October 1, 2015 isn’t Halloween but there are lots of anxious people


October 31, Halloween, is associated with spooky sights, tricks, goblins and scares.  Today, October 1, is a day sure to produce similar anxiety in the health care world.

Ready or not, today marks the day health care providers flip the switch from ICD-9 to ICD-10.  The transition radically changes how billions of dollars of claims are calculated and billed every day.  From what I’ve read, and heard, most large hospitals and large physician groups will make the transition without trouble but some smaller organizations and physician practices are worried about what the future holds.   The conversion has been delayed three different times and some were of the belief another last-minute reprieve would be granted but for those who placed their head in the sand today, and every day after, will be tough.

CMS is ready for the conversion and most large commercial payers are ready as well but is Medicaid?  No one really knows.  CMS has been monitoring Medicaid programs across all the states but they’ve been tight-lipped about their readiness.  They’ve even gone so far as to allow four state Medicaid programs – California, Louisiana, Maryland and Montana – to use a workaround, or a cross walk system, rather than requiring them to fully convert to ICD-10.  These state programs will take incoming fee for service claims coded in ICD-10, convert them to ICD-9 codes, and use the older system to calculate payments.  ICD-9 has roughly 14,000 diagnostic and procedure codes, ICD-10 has close to 70,000 so matching codes will be difficult and claims could be rejected and there are bound to be delays in payment to providers in those states.

For health systems like GVMH, who are ready for the conversion, there are likely to be delays in payments because of decreased coding productivity.  The ICD-10 system is much more complex than ICD-9 so it will take coders longer to process the same number of patient accounts.  Insurance payers will take longer to process claims for the same reason so even the most prepared organizations will see a delay in cash flow.

For a period of time coders will be coding claims in both data sets.  For patients seen prior to October 1 claims still have to be coded in ICD-9 and for patient encounters that span the activation date those claims will have both ICD-9 and ICD-10 codes.  The back and forth will create further delays in payments and processing of claims because not only are the coders working in both worlds but so are payers which means systems to support coding and payment in both data sets must be maintained and monitored.

With any new process productivity decreases so coders will have a hard time processing the same number of accounts in the same amount of time have but add in the additional complexity of ICD-10 compared to ICD-9 and productivity is estimated to decrease by up to 30%.  Productivity for providers will decrease as well.  Most physicians see patients with similar diagnosis and they have many of the common diagnosis committed to memory but ICD-10 will require that they learn new codes and every time they have to stop what they’re doing to look up a new code it will slow them down and do nothing to improve patient care.

Today is a big day in the health care world and anxiety will be at peak levels so if you see a health care provider or coder today please refrain from saying “Boo”, you might just send them over the edge and then someone will have to take the time to look up the ICD-10 code for the event and with 70,000 codes to choose from I’m certain there’s a code for “anxiety attack associated with data overload and conversion to the International Classification of Diseases, 10th edition”…

About Craig Thompson

I am a young professional with two great sons, and I work in the healthcare setting. I am employed in hospital administration and serve as Chief Executive Officer at Golden Valley Memorial Healthcare in Clinton, Missouri. At GVMH we care for our families, friends and neighbors. We're committed to providing the safest, friendliest and most compassionate care to all we serve.
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