As promised, today is the start of a series of blog posts I’m calling ICD-10 Tuesdays. Every Tuesday I’m planning to publish a series of blog posts looking at the challenges and opportunities associated with the implementation of ICD-10 in the US.
I’ll do this for as long as I have interesting ICD-10 content to publish. I won’t be surprised if the series lasts until close to the ICD-10 implementation date, October 1, 2014. I’ll also be soliciting some outside experts to participate in the series as well.
This blog has always been a learning experience for me and this series will be a continuation of that trend. Hopefully you’ll add to the conversation in the comments of each post. The more perspectives given, the more we all learn. Plus, don’t be shy about suggesting other ICD-10 topics I should cover on our contact us page.
Since my love is technology, most of the posts in the ICD-10 series will touch on the technology aspects of ICD-10 in some way. Plus, I’ll likely highlight some interesting companies and people in the ICD-10 space. I’m already scheduling a Google Plus hangout talking about the ICD-10 workforce that will no doubt be part of the series. In fact, we’ll probably have a number of ICD-10 related videos in the series.
Now that you have the ICD-10 Tuesdays plan, I’ll start the series by saying that many in healthcare aren’t ready for the change. Although, even scarier is the large contingent of healthcare organizations that think they’re ready for ICD-10 and they are not. Hopefully as we dig into each aspect of ICD-10 and how it will impact the entire healthcare cycle, organizations will be made aware of places where they can work on their ICD-10 readiness.
Another topic I’m sure we’ll cover much more in the future is physician readiness for ICD-10. I’ve heard organizations say that they didn’t need to train their physicians for ICD-10. Those organizations are in for a rude awakening. In fact, I’m not too worried about the coders being ready for ICD-10. They know that they have to be able to work with ICD-10 if they want to have a job as a coder. So, they’ll be ready. The same can’t be said for doctors.
There’s a little ICD-10 flavor to get ICD-10 Tuesdays started. Much more to come.
This is a great idea! Looking forward to Tuesdays now!
Best,
Joann Doan
@joannkareo
http://www.kareo.com
John – almost everyone can use more information about the upcoming implementation of ICD-10. Focusing on the technology challenges will be a great asset to many. Beyond MD preparation, the actual end-to-end testing of transactions between hospitals/MDs/clearinghouses/payers will be a hot topic in 2014. And an area for much concern. I look forward to your Tuesday posts.
John,
I may have a topic for one of these new articles. We’re all painfully aware of the basic issues migrating from 9 to 10 while keeping up records in 9 for payors (like workman’s comp) that won’t take 10 plus maintaining older records in 9. Providers hope to get it right, and so do insurance companies and other payors.
I recently encountered an interesting gap in the handling of ICD data. A person goes to a doctor with an infection. Doctor swabs, sends to outside lab. Lab submits to insurance company for reimbursement. Insurance company bounces it back for no clear reason other then ‘not covered’. Patient gets nearly useless EOB from insurer, and bill citing the insurance company’s refusal to pay.
a number of months after it all started, I was reading through the latest invoice from the lab. I noticed that it cited 3 CPT codes and made reference to ICD-9 codes – but no ICD-9 code was provided. It turns out that the lab only forwards an ICD-9 code received from the referring provider, and if none is received, passes ‘lab test’ to the insurer instead, rather then bouncing something back to the provider.
It hadn’t occurred to me to think of the lab needing an ICD code from the original provider, but clearly it makes sense. It certainly does add at least one more complication to the situation, especially to lab work payments around the official implementation date or for lab-work done for possible payors that won’t go to 10.
Obviously it’s not just medical testing labs, rather it’s any third party that provides a service where payor reimbursement will be required, and ICD codes – 9 or 10, will be needed. Plus it’s a reminder that sooner or later EHR connected billing systems and practice management will need, when a doctor orders a lab test, to reach out to the insurer, find a lab that’s in plan for the patient and make sure that the specimen or orders go to the right place along with all the proper payment info. This will become very important under the Affordable Care Act where, as it turns out at least in some locations, NOTHING out of plan will be covered at all and the patient who thought that ACA was protecting them actually exposed them to surprise expenses.
R Troy,
You bring up an interesting element. Getting the labs and other auxiliary services on the same page could be a challenge as well.
If a major lab and a good size practice (with EHR for about a year now) can’t handle ICD-9 transmission to the insurance company, I can’t imagine they’ll be able to handle the transition to 10. I blame the lab here for transmitting garbage to the insurance company – if the practice didn’t give them the ICD code they should have pushed back to the practice, and clearly didn’t.
Follow-up – when the lab was originally questioned, they had no idea of why the insurance company didn’t process the claim (which they said they resubmitted, obviously still incorrectly). When advised that they hadn’t provided the ICD-9 code, they finally agreed to reach back to the practice to get it, and then properly submit it. The insurance company had agreed to reprocess the claim once they got the code.
This lab is one of the biggest in the US. If they can’t handle simple things now…
R Troy,
That’s the issue for me. They’ll be able to handle ICD-10, but will they be able to handle when some system sends an ICD-9 incorrectly or something like that or will it just get denied and the patient will have to figure it out?
If they don’t clean up their act on time they’ll be sending patients lots of oversize bills that have been rejected by insurers. SOME will pay but then avoid that lab any time they have a choice. Others won’t pay, and the clowns who answer the phones in billing will keep dropping the ball. I see lower revenue and even worse in their future!
Hi,
This is a nice initiative to start with.
As the above discussion is little more detailed. It is better to start with the idea of Migration of ICD- 9 to ICD1-10.
I.e.: Introduction to
Necessary (like Law).
Impact area(S).
Getting ready.
Major difference.
Migration type (Walk Through or COmplete migration).
Transition period maintenance.
etc.
RCJain,
Thanks for the extra topic ideas. I’ll see what I can do to satisfy each area.