A few days ago, I posted five potential problems of the transition from ICD-9 to ICD-10. You can find that post by scrolling down to the title “What are Ten Problems With ICD-10?” This blog post will explain another five potential issues that could occur with the transition. Let us know what you think by writing in our comments section underneath this article.
Testing is a sixth concern of ICD-10. Practices will determine what code represents the health and condition of a patient. Even the correct use of ICD-10 will be difficult to assess from a processing standpoint. If incorrect monitoring is in place, it won’t be noticed until later down-the-road. Industry testing of ICD-10 remains unverified – Before a claim goes out the door, there’s a chance that it could pass through multiple systems on the provider side. Even within the payer, it might have to be transmitted through multiple systems.
With all the uncertainty surrounding ICD-10, it will more than likely disrupt cash flow. The productivity dip that coders and physicians will encounter will have a negative impact for some time. AR days will spike – so providers should prepare. Payers will react and will likely want more specificity for payment. High ranking officials at BlueCross note that although the majority of payers will not disrupt their payments drastically on day one, several factors could result in a claim being mispaid or denied. Mapping errors or the incorrect ICD-10 code to the claim could cause these errors.
From an analytics point of view, the benefit of ICD-10 will be hard to see for years. Data mining between both coding systems will be too difficult. Data collection and storage is not the problem – it’s when data analytics comes into play that it becomes a problem. There isn’t a one on one match between the two. Those dual sets will make it tough for insurance underwriters because those underwriters tend to set rates based on a retrospective analysis of data. The granularity of moving from version 9 to 10 will make it tough – a payer could identify claims that are associated with cardiology, but not know how many conditions or codes are involved with cardiology.
The expense of transitioning to version 10 is unfunded by the government. Organizations have to undertake this completely on their own expense which makes it tough, especially because calculating how much it could cost is a guessing game. Until providers are told the transition plan of their software providers (vendors), they can’t really determine a budget. For hospitals using older vendor systems, it might be better for them to just replace that old system with a new one in order to limit transitional issues.
The success of the conversion depends on the communication of thousands of organizations. Because one organization is ready does not mean it is enough for a successful transition. Each trading partner needs to be prepared, too; those partners include clearinghouses and additional providers. It affects everyone along the line – payers, providers, and software vendors. Vendors’ software may need to be upgraded, so many are working vigorously on those upgrades in order to be ready for conversions. Constant communication between everyone along the line will ensure the smoothest transition.
