Insurers may get a one-year break on new ICD-10 compliance date

Department of Health and Human Services Secretary Kathleen Sebelius announced the department is proposing a yearlong delay for compliance with new codes used to classify diseases and health problems.

Compliance with the International Classification of Diseases 10th edition diagnosis and procedure codes, known as ICD-10, will be required as of October 2014 if the rule is adopted. The department is currently accepting public comment on the proposed rule.

Contrary to the thinking that workers' comp stakeholders need not be concerned since the system is exempt from HIPAA, officials from the International Association of Industrial Accident Boards and Commissions warn otherwise.

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"Continuing with ICD-9 could have severe consequences for workers' compensation, including health care access issues," the IAIABC said. "Given the small percentage of workers' compensation clients that medical providers see, maintaining an electronic billing system with two coding sets would be impractical and costly. Delayed bills from workers' compensation carriers who cannot accept ICD-10 might force providers out of the system and restrict quality care to injured workers. This would cause more than a few headaches for state agency CEOs, insurance executives and medical providers."

The association said workers' comp payers, especially mono-line carriers, may be surprised by ICD-10. It urged state regulators to ensure payers and providers clearly understand the expectations.

In announcing the rule, the HHS said many provider groups had expressed "serious concerns about their ability to meet the Oct. 1, 2013, compliance date." The proposed change would provide stakeholders with more time to "fully test their systems to ensure a smooth and coordinated transition to these new code sets."

The final rule adopting ICD-10 as a standard was published in 2009. The new codes are designed to "improve the quality of information available for quality improvement and payment purposes," the HHS said.

The IAIABC said that despite the challenges workers' comp participants can benefit from the change. "ICD-10 CM and ICD-10 PCS allows for much greater specificity and accuracy in diagnosis," the association said. "Greater diagnosis specificity could be beneficial in developing fee schedules and pricing schemes, as well as managing the utilization review process."

Read more at the WorkersComp Forum homepage.

April 26, 2012

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