ICD-10 is a multi-headed beast. As such, there are many faces to the new code sets; some are well known while others, often just as important, are not so understood.
In our first installment, ICD10Watch reported the facets that readers likely do not, but really ought to, know more about. That triptych has since proven to be something of a beginning.
And so the list of understated ICD-10 aspects continues:
1. Grey matter
A whole raft of ICD-10 testing and migration tools has emerged and more are sure to surface as the October 1, 2013 deadline draws near. Even so, it's clear that technology will help but it cannot get healthcare organizations all the way to ICD-10 compliance.
“The biggest challenge is what’s going to come up. The largest to date was getting everyone to understand that this truly is a business problem as opposed to a technical problem because all the hype out there is “technical, technical, technical,'” explains Dennis Winkler, Blue Cross Blue Shield Michigan's director of technical program management. “But that’s nothing relative to the number of people [healthcare organizations] are going to have to have available to invest this grey matter on all the business impacts.”
Such grey matter will also be needed, among other things, to bridge the clinical domain knowledge required for speeding up any automation that can be done, and then to ensure correctness of that automation. Full automation is nearly impossible, commented a reader of the first installment of this series, adding that the CMS GEM's show that things are not black or white.
2. ICD-10's relationship with EHRs and PHRs
Meaningful use is a media hog, as well it ought to be: Unlike ICD-10 there are monetary reimbursement incentives involved. But ICD-10 will play a more prominent role in electronic records of all sorts than perhaps most folks are talking about today.
[Related: ICD-10 not in Meaningful Use final rule. Also see our current reader poll: Which ICD-10 cost is of most concern to your organization? Follow the link to vote!]
What's more, ICD-10 yields richer information that can, in turn, also help make patients more informed and care management that much simpler. As EHRs (Electronic Health Records) and PHRs (Personal Health Records) gain purchase in the healthcare realm, and once ICD-10 compliance day comes, the two are destined to be intertwined.
“It would stand to reason that any migration path includes ICD-10 and HIPAA 5010 as a foundation to the work that is coming,” in instituting electronic medical records, explains Mandy Willis, a senior consultant and certified coding specialist of ICD-10 SME at Hubbert Systems Consulting.
3. The non-compliance worst case scenario
This just might be the granddaddy of all ICD-10 issues. If providers are not ready for the new codes, then getting paid will be a problem, to put it subtly.
“It will be difficult for providers and payers to resolve reimbursement disputes for ICD-9 claims received after the compliance deadline,” says Vijay Bhuttar, client solutions manager, healthcare, at Infosys. “No matter how well the payers try to separate the ICD-9 and ICD-10 based reimbursement rules, there will be overlap in this area. Ambiguity of ICD-9 codes will result in reduced payments.”
Most providers understand their cash flow could be disrupted but that's just the beginning. “Prices will go up with demand and services might not be ready for you to be compliant,” says Rhonda Buckholtz, vice president of business and member development at AAPC (The American Academy of Professional Coders). “Face it, you don't want to be left without an income on October 1, 2013.”
What's worse, BCBS Michigan's Winkler adds, “once it’s enforced, there will be huge, huge fines for not being compliant.”
And that goes for providers and payers alike.
Tom Sullivan blogs regularly at ICD-10Watch.com.
