(task) 'An absolute tsunami' | Insurance News Net

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> 'An absolute tsunami'
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> Oct. 04--SANFORD -- A major change to the health care system implemented on Thursday could have a powerful impact on health care providers, patients and insurance companies -- both locally and across the United States.
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> "It's an absolute tsunami," Dr. Keith Merritt, of Acacia Obstetrics and Gynecology on Wicker Street, said of ICD-10, the government-mandated medical coding system to which all U.S. health care providers switched on Thursday. "It's a big change, and everybody's a little frightened by it. But it's actually a better coding system."
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> ICD-10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, has 54,000 more codes -- including codes for squirrel bites, walking into a lamp post and burns from water skis catching on fire -- than ICD-9, which had been in use since the 1970s.
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> "There are some silly ones," Merritt said of the codes. " But one of the big purposes for this is to try to collect data on public health. Medicine is vastly different now than it was in the 1970s. We have different therapies, better medical knowledge, better medicines. We were trying to describe what we do every day with a 50-year-old system, and it wasn't working very well."
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> But that's not to say the new system has been an easy pill to swallow, and health care providers agree that medical practices will see significant delays in receiving payments for services from insurance companies.
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> "Initially, there will be a slowdown on both the health care provider's side as well as the insurance payer side for coding, claim submission and processing of claims," Sue Gaines, director of revenue analysis at Central Carolina Hospital, told The Herald in an email.
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> "This will be due to how vastly different ICD-10 is from ICD-9 diagnostic coding," Gaines continued. "ICD-10 is much more specific than ICD-9 coding and describes the patient's condition to a whole new level of detail. It requires more documentation from the physician and other health care clinicians."
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> And ICD-10 requires not only that the correct codes be sent to insurance providers for payment, but that the codes be sent in the correct order.
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> "Suppose we see 20 people in clinic," Merritt said. "Then we have to collect our charges for each of those people. A patient may have one code, or they may have six codes, for a visit. Those codes not only have to be correct for what we did or diagnosed. They have to be in correct sequence [that we diagnosed them]. If they're not in the correct sequence, they'll be rejected."
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> Merritt posited that difficulty of adapting to a new system, coupled with expected delays in receiving payments, could have disastrous consequences on some health care providers.
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> "It's like any business," Merritt said. "You can only go a certain amount of time of paying expenses for your business and not getting it back before you have to close your doors."
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> But despite it creating short-term difficulties, Merritt and Gaines agreed that ICD-10 is a more effective system.
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> "In the long run, I believe ICD-10 will be a good thing for health care, as it will provide diagnoses that really describes the patient's health care condition," Gaines said. "And that should result in better care. Just getting through the next few months will be the big challenge."
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> (c)2015 The Sanford Herald (Sanford, N.C.)
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> Visit The Sanford Herald (Sanford, N.C.) at www.sanfordherald.com
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