Less than 5 percent of physician practice have made “significant progress” when rating their overall readiness for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the insurance billing process, a new study shows.
Though the conversion to 140,000 new codes that medical-care providers will use in order to bill government and private insurers doesn’t occur until Oct. 1, 2014, it doesn’t look like doctor practices will be ready.
“It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades,” said Dr. Susan Turney, president and chief executive officer of the Medical Group Management Association.New research out this week by the Medical GroupManagement Association shows “only 4.8 percent of practices reported that they have made significant progress when rating their overall readiness for ICD-10 implementation.” More than 1,200 medical groups representing more than 55,000 doctors were part of the research.
The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The current ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services wrote earlier this year to the American Medical Association, which has urged a delay in implementing the new codes.
MGMA’s Turney said the transition will impact documentation of clinical care, physician productivity in how they care for patients and reimbursement to doctors from insurance companies and government payers at a time doctors are also trying to get their practices ready for electronic health records, or EHR.
“Adding to the implementation challenge and clearly taxing all stakeholders, ICD-10 will arrive at the same time that a number of other transformative federal policies go into effect, such as health insurance exchanges and Stage 2 of the (Centers for Medicare & Medicaid Services) Meaningful Use EHR Incentive Program,” Turney said.
“A successful transition to ICD-10 requires coordination between providers and their vendor, clearinghouse and health plan trading partners,” Turney said. “Our data suggest that many practices are in the dark in terms of moving forward with ICD-10 as this coordination has not yet occurred.”
MGMA, the American Medical Association and various other medical-care provider groups worry the health care industry will not be ready, saying they still have to train their office staffs, buy the right computer systems and grapple with the mountain of administrative and related changes necessary that increases the number of diagnostic codes to about 69,000 from nearly 14,000 while the number of inpatient procedure codes rises to about 87,000 from about 3,000.
“Without the necessary software changes and testing, practices will have no confidence that they will be paid for the care they deliver to their patients after Oct. 1, 2014,” Turney said.
Medicare administrator Tavenner has said there are no plans to delay or cease implementation, saying the conversion to ICD-10 was already delayed a full year from October of this year when it was originally scheduled to be implemented.