June 6, 2011

Billy's World: Isn’t There Anything We Can Do?

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Have you ever noticed how we Americans tend to accept mandates as if they were derived rationally? We experience a tax increase or decrease, and we say “rats” or “thanks,” respectively, and then move on. Gas and food prices go up, and we fuss about the high price of whatever, maybe try to justify buying a new car, and start buying cheaper cuts of meat. But as a group we tend to operate on the premise that there usually is nothing we can do.

ICD-10-CM and its illegitimate brother, ICD-10-PCS, are another two examples of the same problem. I’m not going to talk about ICD-10-PCS, which was developed by 3M under contract to CMS, because we all tend to depend on Medicare, and putting it bluntly we have no choice if we want to keep billing and processing inpatient claims.

Yes, much the same could be said about ICD-10-CM, but there is one really big difference:

ICD-10-CM wasn’t developed by 3M for CMS. It actually is rather old in IT terms, having been endorsed by the World Health Organization in 1990 and adopted by most of its members beginning in 1994. CMS and every other ICD-10 fan-boy or -girl tells us that ICD-10 is necessary for proper reporting, proper payments, proper statistics, and proper who-knows-what-else-they- can-think-of at the moment. Which brings me to the second question on my mind: if ICD-10 is so important, why did we wait 23 years from its WHO endorsement to implement it, and why are we one of the last countries to do so? Well, here’s the beginning of an answer:

Insurance companies, information technology companies, providers, clearinghouses, state entitlement programs and HCFA/CMS itself all did everything they could to delay it because of its cost and complexity. And what was the irony in that? They probably were right to do so.

The bottom line now is that CMS is pushing it because it fits in with its long-range plan to get them “points” as guardians of the public welfare. It’s much more satisfying to throw something like this at providers and payers than to clean up their own operation. Consider that it’s only June and CMS already has admitted to two errors in its pricing code for 2011. And even if they never made mistakes, CMS appears to enjoy demonizing the provider system anyway.

These are my thoughts, and mine alone. And that’s quite enough for now.

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Read 7 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.