Feb 11, 2009 | Coding, Billing, and Collections, Laboratory Pathology
Pathologists and lab directors concerned about training staff to implement the new ICD-10 code sets can relax-but only just a bit! The federal Department of Health & Human Services (DHHS) has pushed back the compliance deadline for implementing the International Classification of Diseases, 10th Revision (ICD-10) code sets. The new implementation deadline of October 1, 2013; replaces the existing deadline of October 1, 2011.
As it announced this extension in implementation of ICD-10 on January 15, HHS also set a date of January 1, 2012, for implementing the so-called X12 standard, Version 5010, for certain electronic health care transactions. Version 5010 is an important prerequisite to adopting ICD-10 and includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 accommodates the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard, HHS said.
These two implementation dates give labs additional time to prepare and train for using the new codes. Labs will find the implementation of ICD-10 to be a costly process, in part because ICD-10 uses 155,000 seven-digit codes, compared with the existing 17,000 codes in ICD0-9. Bloomberg news reported on January 14 that the new codes will be a “nightmare” for healthcare providers.
In a report last year, Nachimson Advisors, LLC, estimated that every provider will incur conversion costs in at least six ways. Organizations representing physicians and laboratories, including the American Medical Association and the American Clinical Laboratory Association (ACLA) commissioned the report, which projected the ICD-10 implementation costs for small, medium, and large physician groups.
The Nachimson Report calculated that the typical small group of three physicians would incur costs of $83,290 to comply with ICD-10. A typical medium-sized group of 10 physicians would spend $285,195, and a typical large physician practice of 100 providers would spend $2.7 million. (See “ICD-10 Conversion Costs Underestimated by HHS,” The Dark Report, Oct. 20, 2008.) These costs include expenses for:
1) education;
2) process analysis;
3) changes to superbills;
4) information technology;
5) documentation; and,
6) cash flow disruption
Conversion costs will be even higher for labs. That’s because labs must fund extensive changes in their information systems. Labs will also need to train not only staff, but also referring physicians. One large national lab estimated that it will spend $40 million to convert to ICD-10.
Armed with the knowledge about these high costs to implement ICD-10 and train referring physicians on the new codes, physician groups and ACLA have lobbied Congress to order HHS to delay implementation. HHS received more than 3,000 comments on the ICD-10 proposal, said Kerry Weems, acting administrator of the federal Centers for Medicare & Medicaid Services (CMS).
“A number of commenters asked for a delay in the compliance dates for both ICD-10 and Version 5010, citing implementation costs, the need to train health care personnel, and to assure ample time for testing between trading partners,” noted Weems. “HHS recognized these concerns and the final rules delay the implementation dates between the proposed and final rules by 21 months for the 5010 standards, and by 24 months for the ICD-10 codes.”
Medical laboratories and pathology group practices should already have a strategy in lace for handling the transition to ICD-10 codes. This two-year extension may be welcome today, but the United States is a full two decades behind the rest of the world in its use of ICD-10 codes. So further delays in ICD-10 implementation beyond 2013 should not be expected.
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Oct 28, 2008 | Laboratory Management and Operations, Laboratory Pathology
Federal officials underestimated the costs and time needed to implement the complex new codes for ICD-10, according to a new study released last week on October 14. As a result, laboratories and physician groups can expect to incur significantly higher costs to convert from the current International Classification of Diseases, Ninth Revision (ICD-9), to ICD-10.
The report by Nachimson Advisors, LLC, estimated that every provider will incur conversion costs in at least six ways. The report detailed and projected these costs for physician groups of small, medium, and large. It calculated that the typical small group of three physicians would incur costs of $83,290 to comply with ICD-10. A typical medium-sized group of 10 physicians would spend $285,195, and a typical large physician practice of 100 providers would spend $2,728,780. These costs include expenses for: 1) education; 2) process analysis; 3) changes to superbills; 4) information technology; 5) documentation; and, 6) cash flow disruption. Detailed coverage of the impending conversion to ICD0-10 is provided in the current issue of The Dark Report that was published on October 20, 2008.
One large laboratory with operations nationwide estimated that it will spend about $40 million to convert to ICD-10, including costs for information technology and staff education. This national lab further stated that implementation of ICD-10 code sets is projected to be twice as expensive as implementing the National Provider Identification (NPI) system that caused severe cash-flow problems for labs earlier this year.
