Some physician groups are still unhappy with the federal governments plan to implement the more modern ICD-10 reimbursement diagnostic codes, saying that even with a two-year extension many physicians will take an administrative and financial hit.
A month after the Obama administration announced March 5 that it would follow a Bush administration plan to push back implementation of the rules for the latest iteration of electronic transactions and for ICD-10 diagnostic codes, physician groups say the new dates are still too soon.
We have never gone through something like this before, said Robert Tennant, senior policy adviser with the Medical Group Management Association, of the upcoming ICD-10 transition. It took nearly four years for the industry to adopt the new National Provider Identifier. ICD-10 is going to be a much more complicated change than NPI, Tennant said.
The two rules, which are intertwined, call for moving the deadlines for updating Health Insurance Portability and Accountability Act standards governing electronic transactions to Jan. 1, 2012, and for replacing ICD-9 codes with the ICD-10 codes to Oct. 1, 2013. The original plans called for April 1, 2010, and Oct. 1, 2011, compliance dates, respectively.
Moving to the new ICD-10 diagnostic codes increases the number of codes to more than 68,000 from 13,000. The new HIPAA upgrade on electronic transactions concerns what is known as the 5010 electronic claim form, Tennant said.
Even with the right technology in place, acquiring the software to make these changes is expensive, plus physicians are reliant on the cooperation of third partiesthe vendors and insurance companiesto make this transition go smoothly.
Providers trying to comply with HIPAA electronic standards in the past have been stymied by the fact that software vendors have often been slow to change their product to reflect the latest upgrades, Tennant said.
These vendors, Tennant said, produce the software that enable physicians to use these electronic claim forms.
Its like Turbo Taxyou often have to have the latest version of the practice-management system software in place or you cannot send these electronic transactions directly to the health plans. In many cases software vendors havent changed their software or providers havent updated their software," giving practices no other option but to incur the costs of submitting paper to a third-party clearinghouse, which converts those claims to the latest electronic standard then sends them on to the insurance company, Tennant said.
Once the new and more complex 5010 standard is required on claims, these issues are bound to get worse, particularly for small practices, which may have to purchase hardware upgrades in addition to any software upgrades, Tennant said.
The CMS says its trying to assist small practices by developing a comprehensive national outreach and education strategy for the implementation of ICD-10 and 5010 that will target all affected organizations. Our strategy will include partnering with our Medicare provider communications group, trade associations and others to ensure small providers and others receive support through such avenues as tailored education, said Tony Trenkle, director of the CMS Office of E-Health Standards and Services, in an e-mail.
The real question is what the health plans will require, Tennant said. Once youve got the ability to generate that 5010 claim, theres the task of dealing with the ICD-10 codes, which accommodate a far more detailed diagnosis than ICD-9. Depending on your contractual requirements, you may not be able to simply put down the code for laceration, you may have to include far more specificity in terms of what caused the laceration, such as ice hockey stick, he said.
If a patient cant provide full details on how a laceration occurred, for example, the code may have to be listed as unspecified. Tennant is concerned that some health plans under ICD-10 may want a more specific code and deny the claim if the physician practice cant deliver.