The new medical coding, ICD-10, has been delayed several times. It was scheduled to go into effect Oct. 1, 2014. But at the same time in early April that the Arkansas Medical Group Management Association (MGMA) annual convention in Hot Springs was focusing on this challenge, word came that Congress had voted to delay implementation until Oct. 1, 2015.
The delay is a relief to many since preparing for it has been extremely challenging.
“Medical coding has long been one of the biggest challenges we face when running a medical practice,” said Kelley Suskie, MHSA, FACMPE, administrator, Department of Pathology, University of Arkansas for Medical Sciences, who is the current president of the Arkansas MGMA. “Receiving payment from an insurance company hinges on stringent rules set by each payer. Now with this new code set, that challenge is amplified and the timing of its implementation has only made it worse. With many medical practices implementing new electronic medical record (EMR) systems while trying to get reimbursed by the government for using the EMR system meaningfully, ICD-10 training has not been the only administrative challenge healthcare workers are facing.”
When ICD-10 comes in to replace ICD-9, it will create 55,000 additional codes to choose from. Right now there are 14,000 codes; with ICD-10, there are going to be 69,000 codes.
The greater detail in the new coding will be a huge challenge, Suskie said, because not only are there new codes to choose from, but also new questions to ask the patient with more detailed documentation in the patient’s chart.
“If you have an issue with a patient’s arm, it won’t just be the left arm, but the upper left arm,” Suskie said. “So it is going to create greater detail. We have to bring everybody up to speed as far as training them how to look up these codes and be in concert with the health insurance companies and Medicare\Medicaid to make sure they are accepting what we are sending them as far as all the digits.”
Currently ICD-9 uses three to five digits. IDC-10 goes from three to seven digits. Suskie said there are significant implementation costs for the coding program required by the Centers for Medicaid & Medicare Services (CMS) that is also used by insurance companies.
“There is a good bit of concern from our members about ICD-10,” Suskie said. “It is much more complicated and prone to errors. We also have to make sure our systems are in line to accept the codes. This is just going to magnify all the issues we have now with providers getting paid. Smaller practices don’t have as many resources to comply with ICD-10. They have one coder and that coder has to figure it out by himself/herself. But it is an issue across the board, no matter what size the practice is. This is an issue that doesn’t discriminate.””
One of the additional costs is due to providers having to pay for Certified Coding Certification for their employee(s). People who assign the codes have to sit for a test to be certified.
Suskie said with ICD-10, it is important to have a good software vendor.
“Now most of us have gone to EMRs,” she said. “Part of HIPAA was we transitioned to EMRs. That is another item that we discussed at our annual conference in April in Hot Springs. With HIPAA, computer security is critical. You just don’t realize how fast it can get out of hand. Your systems have to be intelligent enough that, if there is a breach, you can go back and document everywhere that patient’s record has been.”
Another practice management issue that impacts physicians is value-based purchasing, which is part of the Patient Protection and Affordable Care Act. Suskie said because it is imperative to economize on rapidly skyrocketing medical costs, there is a major effort to change the way healthcare is delivered. Those include pay-for-performance models where payers are interested in not just getting patients well, but keeping them well.
“There is greater use of the patient-centered medical home model, taking care of the patient overall, and not just their current disease,” Suskie said.
Rarely have so many changes been made in American healthcare at such a rapid rate. In Arkansas, more than 100,000 people were added to the Medicaid private option expansion earlier this year, and many others in the state transitioned to different healthcare plans. It has created a lot of additional paperwork.
“If all the parts are not in place, if you don’t send them the exact information or credentialing falls out, there can be issues with delayed payments,” Suskie said. “With all the changeover, lots of things happen. It created a cash flow issue. You weren’t getting paid on time. Patients come in and are confused. They are not sure what to do to sign up. A lot of practices have had to help educate patients on the new options available to them. The new private option in Arkansas has generated some confusion.”
Hospitals and physicians are paid for the services provided on separate fee schedules. Hospitals get paid a DRG (diagnosis related group) rate based on a set amount for a specific illness.
“On the physician side, there is still a fee for service, but that is something that is probably going to be changing with the new healthcare law,” Suskie said. “That is unnerving, but we know that the healthcare system can’t sustain itself with the current level of spending. We understand that, but it is a challenge to understand how it is going to work with the new payment models.”
The Arkansas MGMA is an affiliate with the national MGMA that is 25,000 strong. In Arkansas, there are about 200 members across the state, the majority of which are small group practices in private offices.
To Learn More:
Go online to
http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10
