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Regulatory Developments

Industry Prepares for ICD-10 Changeover — Again

The WC industry is not required to convert to ICD-10 codes, but so much of the health care industry and payer community is impacted that comp must be prepared to follow suit.
By: | August 10, 2015 • 5 min read

Oct. 1 is the scheduled implementation date for the latest version of the International Classification of Diseases codes. While the workers’ comp industry is not a covered entity under the Health Insurance Portability and Accountability Act and therefore not required to convert from ICD-9 to ICD-10 codes, many practitioners have heeded the advice of experts and have begun preparing.

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But questions abound about the transition, and physicians have criticized the costs involved. The American Medical Association continues to raise concerns about the impending transition from ICD-9 to ICD-10 codes.

When the latest compliance date of October 2015 was announced, AMA responded: “While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time,” said AMA president-elect Steven J. Stack.

“The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so.”

Payers and others are also questioning the impact on the system once the conversion takes effect.

“ICD-10 [codes] are very detailed. There is one for someone who jumps off water skis after they caught on fire! Who would ever need that code?” — Phil LeFevre, director of business development, Work Loss Data Institute

However, several experts say that while there will be some costs and training involved, things are not as dire as many think.

“The truth is, organizations don’t have to be that scared,” said Phil LeFevre, director of business development for the Work Loss Data Institute, which publishes the Official Disability Guidelines. “I’m the first one to tell you the ICD-10 codes are more detailed than needed. There are 65,000 codes vs. 15,000 [in ICD-9]. Much of the detail is unnecessary from a disability duration and medical management standpoint.”

ICD Background

ICD has been revised for all entities covered by HIPAA. The 10th revision of the diagnostic and procedure coding system was endorsed by the World Health Organization in 1990 to replace the decades old ICD-9 codes.

The codes are used to study health conditions and will also serve as the foundation for documenting diagnoses and associated services provided by health care settings in the U.S.

In October, medical providers will be required to make the conversion to ICD-10 codes despite concerns of the American Medical Association. In one report, the association estimated the cost for small provider practices to convert would be between $56,639 and $226,105 because of the costs of software and training.

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Opponents have successfully delayed implementation of ICD-10 a number of times in the last decade. But workers’ comp stakeholders are fairly confident this year’s planned conversion will occur.

“My crystal ball says there will be continued attempts to delay, but the closer we get, the less successful they will be,” said Jennifer Wolf Horejsh, executive director of the International Association of Industrial Accident Boards and Commissions. “The sense I get is that there is a lot of active preparation [among workers’ comp stakeholders]; so people are really cognizant that it is coming up and making sure they can manage that transition as smoothly as possible.”

The Transition

The multitude of delays in implementing the ICD-10 codes has provided organizations with more time to get ready for the conversion. However, many expect snags.

Ohio, which has a monopolistic workers’ comp system, is requiring providers involved in the workers’ comp system to switch to ICD-10. The effort has been ongoing since last year.

“It will definitely slow down the process of bills being submitted and getting paid,” said Noel C. Shepard, an attorney with Frost Brown Todd LLC in Ohio. “Self-insurers are exempt, but realistically, third-party administrators will probably switch eventually. They will probably all switch over. It will delay the billing process, but not of actual allowances.”

TPA Sedgwick, in fact, recently announced it was finalizing changes to its systems “to ensure our readiness for the conversion.” The company is also providing training to its clients on the proper use of the ICD-10 codes with the ODG.

The Work Loss Data Institute began preparing its clients for the conversion about 10 years ago, according to LeFevre. “ICD-10 [codes] are very detailed,” he said. “There is one for someone who jumps off water skis after they caught on fire! Who would ever need that code?”

Since 2011, the ODG have been set up to allow users to toggle between ICD-9 and ICD-10 to understand what is needed.

“For example, [one of the ICD-10 codes] is a lumbar sprain. There are a bunch of codes below that one that are valid, but they don’t change the disability duration or medical management scenario,” LeFevre said. “What we’ve tried to do is highlight in bold the level of detail they need to focus on.”

All of ODG’s tools are set up to be run in both ICD-9 and ICD-10. CPT codes can also be searched through both.

“It’s a lot, especially for the provider, to get the billing right, for claims and medical staff in workers’ comp,” LeFevre said. “We try to accommodate [users] so no matter what you get from your physician, you can find it — either way.”

Advice

“I think there is a broad awareness of ICD-10, and people recognize that, yes, even though workers’ comp is exempt from HIPAA so they are exempt, so much of the health care industry and payer community is so impacted by ICD-10 that it certainly impacts workers’ comp, even if indirectly,” Wolf Horejsh said. “I know our state members have the infrastructure that is tied to national health care standards. So things even like fee schedules will be impacted.”

