Potential Risks of a Complicated Change - The ICD-10 Billing Transition
As healthcare providers and insurance companies are well aware
of, their systems of operation and communication will be under some
construction in future months but for the average patient, this change
seems non-existent. The alluded to "change" is namely the ICD-10
transition that will take place on October 1, 2015. This change means
that a group of codes, ICD-9, will be replaced by another set of codes,
ICD-10. These sets of codes are used by healthcare providers as a way of
simplifying an inpatient's diagnosis or treatment when billing the
patient's insurance company.Basics of the New Code
The ICD-10 codes are made up of three to seven character codes using a combination of letters and numbers. These codes would appear vastly different than the three to five numeric digit codes used in ICD-9. These striking differences are sure to cause some problems.
Not an Easy Switch
A potential problem would be a miscommunication between coders and doctors/nurses. Even though a thorough knowledge of the ICD-10 coding system is only essential to the medical coder himself, everyone within a healthcare facility must at least have a comprehensive knowledge of the new codes. If this knowledge does not exist then problems may arise. A doctor or nurse may not write enough information regarding the inpatient's procedure/diagnosis for a medical coder to properly code, subsequently the coder must ask the doctor/nurse for more information and this back and forth will continue, causing the delay of a bill.
It Could be Just the tip of the Iceberg
This delay of a bill could compound the issues facing an underprepared hospital. This staff may find themselves without funds to pay their bills and upkeep. Even the most adaptable and prepared hospital will experience a lag in processing while the staff learns the ICD-10 codes but an ill prepared hospital may not be able to learn and process fast enough. Hospitals generally have a "pay as they go" policy which allows them to pay bills as they can from the income they receive. If a staff is too busy learning codes over a long amount of time, bills may not be processed in a timely matter causing a lack in funds.
Another problem facing hospitals is a lack of coders. The job of a medical coder is not a position that can be filled by an individual with only a high school degree. As a result of the ICD-10 transition, medical billers are expected to learn an outrageous amount of new information. A hospitable will need every medical biller they have to be in top shape to avoid government fines. The best way to do this is to divide the workload between billers so that one person can do a perfect job on a small amount of cases as opposed to a bad job on all cases. Hospitals will be on edge to avoid government fines. This fear exists because if a case is filed under the wrong code, the government is not able to get its share of the hospitals revenue as a result of Medicare/Medicade and will therefore charge the hospital with fraud or abuse.
Since these potential problems exist, many hospitals will look to be adequately prepared for the ICD-10 coding transition.
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