FORBES: Conversion To New Government Codes For Healthcare Providers Could Spark More Confusion

By Gene Marcial, Contributor

JUNE 26, 2013 – If you think the issue of healthcare is already a big source of confusion, wait till medical providers try to divine the new diagnostic “codes” the government has prescribed to describe diseases and hospital procedures for insurance companies to pay the costs involved. These codes may turn out to be more complex than the Da Vinci Code.

Here’s the problem: Most of the healthcare providers and vendors have yet to understand and fully prepare for the new “ICD-10 Codes.” What’s ICD-10? It is comprised of about 140,000 new codes that will replace the existing ICD-9 codes, which the gods have decided aren’t clearly or fully defining, or explaining medical conditions and hospital procedures — as opposed to ICD-10, which aims to accomplish all that.

In other words, the government architects of the new coding system believe ICD-10 will speed up payment of claims and reduce delays caused largely by requests by the healthcare providers and vendors for more specific information. But the crux of the problem is how to cope with and understand the huge number of new codes in time to meet the deadline.

The new ICD-10, which establishes a set of new codes, aims to provide “flexibility” to accommodate future health-care needs and facilitate timely electronic processing of claims. But critics believe most healthcare providers and vendors haven’t yet updated themselves on the new codes — and aren’t likely to so do by deadline time on Oct. 1, 2014.

And there is strong opposition to ICD-10. According to a recent article by Forbes contributor Bruce Japsen, the Centers for Medicare and Medicaid Services has urged the American Medical Association to help delay the implementation of the new codes. And many doctors at a recent meeting in Chicago of the American Medical Association endorsed legislation in Congress to prevent the Obama administration from implementing ICD-10.

However, the government is steadfast in asserting that no further deadline delays is possible. Dr. Farzad Mostashari, national coordinator for healthcare IT in the Obama administration, asserted in a keynote address in mid-June at the HIMSS Media ICD-10 Forum in Maryland, that “there would be no more extension of the deadline for switching from the ICD-9 medical coding system to the ICD-10.” The deadline for conversion, he reiterated, would remain Oct. 1, 2014.

And Medicare and Medicaid Services Administrator Marilyn Tavenner has also said in public statements that there aren’t any plans to delay or cease implementation, noting that ICD-10 had already been delayed a full year from October of this year when it was originally scheduled for implementation.

Nonetheless, a big number of healthcare providers, including the American Medical Association, worry that the healthcare industry won’t be ready, noting that they need additional personnel and staff and equipment to grapple with the enormous changes required. It also says the data it has suggests that many healthcare practitioners and providers are still in the dark about ICD-10 and its ramifications.

Some of the large companies that provide products and services to the healthcare industry include 3M MMM -0.81% (MMM), General Electric GE -0.56% (GE), Accenture ACN -10.3% (ACN), Allscripts Healthcare solutions (MDRX), and Cerner CERN -0.7% (CERN). Many smaller healthcare providers also bear the heavier brunt of coping with ICD-10 because of limited funds and lack of wherewithal to do so.

With ICD-10, the number of diagnostic codes has increased to 69,000 from nearly 14,000, and the number of in-patient hospital procedure codes jumps to about 87,000 from some 3,000.

A number of companies have already prepared to provide healthcare providers and vendors with the training and services to keep up with the intricacies of ICD-10. Among them is CodeSmart Group (FICFD), which seeks to address the need to re-educate or train some 20 million people in the new healthcare codes.=

Ira Shapiro, chairman and CEO of CodeSmart, estimates that a shortage of about 3 million coders needs to be filled quickly as a result of ICD-10. He notes that about 40 million new patients are coming into the system next year, in part because of the Affordablle Care Act (ObamaCare), which would require, among oher things, millions of new charts each year that would have to be coded under the ICD-10 requirements.

CodeSmart has established “CodeSmart University” purposely to accommodate the need for ICD-10 training and re-education. It has signed up affiliations with more than 60 colleges and universities, says Shapiro. And CodeSmart has signed an exclusive agreement with one of the largest hospital group that represent 2,800 hospitals to market CodeSmart’s services.

CodeSmart, says Shapiro, is also negotiating agreements with several major hospitals to provide consulting services to assist in their ICD-10 transitions. Shapiro has more than 21 years experience in building more than 50 management teams in the healthcare industry. He worked for 10 years as CEO of New World Healthcare Solutions, a national executive search firm in healthcare.

Shapiro believes the New York-based CodeSmart University is the only company in the U.S. offering full online interactive ICD-10 education through its CodeSmart University, with the capacity and capability of handling the huge near-term demand for trained coders.


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