My manager and I decided to submit our claims online through a clearinghouse to ease the burdensome headaches with the "upgrade" (upgrade for whom, exactly?) for HIPAA 5010 transactions. So today I got a message that many claims were rejected by Medicare, in particular those claims submitted after Sept 30. Closer inspection revealed the ICD-9 codes, which are going to be replaced in 2013 by ICD-10, have been CHANGED FOR 2012 and THE CHANGES TAKE EFFECT OCT. 1, 2011 FOR 2012 UPDATES!!!! Who decided this asinine course? A bunch of codes for skin cancer were DELETED and simply given a 5th digit but the old codes were thrown out, like the baby in the bathwater. So the code for a skin cancer in the ear was 173.2 but on Sept. 30 this ceased to function, and now an ever more specific code, 173.22 or 173.21, must be used if you want to get paid when excising a skin cancer on the ear. The definitions of these codes and the assignment of the new codes is not being divulged by CMS. You have to buy a book for that. Or do a quick couple of searches on Google if you're savvy....
So now, dear friends, it is not enough to operate, educate, explain, empathize, and just in general be a doctor. Now(and since LBJ signed his stupid legislation way back when) we have to play the bureaucracy game by updating all software and all printed materials in the office that have these codes, and pay for it, and do it with a smile :-). And it must be done overnight, 3 months before the new year. I cannot imagine how big clinics or hospitals are dealing with this, because there are a slew of other, newer, more specific codes that will be valid for only 1 year before they ALL GET TRASHED AND REPLACED BY ICD-10. WHY?????
The AMA is doing this to justify its existence. The AMA, in cahoots with the feds, come up with the barrage of diagnostic and procedure codes, and of course one can purchase a book from the AMA where all of these codes are "updated" yearly. Membership is way down and most doctors in America place no value on what this organization does or says; it merely mails out flyers offering new disability or health insurance just about every month, otherwise the AMA is a completely impotent and useless organization.
It would be so great to just see a patient, do what has to be done and prescribe what has to be taken for the illness to get better, have payment rendered at the front desk, and that's it. Instead we have this giant back-office operation where codes, bills, data, procedures, modifiers, etc have to be entered into a portal (which we have to pay for and we can't charge for doing this, expressly stated in the CMS mandate), and then wait at least 3 weeks to be paid. If at all.
I guess all those new employees in DC have to justify their existence. Codes! Modifiers! YES! WE WILL BE NEEDED AND NECESSARY FOR THE FUNCTION OF MEDICARE!!!
