The money providers receive for the treatment of patients in the United States is based upon a code set that translates a diagnosis and/or procedure into numerical form, which can then be tied to a set of pre-defined or contractual allowances that state how much a provider will receive. This code data is known currently as ICD-9, a system that has been in use for over twenty years and has been updated to a new system known as ICD-10. The transition to the new data was set to be mandatory across the United States by the Health and Human Services Administration (HHS) and the Centers for Medicare and Medicaid Services (CMS) by 2013. With any change comes resistance and providers have been voicing concerns that they will be unable to comply with these mandatory changes by 2013. According to a February press release by HHS, they will be delaying the mandatory transition for a certain period of time, which will be announced at a later date.
United States providers happen to be behind the times when compared to the rest of the world. In fact, as a method to properly tracking statistical compilation of data in inpatient settings, the World Health Organization developed the ICD-9 and ICD-10 systems. The use of the system for insurance reimbursement came later. Peer countries such as the United Kingdom and Australia have already put the new ICD-10 system into place and have found that it requires a tremendous amount of administrative work to properly use the new system including the training of personnel.
The administrative work is extensive and requires training for physicians, medical record staff, billing staff, insurance staff, coding staff, registration staff, ancillary services (laboratory, radiology, etc.) as well as many other health care workers. This massive training endeavor translates into dollars and cents. The money needed to update personnel is hard to find with health care providers and facilities finding their budgets tightened even before thinking of the new updates.
Regardless of the date that HHS and CMS decide to use as final for the mandatory transition, health care providers and facilities need to start this education NOW. The new code sets have actually been out a long time now and in use by our peer nations. However, the health care system of the United States is different than that of our peer nations and will require more compliance enforcement as even though it is regulated, the control by the government is much less.
Compliance will be mandatory once the full conversion occurs. If CMS and HHS are committed to making this change there should be financial incentives to providers to help offset the cost of education. Although the origin of the code-sets is for coding diagnoses, reasons for healthcare encounters, health status, and external causes of injury, their utilization to determine reimbursement hits providers in a nervous way, their wallets. In addition, a patient education program should be enacted to start educating patients as to what these changes will mean. More accurate practices should benefit the patient population as a whole and if there was greater push from patients and a good financial incentive from the government, this transition could happen much quicker.