Managed Care - February 2009 - (Page 8) NEWS AND COMMENTARY ulation issued by the Centers for Medicare and Medicaid Services. “The final compliance dates reflect that CMS understands the complexity of these changes and the effort needed to reach compliance, both internally and externally among trading partners,” says Jim Daley, the director of risk and compliance in the information systems department at Blue Cross Blue Shield of South Carolina. A former HIPAA program director, Daley is a nationally recognized ex- pert on the subject. ICD-10 will expand the coding system (currently ICD-9) from 17,000 codes to 155,000. “We support moving to the new coding system, but we had concerns that the original implementation timeline was unrealistic and would not have allowed for a smooth transition,” says Robert Zirkelbach, a spokesman for America’s Health Insurance Plans. Charlie Baker, the chief executive officer of Harvard Pilgrim Health Plan, says the longer transition is a good idea, “given the complexities involved.” He expects that ICD-10 will very much be a part of the discussion as the Obama administration weighs how hard to push health care technology. “I wouldn’t expect the new administration to step back from this,” says Baker. Headlines On Deadline The burden of diabetes just got bigger, according to epidemiologists at the National Institutes of Health and the Centers for Disease Control and Prevention. Nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range. Researchers used newly available data from an oral glucose tolerance test, which gives more information about blood glucose abnormalities than the traditional fasting blood glucose test. Findings are reported in the February issue of Diabetes Care The California Supreme Court has barred the practice of balance billing that hospitals and emergency department physicians use to charge patients directly when their HMOs refuse to pay. The practice occurs when insured people seek emergency care from out-of-network physicians and hospitals. . . . New data-reporting guidelines became effective on Jan. 1. The Centers for Medicare and Medicaid Services has issued guidance documents for group health plans and their insurers and thirdparty administrators (TPAs). The guidelines should facilitate coordination of benefits with Medicare. Insurers, TPAs, and plan administrators are required to collect data, including Social Security numbers or health insurance claim numbers, and file these data electronically with Medicare. — Tony Berberabe Nearly 11 million Americans had individual health insurance policies, but some for only a short time A bout 10.9 million Americans under age 65 purchased individual health insurance policies at some point in 2006, but only 7 million were covered by these policies for the twelve months afterwards, according to findings from the Agency for Healthcare Research and Quality. The 3.9 million who had individual policies for part of the year were covered for about six months, on average. Individual health insurance coverage (number of individuals and percentage) Any individual coverage Full-year coverage 10.9 million 4.3% 7 million 2.7% Partyear coverage 3.9 million 1.5% Age distribution of people with full-year and part-year insurance coverage 30 25 20 15 10 5 0 <18 19–25 26–35 36–45 46–55 10.5 25.5 20.4 Full-year coverage (%) Part-year coverage (%) * * 18.1 20.2 16.5 13.5 21.6 * 11.9 14.3 10.1 5.2 7.7 4.5 55–60 61–64 *Statistically different at the 5 percent significance level Source of both charts: Center for Financing, Access, and Cost Trends. AHRQ. Household component of the Medical Expenditure Panel Survey, 2006. 8 MANAGED CARE / FEBRUARY 2009
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