Until this point most billing is done with ICD-9 codes. These billing codes would be sent from a hospital, clinic, physician's office etc. to a private insurance company or to Medicare and Medicaid offices to let them know what procedure was performed. However now the billing codes need to be changed to ICD-10. ICD-10 is updated and more specific based on the diseases, ailments and surgeries we have in 2015 versus many years ago when ICD-9 were first coded. This means all the procedures, old and new, need to be assigned to this new form of ICD-10 coding.
Believe it or not, not
everything has going completely according to plan with the recent ICD-10
implementation, and there have been “glitches” so to speak.
An article
published by Healthcare IT News has noted some of these glitches and some of
the response.
1. Private payers want your coding to be right. Although
it’s true that CMS is allowing a year grace period to allow coders to get the
hang of it, many private payers are not necessarily committed to the same
standard. Some practitioners are even giving themselves an extra hour just for
coding.
2. “Clearinghouses.” Some clearinghouses cannot go through
until they have been cleared, and not all new codes are currently being
recognized. This may take some time.
3. “Referrals.” For some physicians this is the lifeblood of
their practice. They rely on referrals for much of their patient clientele.
Somehow ICD-10 was not allowing one physician to give, or receive referrals.
4. “Eligibility checks. Some insurance websites were unavailable
for the first 2 days. We were not able to check eligibility on some patients.
We may or may not be paid for these visits and according to our insurance
contracts; we are not allowed to bill the patient. Any patients I saw on the
first 2 days of October who we were unable to verify their insurance was
treated for free and there's nothing I can do about it. I know some people will
say not to see them without this verification but they were sick. What good is
a doctor who doesn't treat sick patients?”
5. “Wait times.” Billers always have a difficult time
contacting payers, it’s probably their biggest complaint. There was a story of
one biller who had to be on hold for three hours with their payer.
In time, the glitches will decrease. Some of them are
obviously very short term while other will take longer to sort out, but one
thing is certain, everyone will be a lot happier when they are resolved.
Share your Thoughts:
Did you know about this change from ICD-9 to ICD-10 codes? Do you think this was a necessary update for healthcare policy? How do you think this healthcare policy change will impact billing to private and public insurance?
Thank you to Baylor University MBA in Healthcare for keeping their students up to date on the changes and future in healthcare policy.
Sources:
http://www.healthcareitnews.com/news/6-glaring-disruptive-icd-10-glitches
http://image.slidesharecdn.com/ppt2013icd-10preparationwrafbfinal11012013-131108070936-phpapp02/95/icd10-presentation-takes-coding-to-new-heights-11-638.jpg?cb=1383894713
Most of the world is much further along on with respect to their coding systems so I believe this change is long overdue. ICD-10 will allow payers to more accurately estimate costs for bundled payments and create more data to track trends and outcome metrics for more specified diagnoses. The AMA has resisted it because ultimately more regulation means increased costs. Most practices are either going to burden the existing staff with more responsibilities or have to hire or contract someone to do help with the coding. Many providers will have to turn to joining larger systems that have the volume to absorb the increased costs.
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