OREANDA-NEWS. On October 1, 2015, the health care industry will switch to a new set of medical codes that will need to appear on all future medical claims. The new tenth revision of the International Classification of Diseases (ICD-10) contains far more detailed clinical information than the previous set of codes and increases the number of codes from approximately 18,000 to over 140,000. According to experts from Aon Health, this complex conversion could lead to disruptions across the medical field, impacting providers, patients and employers:

Providers

  • Providers using improper or outdated codes will have their medical claims denied and will need to resubmit claims with the proper coding. 
  • Providers are likely to experience a delay in their claims submissions while they and their office staff/coders gain familiarity with the new codes.
  • Both scenarios may result in overall claim processing delays, which may lead to a temporary decrease in claims volume and alter claims funding forecasts.

Patients

  • If providers experience a delay in reimbursements from carriers, there may be a rush to collect payments from patients. These patients may erroneously be billed for medical services that should have been covered (e.g., preventive services) or for amounts that the provider should be writing off (e.g., discounts on negotiated rates).
  • Some individuals may have insurance claims that are denied for services that were provided but not properly coded. 
  • Individuals may see a delay in authorization for expensive tests and medical procedures from their insurance carrier if the tests and procedures are not accurately coded.

Employers

  • Employers should inform their HR, Benefits departments and call centers that they may receive increased inquiries from employees about future Explanation of Benefits (EOB) documents and provider bills.
  • Employers should communicate to their employees about the changes to the coding requirements and advise them to be diligent in reviewing their EOBs and provider bills.
  • Employers should advise their financial teams to expect some volatility in claims spend during the 4th quarter of 2015 and into the first half of 2016.
  • Employers that have already scheduled a claim audit in the second or third quarter of 2016, or are considering one, may have the added benefit of verifying that carriers are correctly paying claims under the new ICD-10 coding.