LOS ANGELES--(BUSINESS WIRE)--A fundamental change in how physicians provide, record and receive payment for services rendered – also known as medical coding – is coming to the healthcare industry on October 1. Now one of the nation’s leading authorities on the subject is warning physicians and other affected healthcare providers to avoid the common misconceptions attached to this changeover.
“The changes coming in less than five months will drastically impact how physicians around the country are paid as well as how the care they provide to their patients gets captured and reported,” said Pam Klugman, chief product officer of Clear Vision Information Systems. “Unfortunately there is a lot of misinformation floating around that can be damaging and costly on many fronts if it continues to exist.”
The changes and misconceptions are connected to the industry’s conversion from ICD-9 to ICD-10, the international classification system used to identify known diseases and other health problems. Every procedure performed by a physician has a corresponding code, and those codes translate into reimbursement for the provider. ICD-10 includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9 while including twice as many categories and alphanumeric classifications for the first time.
With that in mind, Klugman specifically warns providers to avoid these five common myths about ICD-10:
- The new ICD-10 codes are simply increased and renumbered code sets. While it is true that the codes are increased and renumbered, to view ICD-10 only in this limited way would be a major mistake. The new codes include fundamental differences such as changes in terminology and a greater level of diagnosis detail to appropriately reflect advances in medical knowledge. These are some of the most important transformations ever in the healthcare industry, and errors in using ICD-10 code sets can have a significant detrimental effect on physicians’ cash flow. The degree and complexity of these changes underscores the need for physician groups to have the right tools, knowledge, people and foresight in place to make this conversion as easy as possible.
- ICD-10 will only impact a limited number of people and departments. The changes brought about by ICD-10 will have an impact on everything within the medical office. That is why in training and implementation, it is important to involve front-office staff, clinical staff, billers and coders, and physicians. Fortunately there are many resources available for providing the necessary training including online learning, workshops, books, webinars, conferences and computer software.
- Not everyone will need to use ICD-10 codes. All entities that are covered by the Health Insurance Portability and Accountability Act (HIPAA) must use ICD-10 codes on all HIPAA transactions. This includes claims for all healthcare services and hospital inpatient procedures performed on or after implementation date. Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. Translation: You won’t get paid for any claims of services if you continue to use ICD-9 codes.
- Existing practice management software can accommodate the change. Depending on what you currently have, this may or may not be true. ICD-10 means much higher data management demands thanks to larger procedure and diagnosis code sets. It is critical to make sure that your software can handle this capacity. Keep in mind that the best software is still dependent upon the accuracy of what is being input. So while you are making sure that your software is adequate, it is a good time to confirm that your billers are equipped with the latest codebooks, not just now but each year to ensure that they are using the most up-to-date codes.
- The U.S. healthcare system will be a role model when it converts to ICD-10. In fact just the opposite is true. The United States will be the last country in the world with modern healthcare to adopt ICD-10 diagnosis codes. ICD-9 is 30 years old, has outdated terms and is inconsistent with current medical practice. In addition, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. So while playing catch-up to the rest of the world is a motivator, it is far from the only reason why this conversion is taking place.
“ICD-10 provides more accuracy and specificity, which is good; but the healthcare industry needs to be prepared for this changeover or a lot of providers will be in for some unpleasant surprises,” says Klugman.
Clear Vision Information Systems provides Medicare Advantage risk adjustment solutions and strategies to health plans and providers nationwide. Leveraging decades of experience at the forefront of Medicare policy, Clear Vision’s portfolio of products and services – including risk adjustment analytics and easy-to-implement continuity-of-care strategies – help clients maximize their revenue while improving quality of care. For further information, visit www.cvinfosys.com.