The ICD-10 Timer is Ticking

The deadline of October 2014 is getting closer and now is the time to prepare. Some changes will take place this October. Are you ready?

 The ICD-10 changes will affect more than just the inpatient and outpatient coders. Its effects will be far reaching. Now is the time to prepare. We should not be waiting until the last minute. 

In order for this to happen, billing forms were updated, EDI formats were updated to 5010.  Vendors, hospitals, clearinghouses, physicians offices and other healthcare providers have to make changes in their systems and update equipment, software, and educate their employees.  It is an overwhelming task if the provider waits until the last minute.

The changes will be like learning a totally different language and culture in a short time. It will take a transition time. CMS has established guidelines to help us prepare to learn the new language. There has to be a learning curve. If the education and implementation are delayed, it will affect the cash flow ultimately. 

According to a survey by CMS called, "Version 5010 and ICD-10 Readiness Assessment" 

Those participating in the survey were:

•  404 health care providers, (including hospital and pharmacy chain administrators and health care practice managers)
• 101 payers, (including directors or higher at health insurance companies, managed care organizations, and pharmacy benefits managers)
• 90 vendors, (including managers at health IT system developers, billing services and clearinghouses)

The results:

Providers

• 83% percent of providers indicated they were aware of the upgrade to Version 5010.  
• 81% percent of providers indicated they were preparing for the upgrade.
• 93% Providers  in  large practices aware of Version 5010
• 96% large practice settings  were taking steps to prepare for the Version 5010 upgrade.
• 80% smaller practices were aware of the changes.
•  75%  of small practices were preparing for upgrades.

• 85% of large hospitals were aware of the 5010 upgrade while
• 80% of small hospitals were aware.
• 84% large hospitals and small hospitals are preparing for the transition.

When it came to the changes with ICD-10 transition, 

• 87%  ICD-10 codes of providers were aware of the changes.
• 78% were aware of specific deadline for compliance . 

 Deadlines

• 75% were aware of the specific deadline for the upgrade.
• 64% said they think their organization will be compliant by the deadline. 

  

To further complicate matters, while the providers are scrambling to educate and train their employees and staff, the payers and vendors are also doing a lot of educating and preparing for 5010, !CD-10, new CMS-1500 forms, etc. to accommodate changes. 

Payers (including directors or higher at health insurance companies, managed care organizations, and pharmacy benefits managers)

• 79%  of payers said they were aware of the upgrade to Version 5010 
• 81%  are aware of the deadline for the upgrade.
• 87%  were aware of the upcoming transition to ICD-10 codes.
• 83%  were aware of  the deadline for compliance.   
• 87%  were preparing for  Version 5010. 
• 80%  said they thought their organization would be compliant by the deadline.
• 88%  said their organization was taking steps to prepare for the ICD-10 transition and   they believed they would be compliant by the deadline. 

Vendors  (including managers at health IT system developers, billing services and clearinghouses)

• 85% percent  indicated they were aware of the upgrade to Version 5010. 
• 84% are preparing for the Version 5010 upgrade.

• 75% said they are aware of the deadline for the upgrade.
• 83% of vendors also said they are aware of the upcoming transition to ICD-10 codes.
• 78% are taking steps to prepare for the ICD-10 transition. 
• 72% are aware of the the deadline for compliance .
• 75 % said they thought their organization would be compliant by the deadline.

By the numbers indicated from this study, the majority of medical providers, payers and vendors are preparing for the deadline for implementation, however some are not. This survey was completed in Dec. 2011. Time has passed since then, but there still may be those who are overwhelmed and not wanting to go to the expense of upgrading. However, the inevitable is happening and those who are ready will transition smoothly. But, if you lack the knowledge and skill, you will essentially be left in the dark ages.

So, what can you do?

Providers:

• Make sure your billing and coding departments/ or outsourced company are prepared by having the education they need to transition. 
• Make sure that your clearinghouses and IT systems are ready.
• If your  billing software and clearinghouse is not ready, find one who is prepared.
• Remember, if the support staff is ready, there will be loss of income to you on a daily basis because your claims will be aging.

Billers and Coders

• Make sure you have the proper tools and training to be able to make the transition smoothly.
• Make sure that that your provider is ready. You may need to educate front desk staff as well as the provider when to learn what is needed for the transitions. 
• The superbills will have totally different codes. Make sure the provider has the new codes ready by the deadline.
• Learn all you can! If billers do not know the ICD-10 codes, now is the time to learn them so you can read the proper charges to submit for services. 

