BCBSA: Administration's Proposed Rule For ICD-10 Will Lead To Healthcare 'Meltdown' For Patients And Providers
BCBSA urges administration to adopt NCVHS recommended timeline
September 4, 2008
WASHINGTON - The Blue Cross and Blue Shield Association (BCBSA) supports the administration's move to 5010 and ICD-10 coding systems, but believes the Department of Health and Human Services' (HHS) proposed timeframes for insurers and providers to implement these massive changes are unworkable.
"The proposed timeline for implementation is completely inadequate," said Scott P. Serota, BCBSA president and CEO. "Rushing the process will result in a major meltdown in the healthcare industry including - unavoidably - inaccurate and delayed payments to providers and consumers, an inability to detect fraud and abuse, and unnecessarily higher total costs of implementation due to the accelerated timeline. We strongly urge the administration to adopt the recommended timeline advanced by the National Committee for Vital and Health Statistics."
The National Committee for Vital and Health Statistics (NCVHS), the official adviser on HIPAA to HHS, recommends a two-year timeframe for implementing the first phase of these changes - the 5010, which must be done before starting work on ICD-10. Then, they support three years for conversion to ICD-10. The NCVHS very clearly states that the implementation of the two should be done consecutively - not concurrently. If the NCVHS process were followed and started now, the soonest ICD-10 could be completed is late 2013.
Converting to 5010 and ICD-10 is a massive undertaking as the codes provide the underpinnings of programs that support: claims payment for millions of people who have private or government insurance; detection of fraud and abuse; programs that base payment on quality indicators (pay for performance); quality assessment programs; clinical research; trend analysis; and disease management. Insurers and providers will have to be ready to move seamlessly from 24,000 ICD-9 codes to more than 150,000 ICD-10 codes.
Experiences with other HIPAA mandates, including the original 4010 transaction and the National Provider Identifier (NPI), illustrate the time needed to implement even the simplest of transactions required under HIPAA. Implementation of the NPI transaction - the simplest of the mandated HIPAA transactions - took four years and four months. It makes no sense to provide less than three years for the massive overhaul that the 5010 and ICD-10 changes will require.
BCBSA is strongly urging the administration to adopt the NCVHS recommendations to implement these massive systems changes. "We need to have a reasonable timeline in place to avoid major disruptions to consumers and providers," Serota said.
The Blue Cross and Blue Shield Association is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for nearly 100 million members - one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com.
