Many doctors may not be ready for the new set of medical billing codes that begin on October 1, 2015. All healthcare institutions, from hospitals to private physician offices, are scrambling to implement these codes by that time so they do not risk inadequate or improper payments. With large staff and ample resources dedicated to implementation of the new codes, hospitals seem more confident in their ability to comply with the codes than are physician offices.
The World Health Organization issued the tenth update to their International Classification of Diseases, or ICD, in 2010. The United States was set to adopt the updates in October of 2013 but delayed instituting the new codes because authorities were concerned that it coincided with the rollout of the HealthCare.gov website.
In a 2013 survey of 785 hospitals by the American Hospital Association, or AHA, 94 percent of hospitals said they were moderately to very confident they would meet the deadline. Greater than 90 percent of critical access hospitals, usually found in rural areas, and institutions with fewer than 100 beds expressed compliance readiness. Two percent of responding hospitals said they were not confident in their ability to implement the new ICD-10 codes by October 1, 2015.
Ninety-two percent of hospitals surveyed said they were actively helping physicians convert to the new system. Many respondents said they had been preparing for the conversion for many years and that part of this preparation included helping doctors make the complex and difficult transition.
Obstacles for Physician Readiness
A June 2013 Medical Group Management Association, or MGMA, survey of more than 55,000 physicians found that clinicians had a variety of concerns about the negative effects of ICD-10 implementation. More than 70 percent of physicians said they were very concerned about the loss of clinician productivity post-implementation and nearly that number said they were worried about loss of productivity among coding staff. Over half the respondents said overall cost of conversion and almost half admitted that cost of software upgrades or replacements were a concern.
In the AHA survey, responding hospitals noted risks to implementation of the new standards. For example, the new codes could make working with payers and technology vendors difficult as various institutions start using the new codes.
Furthermore, the struggle to put the new codes into practice can distract from other priorities, such as adopting electronic health records and meeting Meaningful Use program requirements. In fact, more than half the respondents in the AHA survey name the Meaningful Use as the main competing priority to ICD-10 implementation.
The MGMA survey asked participants whether their individual Practice Management System vendors had given a date for implementing or upgrading to ICD-10. More than 52 percent of respondents said they had not been given a specific date. At the time of that June 2013 survey, only 4.8 percent said the PMS vendors said to expect implementation or upgrade by the October 1 deadline.
Most physician respondents to the MGMA survey said they planned to train staff between January 1 and October 1, 2015. The majority of physician practices will focus training on clinical and revenue cycle staff during that timeframe. Other staff, such as the practice administrator and coding staff will receive training.
Both the MGMA and AHA surveys show that most physicians and hospitals are working towards implementing the new ICD-10 codes by October 2015. With proper planning and assistance from associated hospitals, most physicians should be somewhat ready to use these new billing codes.
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