the change in International Classification of Diseases Codes, or conversion to 140,000 codes under the new ICD-10 system from 17,000 in the current ICD-9 coding system.
The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The current ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” Marilyn Tavenner, Acting Administrator of the Centers for Medicare and Medicaid Service wrote to the American Medical Association, which has urged a delay in implementing the new codes.
But the health care industry is worried it will not be ready, saying they still have to train their office staffs, buy the right computer systems and grapple with the mountain of administrative and related changes necessary that increases the number of diagnostic codes to about 69,000 from nearly 14,000 while the number of inpatient procedure codes rises to about 87,000 from about 3,000.
The WEDI analysis could indicate problems are ahead.
“Over two-fifths of provider respondents indicated they did not know when they would complete their impact assessment, business changes, and begin external testing,” WEDI chairman Jim Daley wrote in a letter last month to U.S. Secretary of Health and Human Services Kathleen Sebelius. “This is essentially the same as in the 2012 survey, and indicates that many providers have not made significant progress toward ICD-10 implementation.”
Members of Congress such as U.S. Rep. Ted Poe, a Republican of Texas, are beginning to weigh in on behalf of medical-care providers that he said are on the verge of being buried by what he called a government intrusion with “more regulations” that only “makes things more complicated.”
In January, more than 40 doctors groups including the American Medical Association, American Academy of Family Physicians and Medical Group Management Association wrote a letter to the Obama administration to stop the new coding system, saying it would cause additional financial pressures on doctor practices, particularly smaller physician offices already getting hit hard by the costs of implementing electronic health records.
The ICD-10 conversion is also adding costs to health insurance companies and will impact the likes of Aetna AET +1.11% (AET), Cigna (CI), Humana (HUM), UnitedHealth Group (UNH) and Wellpoint (WLP) as they use the codes in their claims processing and paying of physicians and other providers. Wedi chairman Jim Daley said about half of the health plans “have completed their assessment and another quarter are nearly complete.” By comparison to medical-care providers, health plans have made “moderate progress over the 2012 survey.”
Despite worries of the health care industry the Centers for Medicare & Medicaid Services’ head Tavenner said there are no plans to delay or cease implementation, saying the conversion to ICD-10 was already delayed a full year from October of this year when it was originally scheduled to be implemented.
“Many in the health industry are underway with the necessary system changes to transition from ICD-9 to ICD-10,” Tavenner wrote to the American Medical Association in February. “Many private and public sector health plans, hospitals and hospital systems, and large physician practices are far along in their ICD-10 implementation and have devoted significant funds, resources and staff to the effort.”
Meanwhile, criticism from the likes of Congressman Poe and doctor groups escalates. Here is a video of Rep. Poe in a recent speech on the floor of the U.S. House of Representatives.