Friday, October 2, 2015

An October 1st Nightmare For Our Doctors and Ourselves

Unless you are a doctor, you are probably unaware of an upcoming change in the way medicine will  be practiced in the U.S.. It will complicate lives and could greatly affect whether or not your insurance company, Medicare, or Medicaid will pay for medical services you receive.

As of October 1st, doctors are now required by law to use a new coding system for diagnosis and treatment called ICD-10 (International Classification of Disease version 10).

For years, they have been using version 9 of the ICD.  Under that system, there were 14,000 different codes that a doctor could pick from to specify a diagnosis and the associated treatment.  More often than not, most insurance claims that were denied were usually because of coding errors.

Now comes ICD-10 and the doctor must now be more specific about his/her diagnosis and treatment to the tune of 87,000 different coding options for a claim submission.  Besides the obvious potential for a severe increase in coding errors and claim denials, the application of ICD-10 coding creates an administrative nightmare for both doctors and the insurers who must interpret what each claim is all about; including the processing of Medicaid claims by both state and federal agencies and by the federal government and supplemental insurers for Medicare claims.  Don't be surprised if Health and Human Services doesn't call for a substantial increase in personnel at the Centers for Medicaid & Medicare Services to handle this additional workload.  In addition, your private insurance rates are sure to go up because of the increased burden.

Now, to the politics of this new ICD-10 implementation.

Obama's Centers for Medicaid & Medicare Services (CMS) have already announced that no claims will be denied on the basis of  coding errors for a period of one year through September 30, 2016; just five weeks before the 2016 Presidential election.  Since it typically takes a few weeks to process a claim, no voter will be aware of the massive amount of claims that were denied until after the election.  How, convenient!

In my opinion, this is a big deal and the media is totally ignoring it.  But, I'll bet they won't be ignoring it next year when claim denials pour in at a higher rate than ever before.  And, while this will be because of doctor coding errors, a lot of billing departments will probably just bill you because of the denial and the poor patient won't even know why.  Thus, the insurers and CMS will be inundated with calls and complaints, complicating the administrative nightmare that ICD-10 created.  Ask yourself this: Will your healthcare be improved by more precise coding?   Probably not!


The New Disease Classification (ICD-10): Doctors and Patients Will Pay:

ICD-10: CMS won't deny claims for first year:

American Medical Association: The Differences Between ICD-9 and ICD-10:

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