Y2K threatened power outages, food and water shortages, bank failures – all of which would render folks around the globe cold, hungry, thirsty, and without any way to get money to quell those. That catastrophe never happened, but ICD-10 has since been compared to Y2K, warranted or not.
Dennis Winkler, director of technical program management of Blue Cross Blue Shield Michigan, speaks with ICD10Watch editor Tom Sullivan about the potential doom and gloom ICD-10 carries, the dangerous reality of “other, undefined,” and why coders, much like COBOL programmers during Y2K, will “walk on water” as the October 1, 2013 compliance day draws nigh.
Q: Even though they never came true, Y2K presented some dangerous possibilities. With all the comparison between it and ICD-10, what's the worst-case scenario if, say, many healthcare organizations do not comply on time?
A: Let’s assume payers will be ready because once it’s enforced, there will be huge huge fines for not being compliant. The bigger issue is we’re going to have our providers and hospitals not be ready and when I say not ready, they’re not going to send ICD-10 codes in or valid codes. Worst case for the small provider that doesn’t update their codes, they’re going to have all their claims rejected if payers are following and enforcing the HIPAA regulations. When you disrupt their payments, if they’re small you could potentially put them out of business. And that’s something that nobody wants to have any involvement in doing. We’re not here to put providers out of business but if we’re forced to enforce compliance, and our providers are not sending us compliant transactions we have no choice but to reject those transactions.
[Related: Understated aspects of ICD-10, part 3. See also: ICD-10 among reg's demanding that payers rework 90 percent of IT architectures.]
Q: Even small providers going-out-of business could cause big problems. What are some of the other worst-case consequences?
A: There’s this thing in ICD-10 codes called “other undefined.” So everybody’s complaint but we if we get 95 percent of all our claims come in as “other, undefined,” ICD-10 codes? They get paid, life is good, but the benefits associated with this additional level of granularity, and the ability to get more finite as to what’s really going on in the doctor’s office or the hospital, you lose. So nothing breaks, everyone gets paid, but none of the benefits will materialize.
Q: What’s the likelihood of that happening?
A: It is speculative but it would not surprise me if we get this new type of consulting company that smells an opportunity for those late adopters that are not getting ready to be ICD-10 compliant in a timely enough fashion and they could swoop in, do their mappings for them before they’re ever sent out, and deal with it. I’m not saying that’s the case but I see that as a potential market out there.
Q: And then that just drags the whole ICD-10 project on all the longer…
A: Oh yes because now you’ve got the issue of education. Quite frankly, a small provider could be sitting there saying “What’s in it for me? What do I get out of doing all the extra level of detail?” At first blush there’s nothing.
[Related reader poll: 60 percent of health org's uncertain about meeting HIPAA 5010 Level 1 compliance. See also: AAPC's 16 steps for easing ICD-10 implementation.]
Q: What's been the most challenging aspect of ICD-10 for you and your team at BCBSM?
A: The biggest challenge is what’s going to come up. The biggest to date was getting everyone to understand that this truly is a business problem as opposed to a technical problem because all the hype out there is “technical, technical, technical.” But that’s nothing compared to what I think the opportunity is going to be within the business community relative to the number of people [healthcare organizations] are going to have to have available to invest this gray matter on all the business impacts. If you remember back to Y2K a COBOL programmer was worth his weight in salt. And contractors were jumping for 50 cents on the hour increase in the billing rate, there was no allegiance, there was no nothing. So you had this contingent workforce that were naming their price and their hours and floating wherever they needed to for about 3 years.
Q: And you expect the same to happen with ICD-10?
A: Yes, but on the business side. People that know ICD-9 and have been trained in ICD-10, oh my goodness, they’re going to be walking on water.
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Tom Sullivan blogs regularly at ICD10Watch.com.
