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Life Health > Health Insurance

70,000 ways to die or get sick (and then bill insurance)

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(Bloomberg) — There are 70,000 ways to get sick, hurt or mortally injured, and the U.S. is making them official.

On Thursday, U.S. hospitals, doctors and other care providers have to start using internationally developed standards called ICD-10 codes to bill government programs and private insurers in the nation’s $2.9 trillion-a-year health care system. The codes cover everything from parrot bites to getting sucked into a jet engine.

See also: 3 earth shakers from the 2016 Medicare plan announcement

Doctors have already begun mocking the diagnostic list, picking out the most absurd and arcane, such as Z63.1, “Problems in relationship with in-laws,” or V91.07XA, “Burn due to water skis on fire.” Yet for health care providers who have payments at stake, the complex change is no joke.

Health insurers and government programs stopped accepting the old set of codes, called ICD-9, in the early morning hours Thursday, completing the switch. In a study released last month, the Government Accountability Office, the investigative arm of Congress, said “little is known” about how much it will cost the health care system to make the transition. HCA Holdings Inc. (NYSE:HCA), the Nashville, Tenn.-based hospital chain, said 2015 costs for the transition to the new codes will be about $30 million.

Insurers began preparing for ICD-10 in 2010 and have been ready since the government first delayed implementation in 2012, said Clare Krusing, a spokeswoman for America’s Health Insurance Plans (AHIP). “Every deadline that has come up, we were ready.”

‘Smooth transition’

Concerns about the changeover grew as the possibility loomed that Congress might not pass a spending bill and cause a shutdown of the federal government. The administration, which mandated adoption of the new codes, has said it’s ready, despite any political or technical challenges.

“We will pay claims and we’ll continue to implement the rollout,” said Patrick Conway, chief medical officer for the U.S. Centers for Medicare & Medicaid Services. “Our goal is to have a smooth transition.” Conway spoke during a conference call last week during which Obama administration health officials acknowledged industry anxiety about the changes.

Administration officials, who have already delayed the codes’ debut twice, say the system will help identify efficient ways to manage all kinds of conditions, from heart disease to roller-skating injuries.

More paperwork?

To doctors, it looks like more paperwork and, for at least a while, the possibility of slower payments.

“I think there could be a lot of delays in payments and a cash-flow crunch across medicine,” said Peter Masucci, a pediatrician in private practice in Everett, Massachusetts, just outside Boston. “That’s the biggest concern.”

Since having severe problems with reimbursement delays in the early 2000s, Masucci has worked to get payment times down to about three weeks. A new group of billing codes, almost five times as long as the existing one, might mean a return to long waits for payments from insurers, he said.

“Are the payers as ready as we are?” he said. “That’s what worries me. My staff have a bad habit of wanting to get paid every Thursday.”

Cash reserves

Some hospitals and physician groups are putting aside reserves in case of interruptions in reimbursement, said Lana Cabral, senior director of case management services for Conifer Health Solutions, a unit of the hospital company Tenet Healthcare Corp. (NYSE:THC). Conifer, which processes bills for doctors and hospitals, has set up a “command center” to manage the transition, she said.

Conifer has helped doctors and their staffs train for the change by teaching them to be as specific as possible in using the new codes, she said.

“If we’re using codes that are less specific, it results in lower acuity,” she said. “That doesn’t mean you don’t get paid or don’t get paid on time, but you may get less money.”

See also: Actuary: PPACA drags insurers into diagnosis code war

Athenahealth Inc., which sells and maintains billing software for Masucci and other health care providers, has been working for years to prepare for the new codes, said Todd Rothenhaus, chief medical officer for the Watertown, Mass.-based company. Despite efforts by insurers and billing services companies, there are bound to be glitches, he said.

“I guarantee you that some practices will not have a single claim dropped, and there will be others that will have no claims paid,” he said.

Rothenhaus said that the biggest concern for his clients is local insurers, such as state Blue Cross/Blue Shield plans that make up a large proportion of some providers’ bills. If these plans fail to implement the new codes properly, it could hurt individual doctors, he said. The company will be issuing reports on the performance of the new system and looking for trouble spots, he said.

And if, even after all the efforts to get the transition right, doctors and hospitals are still dealing with problems, there’s an ICD-10 code for that — F43.22: “Adjustment disorder with anxiety.”


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