Medical coding’s makeover looking pretty…so far
They’ve been working around the clock at Athenahealth since the Oct.1 launch of the nation’s new medical coding billing system known as ICD-10.
In a makeshift nerve center at the medical billing company’s offices outside Boston, a team of expert coders hunch over computers monitoring the flow of physician claims submitted over the Athena platform, ready to pounce on glitches.
“We can watch these claims go out, we can watch them hit the payer … and we can zoom in on the goofs,” said CEO Jonathan Bush, though he’s quick to add the goofs have been rare.
In the first week since the transition to the new billing system, fewer than 500 were rejected for coding errors of more than a million claims submitted.
“ICD-10 has been delayed a couple of times, so we’ve had fire drills before to get ready for this,” Bush said. “So, by the time it actually happened, it really went off smoothly.”
At rival medical records vendor Cerner’s facilities in Kansas City, Missouri, it has also been a fairly quiet first week in its ICD-10 war room.
“It’s definitely smoother than I anticipated, considering that we’ve never had to do this before,” said Mike Hourigan, director of regulatory and compliance strategy at Cerner. “We’ve never had all providers, health-care systems, insurance companies, including Medicare and Medicaid, go through a change like this all at the same time.”
So far, so good
The Obama administration twice postponed the transition to the newest version of the International Classification of Diseases, during the launch of the Affordable Care Act.
Yet even after two years of delays, at hospitals like Montefiore New Rochelle outside New York City, getting staff up to speed on the complexity of ICD-10 has been a challenge.
“We now have up to 68,000 diagnosis codes and 76,000 procedure codes that we are required to report for billing and regulatory purposes,” said Rhonda Ruiz, associate director of operations and health information management at Montefiore.
A number of new codes have inspired ridicule, such as getting burned by water skis on fire and being struck by a turtle. And here are some more.
But the idea behind the fivefold increase in the number codes is that more detailed health data will lead to better care and ultimately better health outcomes.
“I think long term this can be a very good thing for medicine and patients in general,” said Dr. Andrew Kleinman, a surgeon at the hospital. “It will give us a much better idea of how the results of our treatment are going having this level of specificity.”
Last spring, Kleinman told CNBC his real concern is how the transition will impact his private practice. His medical billing vendor was telling doctors to expect glitches and error codes, and delayed payments.
While he’s relieved the transition is going smoothly at Montefiore, he’s still worried about the impact of the system overhaul on smaller doctors’ practices.
“In a hospital it’s great; we have a lot of backup. We have people running it. In my office, I’m the chief of IT,” he said. “That takes time away from patient care. The loss of productivity can be quite substantial.”
Too early to call it a success
After the disastrous launch of the healthcare.gov insurance exchange two years ago, federal health officials are likely relieved the transition is getting off to a smooth start. CMS, the Centers for Medicare and Medicaid Services, said it has been business as usual for its Medicare billing systems in the first week of the transition.
Health IT players aren’t ready to declare it a victory yet.
“It looks like at least on the front end, getting claims in the door has gone amazingly smoothly,” but that’s just half of the challenge, said Holly Louie, chair of the Healthcare Billing and Management Association’s ICD-10 Committee.
“By the end of the month, we should have a real good sense if there’s been any major blowups on the back end of the payment adjudication” she said.
At Athenahealth, the first ICD-10 claim payment came through seven days after being submitted without any problems, from insurerHumana.
Still, Bush says it will take a couple of billing cycles to know just how well the new system works.
“You might want to check back, between day 30 and 45 when some of the slower, more manual payers are getting around to sending out their first payments,” he said.