Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the health insurance exchanges. Hopefully, this nation-wide "social experiment" will work better than the federal exchange website, healthcare.gov. We also witnessed the Alabama Medicaid program begin its journey from fee-for-service to a capitated managed care program controlled by "regional care organizations" or RCOs. These changes and others continue to drive consolidation in the healthcare industry, with several significant hospital and pharmaceutical deals announced this year. And, of course, what would healthcare be without new regulations and increased government investigations. So, without further delay, following are my top ten 2013 healthcare events for Alabama providers.
10. NEW CODING REQUIREMENTS. In order to better evaluate the relationship between patient diagnosis and the resulting treatment, this year BlueCross BlueShield of Alabama tripled diagnosis code requests from four to twelve. In a similar move, effective October 1 of next year healthcare providers will switch from ICD-9 to ICD-10 diagnosis coding, which will increase the number of coding choices from approximately 13,000 to 68,000. Laterality (side of the body affected) has been added to relevant codes and accounts for the majority of the changes. While ICD-10 will not be effective until 2014, healthcare providers should start now to prepare for this significant change.
Originally Published in the Birmingham Medical News - December 11, 2013.
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