Doctors in Colorado and across the country are facing a facing a major shift in how they bill for treatments — a shift that threatens to slow their ability to get reimbursements if they do not make it correctly.
By Oct. 1, physicians and insurers must make the transition to what’s called ICD-10, a new iteration of the International Classification of Diseases system of coding injuries and illnesses. Most of the developed world has been using ICD-10 coding for years, but it wasn’t until 2008 that the Centers for Medicare and Medicaid Services decreed American doctors also must make the change-over.
And after several delays, federal officials have said the Oct. 1 date now is set in stone.
The difference between current ICD-9 coding and the new codes will be extensive. Where there are currently two codes for, say, a broken left fibula, there will be hundreds of codes for doctors to describe which leg is broken, where the break is and how it is casted, explained Steve Tutwiler, Denver-based vice president of staffing for JRP Group, a staffing company that’s been working with physicians’ offices.
In all, the system is going from about 12,000 possible codes in ICD-9 to about 69,000 in ICD-10, he said.
And the penalty for physicians who don’t code correctly after Oct. 1 will be denial of claims, an action that likely will cause them to have to re-submit, will slow down their time frame for reimbursement and could have a major operational effect on physicians’ offices’ operating cash flow.
When Canada switched from ICD-9 to ICD-10, claim denials rose sharply and physicians had to limit the number of patients they could see while waiting for reimbursement. Patient appointment cancellations rose between 20 percent and 70 percent per practice, Tutwiler said.
“It’s the time. It is a project management environment that has to take place,” he said. “There has been enough information that’s been put out there in the marketplace saying ‘If you’re not ready, you’re not going to get paid’ by the insurer community.”
The physicians community also has been working to bring doctors up to speed on a change that backers say is necessary in order to ensure there is more information available on patient conditions and on best practices to treat them.
The Colorado Medical Society began working with practices last year on the changes and now is pushing doctors specifically to become educated on the new codes, said Marilyn Rissmiller, the organization’s senior director of health care finance. But she warns the switchover can be expensive, requiring computer-system upgrades and a knowledge of the new codes to be pulled off properly.
“We’ve been trying to encourage people not to put that off too long, because you don’t want to get caught in a long line” waiting for a consultant to teach more about the new system, Rissmiller said. “If you’re not ready, you won’t get paid.”
Sandra Robben-Weber, a certified medical manager for the Colorado Springs Pulmonary Consultants medical practice, said she is not concerned about the cost as much as the time burden in adapting ICD-10. She’s been working several hours a week on the new coding since last year, and it could take up the majority of her time by May.
She believes most doctors eventually will be happy with the increased information provided by the coding in the new system. Until then, though, she compares it to the anxiety that surfaced during the Y2K build-up in late 1999: a lot of preparation that she hopes will lead to a smooth transition.
“The part that concerns me is: Is everybody else really ready?” Robben-Weber said. “It’s bringing payers and providers and educators together like this for the first time maybe ever … We just have to dot every i and cross every t.”
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Originally published on: Denver Business Journal
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