Patient Care Forum

Are Caregivers Ready for ICD-10?

On October 1, 2015, hospitals, physicians, and caregivers will be tasked with using a new system of documenting the condition and treatment of their patients. A recent study published by Porter Research found that 57% of survey respondents claim that they are NOT on track for the deadline. At the same time, the Centers for Medicare & Medicaid Services (CMS) is convinced that providers will be ready on October 1st.
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On October 1, 2015, hospitals, physicians, and caregivers will be tasked with using a new system of documenting the condition and treatment of their patients.  While the Patient Protection and Affordable Care Act (ACA) has altered healthcare in numerous ways, the implementation of the International Classification of Diseases, Tenth Revision (ICD-10) may prove to have the largest impact. 

The current standard, ICD-9 has been in effect for 30 years and contains approximately 14,000 diagnosis codes and an additional 3,000 codes for medical procedures.  Physicians, nurses, therapists, and others work with the medical coder to ensure that a patient’s diagnosis and treatment plan are coded accurately.  Providers are reimbursed based on the payment schedule for each code.

On October 1st, providers will be required to code their activities based on the new ICD-10 system.  Why are providers worried about ICD-10 implementation?  Simply put, the ICD-10 requirements are posing an immense challenge due to the complexity of the new classification scheme.  ICD-10 contains over 68,000 diagnosis codes, an increase of 54,000 codes over their current system.  The procedure codes contained in ICD-10 have increased to almost 87,000 individual codes. 

This massive increase in complexity and volume is going to put a major burden on providers and coders alike as there is no allotted phase in period.  Originally, the ICD-10 implementation was scheduled for October 1, 2014, but after pushback from the medical community, the implementation was delayed one year to allow additional time for preparedness.

At the onset of the implementation, consumers may not notice the challenges that ICD-10 presents.  The issues will largely remain behind the scenes.  There will inevitably be coding errors and accuracy issues as provider coding specialists adjust to the changes.  This confusion may lead to an increase in denial rates leading to a lengthening of the Accounts Receivable cycle for providers. 

Ultimately, if there are ongoing disputes between payers and providers, consumers may see an increase in their insurance rates.  Another potential impact on consumers is that a claim that was previously accepted when coded in ICD-9 may end up being denied in ICD-10.  Obviously the opposite is true as well.  ICD-10 coding may subject a claim towards approval where it was previously denied.

recent study published by Porter Research found that 57% of survey respondents claim that they are NOT on track for the October 1st deadline.  At the same time, the Centers for Medicare & Medicaid Services (CMS) is convinced that providers will be ready on October 1st.  In late July, CMS conducted a third series of end-to-end testing with extremely successful results.  More than 1,200 providers submitted over 29,000 test claims resulting in an 87% successful acceptance rate.  The results are promising, leading to a measure of confidence throughout the medical community. For providers, there has been ongoing support available from CMS to aid in their readiness.

Additionally, CMS is offering Medicare acknowledgement testing for providers through September 30th.  After this date, Medicare claims processing systems will not be capable of accepting claims using ICD-9 codes for service dates after September 30th. 

After multiple implementation delays and much hand-wringing, starting October 1st, it is go time for ICD-10.