The realm of medical coding in the US is in for a big overhaul. Because of the recent mandate by HIPAA, healthcare providers all over the country are getting ready to implement the latest ICD-10 codes for all their billing and documentation processes. The United States is in fact one of the last countries in the global community to embrace the 10th revision of the ICD codes, which was endorsed by the World Health Organization in 1990.

The ICD-10 code set replaces the ICD-9 codes, which have simply outlasted its utility. The previous codes were adopted by the US more than three decades ago and in the course of this period, numerous additions and expansions in healthcare have overtaken the proficiencies of ICD-9. As a result, it has become almost impossible for physicians to record patient medical history and treatment with precision using the outdated codes.

The Deadline and Costs of Transition:

The deadline for adopting the ICD-10 codes is 1st October 2015 and experts are of the opinion that this will be a momentous undertaking for providers, payers, and vendors. They feel that the transition will drive business and systems changes throughout the healthcare industry, and to ensure a smooth transition, healthcare organizations need to devote significant staff time and financial resources.

As per a recent report, the price of adhering to the latest HIPAA regulation (i.e. the mandated ICD-9 to ICD-10 transition) could range anything from $84,000 to $2.7 million, depending on the size of the healthcare practice. And this covers everything from costs associated with education and process analysis, to additional staff needs and overtime fees.

Yes, shelling out such a huge amount is no mean task. But failing to adhere to the HIPAA mandate by the deadline can be even more disastrous. For those who don’t complete the transition from ICD-9 to ICD-10 all their claims and other transactions will be rejected, and they will have to resubmit the claims with ICD-10 codes.

Exactly how prepared are providers for ICD-10?

There is no clear cut answer, say experts. As per a recent Porter and Navicure’s survey, nearly 85 percent of respondents were confident that they will be all set to fully adopt ICD-10 codes; but the picture looks gloomy when 57 percent admit that all is not well with their preparation for the shift.

Other studies have revealed that the situation is a bit tricky and confusing to say the least. This is because while larger healthcare practices are at the cross line when it comes of ICD-10 readiness, their smaller counterparts are on shaky ground and are more likely to face claims and cash flow disruption.

It is also worth mentioning that even among the 43 percent respondents who claimed to be on path to ICD-10 readiness, nearly half feared negative repercussions on their finances, operations and staff morale, which was adding to the confusion.

Need help?

All the confusion and the complication of ICD-10 transition can be eliminated by hiring an outsourced medical billing service provider. Not only will this help health service providers to adhere to the latest HIPAA regulations, but also will have a positive impact on their bottom-line.


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