Coding gets exciting

Mary Stevens, Editor, CMIO magazine

Medical coding and billing—vital to any healthcare organization, but never the most exciting departments—have entered an era that’s going to be anything but dull.

The impending ICD-10 code set will accommodate far more medical procedures than did ICD-9, enabling greater specificity for patient records and billing, but it’s an immense transition to a set with exponentially more codes. The 2013 deadline for conversion from ICD-9 is looming, and with no postponement in sight (as yet), “ICD-10 analysis/transition” debuted as a business priority in our recent Health IT Top Trends Survey. It was mentioned by close to 44 percent of respondents and landed at number three on the priority list, trailing only “Physician adoption of technology” and “Planning for meaningful use.”

Before ICD-10 can be deployed, however, organizations must transition to Version 5010 of HIPAA’s electronic transaction standards. The Medical Group Management Association (MGMA) called for a federal strategy to ensure providers and trading partners are prepared for the transition to Version 5010. MGMA surveyed more than 350 practice administrators and found that the vast majority of practices are aware of the Version 5010 mandate, but most aren’t ready to make the transition. “Should providers not be ready and experience wide-scale rejection of claims, practice operations and patient access to care could be negatively impacted,” the association warned.

Preparing for reimbursement models that place a greater share of financial risk on the practice is the top challenge cited by group practices, according to another recent member survey by the MGMA. Implementing and/or optimizing an accountable care organization model was also in the top five.

This is where some health information organizations come in or will soon: the eHealth Initiative reported that more advanced HIEs are preparing to offer billing and coding among their data exchange service options. In an ACO world, using an HIE service could speed exchange, and thus payments and reimbursements.

Meanwhile, Medicaid reimbursement rates are still dropping as states roll with the economic downturn. Although no long-term solution is in sight, the American Medical Association (AMA) recently joined forces with 112 state and medical specialty groups to urge the Obama Administration and Congress to repeal the Medicare Sustainable Growth Rate (SGR) formula and permanently reform the Medicare physician payment system as part of any agreement authorizing an increase in the debt ceiling.

Is your organization prepared for ICD-10? Let me know at mstevens@trimedmedia.com.

Mary Stevens, Editor