The governing board of the American Medical Association (AMA) has been considering a proposal that could save commercial health insurers tens of millions of dollars but slow insurers’ efforts to develop modern claims analysis and management strategies.
The proposal would affect what the U.S. health care system does about the current, outmodated diagnostic code system — the International Classification of Diseases, 9th Edition (ICD-9).
The body that runs the AMA, Chicago, is the AMA House of Delegates. The Georgia delegation at the AMA House is suggesting that the U.S. health care system might be able to avoid a world of ICD pain by ending the controversial struggle to shift to ICD-10 and move directly to adopt an edition that is supposed to come out in 2015, the 11th edition.
The World Health Organization (WHO) started work on ICD-9 in the 1970s, and it completed work on the next edition, the 10th in 1994.
Federal laws and regulations adopted before the Patient Protection and Affordable Care Act of 2010 (PPACA) came along originally were going to require the United States to shift to ICD-10 by Oct. 1, 2013. But the U.S. Department of Health and Human Services (HHS) now says it will push back the compliance date. HHS has not yet said what the new compliance date will be.
Health insurers care about ICD modernization because ICD codes are critical to health care and health insurance administration.
America’s Health Insurance Plans (AHIP), Washington, estimates a shift to ICD-10 will cost health plans about $11 to $38 per plan enrollee, or a total of about $3 billion industrywide.