MANAGED CARE November 2011. ©MediMedia USA
All the focus on accountable care organizations might be overkill, considering that participation is voluntary. Health plans face other deadlines, however. For instance, the clock is running for insurers to plan and prepare for transition to the ICD-10 coding system. The compliance date is Oct. 1, 2013, and the preparation involves a lot of work: There are approximately 13,000 ICD-9-CM codes; ICD-10-CM will have 68,000.
“Medical directors need to ensure their medical policies have been reviewed and updated as warranted for ICD-10,” says Jim Daley, director of risk and compliance information at Blue Cross Blue Shield of South Carolina and a nationally recognized expert on ICD-10. “Depending on the extent that specific codes are referenced in policies and on the number of policies, the policy review itself can consume hundreds or even thousands of hours. Even if specific codes aren’t mentioned in the policies, medical directors need to ensure that the policies will continue to operate as intended under the new code set.”
Expect IT challenges galore, says Daley. “IT applications may contain logic that enacts the medical policies, and that logic must be reviewed and updated for ICD-10. This will require the knowledge of medical directors to properly map logic to the new codes.”
ICD-10 (the International Statistical Classification of Diseases and Related Health Problems 10th Revision) is the latest code set from the World Health Organization to categorize diseases. It is overseen in this country by the Department of Health and Human Services. Periodically, ICD goes through major revisions. In between, there is continuous updating of codes, as well as the addition of a handful of new ones each year. ICD-10 represents a scope of change not attempted since 1946 with ICD-6.