Get Ready For ICD-10 Now, Or Lose Money Later
By Katie Wike, contributing writer
ICD-9 is outdated and ICD-10 is needed — as long as improved provider payment benefit comes with it.
With the deadline just over a year away, the transition to ICD-10 is considered by some a potential nightmare. EHR Intelligence writes, ”New surveys and industry polls are usually filled with bad news when it comes to ICD-10. When asked about their implementation plans, providers, vendors, and payers all confess to being behind on their preparations and unclear about the path forward.”
MGMA released research results that indicate, “The greatest concern is the lack of communication and critical coordination between physician practices and their essential trading partners (such as claims clearinghouses, electronic health record vendors, and practice management system vendors) regarding software updates and testing, which has not yet occurred. Only 4.8 percent of practices reported that they have made significant progress when rating their overall readiness for ICD-10 implementation.”
Despite industry trepidation and several deadline adjustments, CMS notes in a fact sheet the transition is necessary because, “ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.”
So, what’s a provider to do? Simple — if they want more efficient payment, they should get onboard the ICD-10 train.
According to the same EHR Intelligence article linked above, “ICD-10 does have the potential to make healthcare better. Physicians who provide more detailed documentation can receive more appropriate payments for their services, which may translate to higher reimbursements for some providers.”
Erik Newlin, co-chair of the ICD-10 Transition Workgroup at WEDI, told EHR Intelligence, “We see this as an exercise that will help us move toward more appropriate payment. There are providers out there that are being undercompensated, and there may be providers who are overcompensated for the same work.”
Newlin, when asked what advice he would give the industry ahead of the October 1, 2014 deadline, responded, “Providers and payers need to engage in meaningful dialogue. I know it sounds almost silly, but communication is key to all of this. Any project that ever failed had a core communication problem. It’s project management 101. Providers and payers need to make sure they’re walking through this together.”
Newlin also urged CMS to “state, in some official capacity, that providers will operate in a dual mode for some amount of time. That still puts the pressure on payers to make sure they’re ICD-10 ready, but it doesn’t have that kind of over-the-cliff effect where you go over the waterfall and just have to hope everything works out. Dual processing is how you mitigate that effect, and I think CMS is going to have to make it official.”