Are Doctors Prepared for Impending Changes to Medical Billing Practices?

Medical billing is an intricate and international system of codes used by health care professionals — including doctors, private insurers, hospitals, Medicare, and Medicaid — when determining patients’ conditions and/or diseases as well as how much should be paid for treatments. In a change unrelated to the new health care law, public health officials have proposed switching to a new set of codes on Oct. 1, 2014. Already some doctors as well as health care IT specialists have raised a cry and are insisting on a delay. Though it may be argued their response is merely an “anniversary reaction” to the botched deadline for the federal health insurance website, their fears are justified in at least one sense.

“If you don’t code properly, you don’t get paid,” Dr. W. Jeff Terry, a urologist in Mobile, Ala., told The New York Times. “It’s going to put a lot of doctors out of business.” He believes support staff as well as the computer systems on which they work, particularly those in small medical practices, may not be adequately prepared for an Oct. 1 deadline.

Who Decides?

The new set of codes, which are referred to as ICD-10 (International Classification of Diseases, tenth revision), follow from the existing codes currently in use, the ICD-9. All disease codes are currently issued by the World Health Organization (WHO), though the practice more or less officially began when a French physician introduced theBertillon Classification of Causes of Death at a congress of the International Statistical Institute in Chicago. America adopted the system in 1898; the first conference to revise an “International Classification of Causes of Death” took place in 1900; and revisions have occurred every 10 years thereafter. The original intent of a common global code is to promote comparability when collecting, processing, classifying, and presenting the causes of death and illness. In the U.S., the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) oversee all changes and modifications to the codes, which can be tweeked by each country, within limits, to suit their individual medical billing systems. Most other nations have already adopted ICD-10, if only for record-keeping purposes.

Originally, the ICD-10 was scheduled to launch in the United States this past Oct. 1, but that would have coincided with the rollout of the HealthCare.gov insurance website. A spokeswoman from CMS told The Times the agency remains committed to implementing ICD-10 on Oct. 1, 2014, and that will not change.” In comparison to the previous revision, the ICD-10 reportedly permits greater detail when describing illnesses, injuries, and treatment procedures. In turn, this should improve the recording and tracking of public health threats and trends while also expanding the capability of analyzing the effectiveness of treatments.

The American Hospital Association found in a recent survey that about 94 percent of hospitals were moderately to very confident about being ready by the Oct. 1, 2014, deadline. Yet more than half of the hospitals surveyed cited meeting the requirements of the Meaningful Use program for electronic health records (EHRs) — the specific objectives that eligible professionals and hospitals must achieve to qualify for CMS incentive programs — was the largest competing priority for ICD-10 implementation. Additionally, some hospitals suggested that external factors, such as timely testing and the receipt of necessary upgrades from vendors, might also threaten ICD-implementation. Nevertheless, most believe health care professionals will be both practiced and prepared for this necessary change when the deadline looms.

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