The proposed transition to ICD-10 and HIPAA 5010 will lead to chaos, fraud, abuse and consumer dissatisfaction because the current timeline is unworkable
The Blue Cross and Blue Shield Assn. launched a campaign last month to extend the deadline set by the federal government for adopting new electronic transaction codes and standards. The current timetable for implementing the ICD-10 diagnosis and procedure code sets and the HIPAA 5010 transactions standards “will result in a major meltdown in the healthcare industry,” according to Scott Serota, Blues president, referring to the rule proposed by the Department of Health and Human Services (HHS) to implement 5010 standards by April 2010 and ICD-10 by October 2011.
Instead, insurers and a coalition of healthcare providers want at least two more years to make these changes. Implementation should be staggered, instead of both changes occurring simultaneously.
Insurers have voiced concerns about the HHS proposal for months, but are stepping up opposition as the deadline decision nears. Adopting the 5010 next generation of the electronic transaction standards involves “massive modifications,” explains BCBS vice president Alissa Fox.
The nine transaction standards involve provider payments, beneficiary enrollment, premium payments, provider inquiries about benefits, claim status requests and other issues central to health system operations.
If the insurer does not receive the correct diagnosis code from a physician from the more detailed ICD-10 coding system, it will have to deny the claim.
Unless insurers have time to implement ICD-10, they won’t be able to pay doctors and consumers the right amount at the right time, Fox says. While other nations have made the switch, the U.S. system is far more complex than those used in other countries or by the World Health Organization. Fox predicts chaos in which insurers won’t know what they’re paying for.
The change also opens up the system to widespread fraud and abuse during the transition as well as setbacks for efforts to promote quality measures and pay for performance.