Managed Care - December 2008 - (Page 19)

ICD-10 beyond our shores here’s a prevalent notion that the rest of the world has already adopted ICD-10, and it’s one that Jim Daley likes to rebut. Daley, the director of risk and compliance information at Blue Cross Blue Shield of South Carolina, is a nationally recognized expert on ICD-10. He says that countries do use the ICD-10 code for mortality statistics, as does the United States. However, they have not adopted either ICD-10-CM (clinical modification), or ICD-10 PCS (procedure coding system), at least not in the detail that the United States plans. “Australia has 16,000 ICD-10-AM (Australian modification) codes, and Canada has 30,000 ICD-10-CA,” says Daley. “We plan on having 68,000. It was 120,000 a year ago. They shrunk it down a bit. Still, we have a lot more granularity.” As for the ICD-10-PCS, which will be used for hospital inpatient services, Daley says that “there are no procedure codes in the WHO version of ICD-10. So that’s strictly ours.” Not that the rest of the world isn’t watching — and waiting. CMS’s notice of proposed rulemaking in the Aug. 22, 2008 Federal Register that deals with this issue states, “Until the United States implements ICD-10 for morbidity reporting applications, data incomparability will continue to increase throughout the world.” T paid correctly and on time during the transition. There are a host of other objections, but so far CMS had been adroitly batting them away. For instance, regarding the payment of providers, CMS states in its NPRM “that the slowdown associated with the implementation of the new code sets may cause serious cash flow problems for providers. The risk of a payment slowdown always exists whenever a new payment system or policy is implemented.” However, it adds that “even with major policy changes, plans have learned over time to anticipate these problems and have instituted measures to provide periodic interim payments (PIP) for providers who may be affected by the processing slowdown. Most payers have learned through experience the cash flow needs of their providers and can easily set up PIPs and perform reconciliation at the end of the fiscal year.” 82 percent of the time. ICD-10 has 14 codes for sinusitis, but who is to say that doctors won’t just choose “unspecified?” Even cooperative physicians will need to be trained, and AHIP estimates that it could cost from $277 million to $415 million. AHIP arrives at this number by estimating that approximately 692,000 doctors will each need between 4 and 6 hours of training. CMS disputes this, saying in the Federal Register that “… we continue to believe that there will be a minimum number of physicians who will desire such training, leaving it instead to their staff coders or the use of ‘super-bills’ to update their coding information. In the case of the latter, we continue to believe that contract re-negotiation costs are considered for purpose of this analysis to be a cost of doing business, and would take place whether or not the transition to ICD–10 took place.” That’s just one challenge of the many that ICD10 presents. Those challenges, health plans, physicians, hospitals, and others argue, are reasons CMS should delay the launch of ICD-10 by at least two years, and even more. According to AHIP, a delay would allow vendors to build “packaged solutions” and better coordination between payers and physicians so that claims are CMS wants to help One might be tempted at this point to quote Ronald Reagan, who said the most terrifying words in the English language are “I’m from the government and I’m here to help.” Of course, Reagan’s presidency ended 20 years ago, and each generation seeks its own way. CMS wants to help, stating in the Federal Register that it “plans on proactively conducting outreach and education activities, as well as engaging industry leaders and other stakeholder organizations to provide education and other resources to their respective constituencies.” Might be worth looking into. MC For further reading Wildsmith TF. Examining the cost of implementing ICD-10. October 2006. Available at http://www.ehcca.com/presentations/hithipaa414/3_04_1.pdf Department of Health and Human Services. HIPAA administrative simplification: Modification to medical data code set standards to adopt ICD-10-CM and ICD-10PCS. Federal Register. August 2008. Available at http://library.ahima.org/xpedio/groups/public/documents/government/bok1_040507.hcsp?dDocName=bok1_040507 Libicki M, Brahmakulam I. The costs and benefits of moving to the ICD-10 code sets. Rand Corp. March 2004. Available at http://www.rand.org/pubs/technical_reports/ TR132/index.html Robert E. Nolan Company. Replacing ICD-9-CM with ICD10-CM and ICD-10-PCS: Challenges, estimated costs and potential benefits. October 2003. Available at http://www.renolan.com/industries/ICD10Study_1003. pdf DECEMBER 2008 / MANAGED CARE 19 http://www.ehcca.com/presentations/hithipaa414/3_04_1.pdf http://www.ehcca.com/presentations/hithipaa414/3_04_1.pdf http://library.ahima.org/xpedio/groups/public/documents/government/bok1_040507.hcsp?dDocName=bok1_040507 http://library.ahima.org/xpedio/groups/public/documents/government/bok1_040507.hcsp?dDocName=bok1_040507 http://library.ahima.org/xpedio/groups/public/documents/government/bok1_040507.hcsp?dDocName=bok1_040507 http://www.rand.org/pubs/technical_reports/TR132/index.html http://www.rand.org/pubs/technical_reports/TR132/index.html http://www.renolan.com/industries/ICD10Study_1003.pdf http://www.renolan.com/industries/ICD10Study_1003.pdf

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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