At a time when the Centers for Medicare & Medicaid Services is putting extreme value on high-quality data, the repeated delays to the implementation of ICD-10 are impeding progress toward that very goal.
Originally slated for implementation in October 2013, the new clinical codes have been delayed twice, each time costing the industry between $1 billion and $6 billion, according to the American Health Information Management Association (AHIMA), a Chicago-based trade group.
But it looks like this October, the new coding practices will, indeed, go through. Most stakeholders believe the chances of another delay are slim — although the second delay last year, just on the cusp of implementation, was also deemed unlikely — and would be disastrous for healthcare. The insurance companies that have spent millions to ensure their computer systems could deal with the new codes, and hospitals that have spent like amounts as a group on staff training would likely raise a ruckus loud enough to discourage such action if there was even a suggestion of it, says Angie Comfort, RHIA, CDIP, CCS, senior director of health information practice excellence at AHIMA.
Current ICD-9 codes have been used for 35 years, and the United States is all but alone in continuing to use them. The nation had 14 years’ notice for ICD-10, but delayed so long that the World Health Organization (WHO) has already begun creating ICD-11, which is due to be released in just two years, she says.
And just as the country is lagging, so are many hospitals who have been sitting back waiting to see what happens next before making any commitment to a change, says Comfort.
However, the time to move has come, she says. The recent passage of the Medicare sustainable growth rate (SGR) repeal bill by Congress, which provides a permanent fix to physician pay and included no mention of ICD-10, seems to indicate that it really is going to happen this October. “There are still opponents to it,” Comfort says, “and there are probably more hurdles.” At press time the Senate had yet to pass the SGR bill, leaving a little bit of doubt still hanging over the implementation of the coding procedures.
There are just a few short months to ensure your systems and your staff are ready, says Comfort. There are still opportunities to help get your staff trained. “It is not just your coding staff that has to know this,” she says. “Others have to, too.” Registration, providers, anyone who does orders, data analysts, case management, and utilization review will all have to be familiar with the new coding at some level.
And the new system is quite different — it is not just numbers, but numbers and characters. Generally, Comfort says it takes about six months to train staff adequately, and “we are well under that time period before the new system goes live.”
Vendors also need to be ready, and it is up to hospitals to make sure that their systems are ready to go and handle the changes come October 1, she says. “You want to test ahead of time. CMS has already done testing to make sure they can accept the new codes, and so far, so good.”
Contact payers to make sure they are ready, too, Comfort advises. “Are your contracts up to date? Have you done any testing with your third party payers? You have to worry about more than just CMS.” Many of the big insurers have already announced their readiness, like the Blue Cross Blue Shield organizations. “They were very upset about the delays,” she says. “They have been ready for a while.”
Do you have a contingency plan if things do not work? Comfort says even if all your testing runs smoothly, be sure you have an idea of how things will work if there is a problem when things go live. “How will you have continual operations with payers if you have to submit paper claims? How long will that take and what will the impact be?”
It is about more than money, too, because all those numbers being input into computers — or if things go wrong, written on forms — are important data points that need to be available for quality reporting programs. If you can’t extract the information from the new coding electronically for some reason, will your staff be ready and up to the task to abstract the data manually?
It all circles back to training, she says. AHIMA has ongoing classes, both in person and online. There are past webinars on the organization’s website, as well as a checklist — albeit created when everyone thought ICD-10 would be implemented in 2013. You can find the checklist at http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Information on the classes is available at http://www.ahima.org/education/onlineed/Programs/ICD10.
“WHO says we can’t skip from ICD-9 to ICD-11,” she says. “There can’t be another delay.”
For more information on this topic, contact: Angie Comfort, RHIA, CDIP, CCS, Senior Director, HIM Practice Excellence, American Health Information Management Association. Chicago, IL. Telephone: (312) 233-1915.