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For workers’ comp practitioners, the best advice is to become comfortable with the new codes. The Work Loss Data Institute is providing online training for its clients.

“It doesn’t have to be as daunting as it sounds,” LeFevre said. “You don’t have to unload 65,000 codes on the adjuster. Just go back to the lumbar sprain. There are 15 codes and only one that [relates to] return to work.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

The Profession

Curt Gross

This director of risk management sees cyber, IP and reputation risks as evolving threats, but more formal education may make emerging risk professionals better prepared.
By: | June 1, 2018 • 4 min read

R&I: What was your first job?

My first non-professional job was working at Burger King in high school. I learned some valuable life lessons there.

R&I: How did you come to work in risk management?

After taking some accounting classes in high school, I originally thought I wanted to be an accountant. After working on a few Widgets Inc. projects in college, I figured out that wasn’t what I really wanted to do. Risk management found me. The rest is history. Looking back, I am pleased with how things worked out.

R&I: What is the risk management community doing right?

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I think we do a nice job on post graduate education. I think the ARM and CPCU designations give credibility to the profession. Plus, formal college risk management degrees are becoming more popular these days. I know The University of Akron just launched a new risk management bachelor’s program in the fall of 2017 within the business school.

R&I: What could the risk management community be doing a better job of?

I think we could do a better job with streamlining certificates of insurance or, better yet, evaluating if they are even necessary. It just seems to me that there is a significant amount of time and expense around generating certificates. There has to be a more efficient way.

R&I: What was the best location and year for the RIMS conference and why?

Selfishly, I prefer a destination with a direct flight when possible. RIMS does a nice job of selecting various locations throughout the country. It is a big job to successfully pull off a conference of that size.

Curt Gross, Director of Risk Management, Parker Hannifin Corp.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Definitely the change in nontraditional property & casualty exposures such as intellectual property and reputational risk. Those exposures existed way back when but in different ways. As computer networks become more and more connected and news travels at a more rapid pace, it just amplifies these types of exposures. Sometimes we have to think like the perpetrator, which can be difficult to do.

R&I: What emerging commercial risk most concerns you?

I hate to sound cliché — it’s quite the buzz these days — but I would have to say cyber. It’s such a complex risk involving nontraditional players and motives. Definitely a challenging exposure to get your arms around. Unfortunately, I don’t think we’ll really know the true exposure until there is more claim development.

R&I: What insurance carrier do you have the highest opinion of?

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Our captive insurance company. I’ve been fortunate to work for several companies with a captive, each one with a different operating objective. I view a captive as an essential tool for a successful risk management program.

R&I: Who is your mentor and why?

I can’t point to just one. I have and continue to be lucky to work for really good managers throughout my career. Each one has taken the time and interest to develop me as a professional. I certainly haven’t arrived yet and welcome feedback to continue to try to be the best I can be every day.

R&I: What have you accomplished that you are proudest of?

I would like to think I have and continue to bring meaningful value to my company. However, I would have to say my family is my proudest accomplishment.

R&I: What is your favorite book or movie?

Favorite movie is definitely “Good Will Hunting.”

R&I: What’s the best restaurant you’ve ever eaten at?

Tough question to narrow down. If my wife ran a restaurant, it would be hers. We try to have dinner as a family as much as possible. If I had to pick one restaurant though, I would say Fire Food & Drink in Cleveland, Ohio. Chef Katz is a culinary genius.

R&I: What is the most unusual/interesting place you have ever visited?

The Grand Canyon. It is just so vast. A close second is Stonehenge.

R&I: What is the riskiest activity you ever engaged in?

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A few, actually. Up until a few years ago, I owned a sport bike (motorcycle). Of course, I wore the proper gear, took a safety course and read a motorcycle safety book. Also, I have taken a few laps in a NASCAR [race car] around Daytona International Speedway at 180 mph. Most recently, trying to ride my daughter’s skateboard.

R&I: If the world has a modern hero, who is it and why?

The Dalai Lama. A world full of compassion, tolerance and patience and free of discrimination, racism and violence, while perhaps idealistic, sounds like a wonderful place to me.

R&I: What about this work do you find the most fulfilling or rewarding?

I really enjoy the company I work for and my role, because I get the opportunity to work with various functions. For example, while mostly finance, I get to interact with legal, human resources, employee health and safety, to name a few.

R&I: What do your friends and family think you do?

I asked my son. He said, “Risk management and insurance.” (He’s had the benefit of bring-your-kid-to-work day.)

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]