The U.S. government recently implemented a series of changes to the codes insurance claims use to report various illnesses and causes of injury, which could mean bad news for your medical bills.
The Centers for Medicare and Medicaid Services are the departments behind the change to the new coding system, who claim the new codes will offer more clarity and specificity to the description of the different reasons for treatment at hospitals and clinics across the country.
The new codes, they claim, will provide greater flexibility for dealing with healthcare needs in the future, and will help ease the burden on digital claims processing programs by streamlining the information shared.
Doctors aren’t so convinced, however. Dr. Steven Stack, the president of the American Medical Association said earlier this week that there will be no way to assess the full impact of the change until after claims begin to be processed under the new code. Surveys of medical professionals have shown a worrisome lack of confidence in the new program, with many doctors concerned over the potential challenges posed by the adoption of a new code.
According to Dr. Halee Fischer-Wright, the CEO and president of the Medical Group Management Association, a recent survey revealed that more than 20 percent of doctors’ offices still haven’t received the new updates for their billing systems in light of the switchover to the new codes. She worries that this lack of preparation could lead to a serious disruption in patients’ ability to submit insurance claims.
It hasn’t been easy to make the switch thus far for private insurance companies either. Insurers will use the new codes as they process claims from patients, and will need to take extra care to ensure they are on the same page as the doctors that author the medical reports upon which the claims are based. So far, insurance companies Anthem, Aetna, Cigna, Humana, and UnitedHealth Group have all reported serious additional capital expenditures in handling the new change in medical reporting language.
Some experts warn that people enrolled in certain health plans might face delays in the authorization of certain procedures and diagnostic tests if doctors fail to accurately describe them in the updated coding language. This could also result in the insurance companies rejecting claims until they are correctly filed.
Still, many believe the switch to the new codes might not be such a bad thing after all. As healthcare providers shift from a fee-for-service payment system to one that pays for specific outcomes and an expected level of quality in care, an updated reporting language will help professionals prepare for the healthcare needs of the 21st century.
ICD 10 codes are written by the World Health Organization, and describe a wide range of diseases, signs and symptoms, findings, complaints, societal circumstances, and various causes of injury or illness.