A group of organizations representing physicians and laboratories, including the American Medical Association (AMA) and the American Clinical Laboratory Association (ACLA), commissioned the report. The deadline for compliance with ICD-10 is October 1, 2011, but physician trade groups are lobbying Congress to order the federal Department of Health and Human Services (HHS) to delay implementation. One reason the conversion is complicated is because ICD-10 uses 155,000 seven-digit codes, compared to the existing 17,000 codes in ICD0-9. Conversion will be particularly complex for laboratories because of the extensive system changes and the need to train not only staff, but the physicians who refer specimens to the laboratory.
“We have known this transition was going to be a big problem for a few years,” said ACLA President Alan Mertz. “The Nachimson study confirms that belief. ACLA has also consulted with our members and some of the larger labs tell us the costs for transitioning to the new codes and then the ongoing costs to use the new codes will be quite high. It will be costly for lab billing personnel to have to go back to the referring physicians to get the right diagnosis codes.”
Joseph M. Heyman, M.D., Board Chair of the AMA, said, “The AMA is deeply concerned that HHS is rushing head-first into the transition to a complex coding system without fully recognizing the impact on the health care system. Physicians, insurers, medical labs and others are raising the alarm that the costs, documentation and training required by ICD-10 will be significantly greater than HHS now recognizes.”
Medical laboratories and pathology group practices will need to develop a strategy for handling the transition from ICD-9 to ICD-10. Although providers are already pressuring federal health policymakers to delay the October 1, 2011 implementation date for ICD-10, there are many reasons why the United States must move to ICD-10. These reasons are detailed in current issue of The Dark Report.
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Oct 15, 2008 | Laboratory Management and Operations, Laboratory Pathology
When it comes to hospital accreditation, the Centers for Medicare and Medicaid Services (CMS) recently disrupted the status quo in at least three ways. First, last month it approved Norway-based Det Norske Veritas (DNV) as a hospital accreditation program in the United States. Significantly, this is the first new hospital accreditation organization in the U.S. in 40 years.
Second, by taking this action, CMS is bringing the hospital industry closer to the use of ISO 9001 quality management systems. That’s because Det Norske Veritas, which already accredits hospitals in several countries worldwide, bases its accreditation process on use of ISO 9001. It has also created a program that combines the CMS “Conditions of Participation” with the ISO 9001 quality management system. DNV calls this program the “National Integrated Accreditation for Healthcare Organizations (NIAHO).” At least 22 hospitals in the United States have already earned accreditation using NIAHO.
Third, by granting deeming status to DNV, CMS has introduced a new competitor for accreditation business into the U.S. marketplace-one that incorporates its accreditation standards on the ISO 9001 quality management system (QMS). Dark Daily predicts that it won’t take long for the Joint Commission to respond to this new competition by introducing an accreditation program that is also based on a quality management system like ISO 9001.
One U.S. hospital that has worked with Det Norske Veritas since 2005 is Newport Hospital in Newport, Rhode Island. During this time, the 120-bed community hospital has been surveyed four times by teams from DNV under its NIAHO program. Early in 2008, Newport Hospital was also surveyed by the Joint Commission and CMS, giving it a unique perspective on the similarities and differences from each of these survey programs. According to Terry McWilliams, Vice President of Medical Affairs at Newport Hospital, “They [Det Norske Veritas] consistently look for system-related issues and overall process improvement.” He further stated that the DNV survey, as conducted in his hospital was “clearly never inferior to our experience with any other agency-and at times superior! They really objectively look at your processes and how you might be able to improve them to get to that next level.”
For regular subscribers and readers of Dark Daily, these new developments are consistent with the healthcare trend of incorporating quality management systems, such as ISO 9001 and ISO 15189 Medical Laboratories, into the operation of healthcare organizations. It was in September that Dark Daily reported that the first two American laboratories were closing in on their ISO 15189:2007 accreditation. Piedmont Medical Laboratory (PML) of Winchester, Virginia, and Avera Health Laboratories of Sioux Falls, South Dakota, are in the process of completing the final steps required to earn accreditation under ISO 15189:2007. Each laboratory is using the College of American Pathologists (CAP) as its ISO 15189 accrediting body. (See “Two Labs in Friendly Race to Win First ISO 15189 Accreditation in U.S.“)
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