Citing significant financial and administrative burdens, the AMA has asked Secretary Sebelius to postpone and streamline the 2013 mandated conversion to ICD-10. The AMA is clear that there are a wide range of health information technology initiatives and regulations they have to adopt and comply with right now and contends that converting from the 9th revision of the International Classification of Disease (ICD-9) to ICD-10 by October 2013 is stretching physician practices too thin.
Frankly, physicians, hospitals and behavioral health specialists are working overtime to implement certified electronic health records, Meaningful Use, e-prescribing, clinical decision support systems, outcomes measures and comply with the HIPAA 5010 rule so I would side with the AMA on this one. Frankly, most behavioral health providers I speak to around the country aren’t aware of ICD-10 and its implications and would sooner punt to their software vendors to fix the problem for them. That is not a viable or safe assumption. ICD-10 will reshape most if not all administrative and business functions and clinical documentation practices. Failure to properly convert to ICD-10 will strangle claims and cash flow. Aside from health care reforms like Medicaid expansion, ACOs and health insurance exchanges, this is the biggest challenge facing the behavioral health field so I hope readers heed this warning.
AMA on ICD-10
“Implementing ICD-10 is not just a technology project. It will impact most business processes within
a physician’s practice, including verifying eligibility, obtaining pre-authorization for services,
documentation of the patient’s visit, research activities, public health reporting, quality reporting, and,
most of all, submitting claims. Implementing ICD-10 requires physicians and their office staff to
contend with 68,000 diagnosis codes – a five-fold increase from the current approximately 13,000
diagnosis codes. This is a massive administrative and financial undertaking for physicians, requiring
education, software, coder training, and testing with payers. As HIPAA-covered entities, physicians
are responsible for complying with this ICD-10 mandate, and therefore must bear the entire cost of
such a transition, without any financial aid from the government. Depending on the size of a medical
practice, the total cost of implementing ICD-10 ranges from $83,290 to more than $2.7 million. The
Centers for Medicare & Medicaid Services’ (CMS) own assessment of the move to ICD-10
acknowledges that there are significant claims processing and payment disruption risks to physicians
undergoing a transition of this magnitude. History has shown how disruptive industry-wide
regulatory transitions can be to the processing and payment of health care claims.
NOT a Technology Project
The best thing behavioral health providers can do now is (1) to study the mandate, (2) become familiar with the functional and technical requirements of ICD-10, (3) and begin to discuss solutions with your software vendors. Bear in mind that solutions involve significant changes in workflow and process as much as they involve reconfigured software.