The more we are all informed and plans for upgrades are implemented, the better it will be for all of us in the medical community. The changes are coming. Get Ready!

Thanks for reading.

Donna McHugh, CMRS

Resource:

www.cms.gov "Version 5010 and ICD-10 Readiness Assessment" 

Affordable Care Act Pros and Cons

According to the Health  Health and Human Services (HHS) Secretary Kathleen Sebelius announced (March 2013) that

 71 million Americans in private health insurance plans received coverage for at least one free preventive health care service, such as a mammogram or flu shot, in 2011 and 2012 because of the Affordable Care Act. 


Additionally, an estimated 34 million Americans in traditional Medicare and Medicare Advantage plans have received at least one preventive service, such as an annual wellness visit at no out of pocket cost because of the health care law.

Taken together, this means about 105 million Americans with private health plans and Medicare beneficiaries have been helped by the Affordable Care Act’s prevention coverage improvements.

According to this report:

The Affordable Care Act is giving Americans better value for their health insurance plans by:

• Eliminating lifetime dollar caps on essential health benefits, and phasing out annual caps. 
• Prohibiting health insurance companies from denying coverage to children based on a pre-existing condition, such as asthma or cancer.
• And in 2014, it will be illegal for health insurance companies to deny coverage to any American or to charge more because of a pre-existing condition.  No longer will 129 million Americans with health conditions have to fear seeing their premiums increased or getting locked out of the insurance market.
• The law will also make it illegal for a health insurer to charge women more simply because they are women. “That means,” Secretary Sebelius said, “being a woman will no longer be a pre-existing condition.”

But is the Affordable Care Act really a good thing for Americans?

Some think not. There are a lot of different areas of healthcare that will not improve.

• There will be a shortage of healthcare professionals. 

 A new study by the National Monitor predicts that the implementation of the PPACA, coupled with the nation’s aging population, could lead to a shortage of 52,000 primary care physicians by 2025.

The study also noted that office visits to primary care physicians will likely increase from 462 million to 565 million by 2025, further straining the system.

The shortage will be made worse by funding cuts for residency programs for newly graduated physicians. Without the hands-on training, quality will suffer. Residency is vital to the success of doctors of all specialties.

Higher drug costs. Pharmaceutical companies will pay an extra $84.8 billion in fees over the next ten years to pay for closing the "donut hole" in Medicare. This could raise drug costs if they pass these fees on to consumers.

Obamacare does not apply to businesses with less than 50 employees. Larger businesses are required to offer health insurance, but receive tax credits to help employees pay premiums. In 2014, the tax credit increases to 50%.

Higher deductibles and fines to poor Americans.  Those who don't purchase insurance, and don't qualify for Medicaid or subsidies, will be assessed a tax of $95 (or 1% of income, whichever is higher) in 2014. It increases to $325 (or 2% of income) in 2015, and $695 (or 2.5% of income) in 2016. 

Employment and benefit losses.  Even now employers are making tough decisions. People who have  been full time workers are being reclassified as part-time workers and as a result are losing benefits. The employers cannot afford to pay insurance premiums for their employees. Some are changing to a higher deductible plans for families. That means more hardships for families as they, too, are making tough choices.

Between 3-5 million people could lose their company-sponsored health care plans. Many businesses will find it more cost-effective to pay the penalty and let their employees purchase their own insurance plans on the exchanges. Other small businesses might find they can get a better plan through the state-run exchanges. 

ObamaCare is going to be about more than making healthcare choices. It is going to affect our everyday lives because of job losses, less hours, and reduced benefits, higher deductibles and co-pays...and the list goes on.

So, while the government says The Affordable Care Act is a good thing, many disagree and are forced to make difficult decisions that will affect many for generations to come.

Thanks for reading,

Donna McHugh, CMRS

Resources:

 http://www.healthcare.gov/law/timeline/full.html

http://aspe.hhs.gov/health/reports/2013/PreventiveServices/ib_prevention.cfm

Healthcare.gov 

(Source: CBO CBO Report on Health Care Reform and the Budget; Wall Street Journal, What Health Insurance Ruling Means, June 28, 2012; NPR, Medicaid Expansion, June 27, 2012)

Obamacare Cons

( Washington Post Factchecker, Tax Breaks vs Tax Hikes, July 6, 2012)