As if things weren’t complicated enough for healthcare in this country, they’re about to get worse. And if small medical practices aren’t properly prepared, the changes could increase wait times around the country.
So if things seem a bit tense in your doctor’s office soon, this new behind-the-scenes red tape is likely to blame.
Oct. 1st is the day when the nation’s physicians and hospitals must start using a massive new coding system to describe your visit on insurance claims so they get paid.
Today, U.S. health providers use a system of roughly 14,000 codes to designate a diagnosis, for reimbursement purposes and in medical databases. To get more precise, the updated system has about 68,000 codes, essentially an expanded dictionary to capture more of the details from a patient’s chart.
How precise? Get nipped feeding a bird, and the codes can distinguish if it was a goose or a parrot. Have a bike accident with one of those horse-drawn tourist carriages? Yep, there’s a code for that, too.
“ICD-10 has the potential to create many improvements in our public health system,” Andy Slavitt, acting administrator of the federal program Centers for Medicare and Medicaid Services (CMS), told health providers in a recent conference call.
But with the deadline approaching fast, he urged providers to make sure their offices are ready, and that they take advantage of Medicare-offered testing that lets whoever handles their billing file practice claims.
Why change things at all? Some say that with medical care gone digital, more precise diagnosis codes could allow researchers, even doctors themselves, to get a closer look at trends in one office or the entire country, Wergin said. A search of an office’s data could show how, say, all pregnant women with a urinary tract infection in the third trimester fared.
CMS can’t estimate how many health providers are ready for the switch but officials think most large practices and hospitals are, so the agency is intensifying its focus on smaller doctors’ offices, said Dr. Mandy Cohen, CMS’ chief of staff.
Private insurers told Congress months ago that they, too, are focusing on small providers.
Responding to concerns from doctors, CMS has promised some flexibility in the first year of assessing claims, if the coding is close.
“There will be bumps and challenges,” CMS’ Slavitt said, as he appointed an ombudsman to be the contact for health providers who experience them.
The Associated Press contributed to this article