Health care finance has been the focus of many IT projects since the inception of HIPAA.  The next phase of financial based mandatory IT changes for providers is coming in 2013.  Upgrades are supposed to be mandated by the beginning of next year.  These upgrades relate to the first coding changes in at least 20 years.  ICD-10, the new coding language has been a topic of discussion at boardrooms, conference rooms, and coffee shops as providers and administrators discuss how to integrate the new mandates into their system.

ICD-10 has two hallmark differences that will impact reimbursement.  First, the length of the diagnostic code is growing to help accommodate more specific diagnostic care.  Treatments and actual disease have changed since the inception of ICD-9, and those codes have left some room for interpretation by coders, which can lead to improper reimbursement.  The new lengths can accommodate changes in care and allow providers to be more exact.  The other change is in ICD-10’s accounting for pre-existing conditions during hospital stays.  The ability to show which diagnoses are new, and which are pre-existing can help insurance companies reimburse more accurately.

These changes require IT companies to update their systems to include room for additional digits and new fields.  This may not sound like a horribly daunting task, but it can be if not done with correct application.  IT solutions can be remarkable at the front end, allowing providers to work quickly and get their data inputted correctly.  The challenge comes when exporting the data in a standard format that CMS and other insurance companies can utilize.  Although HIPAA has become the term used to define patient data privacy, it is actually more about transmission of billing data correctly.  The necessary changes to comply with the new guidelines will take time to become second nature.  Specifically CMS is calling this upgrade version 5010.  The upgrade in its transmission requirements is required as of this past January but will not be enforced until March.  This upgrade includes those necessary changes to prepare for ICD-10.  Visiting the CMS website can provide beneficial information about the changes.

The next few months should be interesting to watch as providers and staff learn new languages and technology while IT gurus work to make a smooth transition.  Many areas are involved in these crossover processes.  Laboratory and Radiology departments are an example.  Each department has a multitude of procedures that range in cost.  Administrators and staff are learning new processes to prevent delays in reimbursement and monitor the new changes to the system.

Providers, especially single physicians not associated in a large group practice, will need to become acutely aware of all these guidelines to ensure appropriate reimbursement.  These changes may lead to a reduction in single physician practices and return to a more “Old HMO” style practice over the next few years.  Certainly those providers like hospitals, which have a wide range of services including Family Care Centers with greater access to staffing for these changes, will find much success.