Backlogged insurance payments. Cash flow problems. Emergency bank loans.
That’s a taste of what doctors’ offices in Charlotte and across the country expect as the nation’s health care system switches to a new digital documentation system, which became effective Oct. 1.
The health care system has transitioned from an old disease-classification system called ICD-9 (for International Classification of Diseases, Ninth revision), which has been in use since 1979. In its place, doctors, hospitals and insurers are using ICD-10, an updated list of diseases and procedures containing tens of thousands more codes.
The back-office coding switch is supposed to be invisible to patients. But if claims processing grinds to a halt, delays will trickle down. That means doctors and hospitals could wait several months to be paid. Most large metropolitan hospitals have cash reserves to cover several months, but smaller offices could have to tap into savings or take out loans.
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Colleen Dey, treasurer of the Independent Physicians of the Carolinas, said she knows several Charlotte-area physicians who have arranged for loans, just in case.
Dey, who is also project manager for Carolina Family Healthcare in Charlotte, said the group is limiting the number of patients it will see each day because it takes doctors and nurses longer to code each visit.
“Even after they get used to the new coding requirements, we are expecting ICD-10 to add 3 to 5 minutes of documentation time for each patient visit,” Dey said. “That means each provider will see four to six less patients each day.”
Blue Cross and Blue Shield, North Carolina’s largest health insurer, has been preparing for ICD-10 for five years, and has been processing dummy claims for the past 13 months to make sure they go through.
“We’ve had no problems or issues at all,” said Mo Coleman, Blue Cross’ ICD-10 transition program manager. “We don’t expect any significant delays.”
The biggest backlog Blue Cross is expecting: a spike in calls from flummoxed physicians and medical practice managers struggling with ICD-10.
NCTracks, North Carolina’s payment processing system for Medicaid claims, tested dummy claims with over 500 entities and expects some doctors’ offices to struggle with the transition.
The switch to ICD-10 is mandatory for everyone covered by the Health Insurance Portability Accountability Act, or HIPAA, the 1996 electronic-billing and confidentiality law that covers Medicare, Medicaid, insurers, hospitals, doctors and labs. Dentists and pharmacies won’t be affected.
With ICD-10, the number of diagnoses will increase from 11,435 to 77,986, and the number of procedure codes goes from 2,805 to 82,453.
The new codes are more specific about each diagnosis or procedure. For example, codes now distinguish bite injuries by the source: human, shark, snake, spider, squirrel, and so on. Websites have sprung up to document bizarre and outlandish ICD-10 codes, such as walking into a lamppost or being struck by a turtle.
For patients who get joint replacements, “We now can tell if it was the right or left joint, whether the surgery was performed in the front or the back and what material was used in the device,” said Richelle Fleischer, senior vice president of revenue cycle at Novant Health.
Hospitals have been preparing for the switch for years and have trained their “coders” – employees who submit claims to insurers – to accurately translate patient records and documentation submitted by doctors.
Novant Health, based in Winston-Salem, said more than 1,500 Novant providers and 150 coders completed training for ICD-10, and the system has invested $11 million in preparations.
Bryan McRae, Novant’s project manager for the transition, is confident the organization is ready, but he acknowledged that if others in the industry haven’t made the necessary preparations, there could be a “chain reaction that might impact us.”
Carolinas HealthCare System, based in Charlotte, has provided training for about 20 new coders, in addition to about 100 already on staff.
“We’ve had lots of time to think about what we’re going to do,” said Brent Lambert, the system’s chief medical information officer. “We’re not anticipating there will be any long-term effects as far as reimbursement goes. I think it will be invisible to patients mostly.”