On April 1, President Obama signed a delay of ICD-10 implementation wrapped in with another patch to the sustainable growth rate formula. This was the second delay of the launch of the code set, originally scheduled for October 2013, and although we won't see ICD-10 implemented until October 2015 at the earliest, it's important for brokers to understand what the transition entails because the changeover is likely to disrupt the claims submission (and payment) process.

"The payers themselves are probably one of the most overlooked links in this whole crossover," notes Rex Stanley, RN, president of Alpha II, a company that develops data content and rules engines that drive diagnostic coding, claims editing and adjudication. "There has been a lot of hand-wringing and hair-pulling and talk about what the hospitals have to do and what the hospital vendors have to do and what the doctor's offices have to do, but there's really been very little said about what the payers have to do, and they probably have more work to do than anybody else.

"This data structure has been built up over a 50-year period," he adds, "and somebody has to change the data structure from the inside so that it will accommodate a larger number system."

The codes themselves will be moving from four or five digits to seven, and Stanley says this change is analogous to what happened during Y2K.

If payers or providers aren't ready for the changeover in October 2015, it could lead to disruption in payment – and that's something that could affect your clients.

"A lot of the standard policies are set up so if the insurance company doesn't pay the bill, it falls back to the patient," Stanley notes. "All of a sudden, the money isn't there, so you have to consider the effect this is going to have on your ability to sell policies and the questions that are going to come in to your office because people are suddenly not happy. There is a potential that this could cause a big hiccup, and it probably wouldn't hurt to have some internal memos on tap to be able to send out to patients, saying 'this is something we're working through with your physicians.'"

"ICD-10 is going to completely change the way providers input the diagnosis and payment codes," notes Larry Bridge, senior vice president of strategy and corporate development at TriZetto, which provides integrated health care management solutions. "Where in the past they might have had one code…for a certain type of office visit, they might have five to 10 to 12 codes to choose from in the future. That's where you might see some disruption.

It's worth pointing out that while we're still struggling to make the transition, the rest of the world has been working with ICD-10 since 1994. In fact, work has already begun to prepare for the adoption of ICD-11 in 2017. The beta draft of that new standard has been online for nearly two years.

"Moving from ICD-9 to ICD-10 should be payment neutral," he adds, but he sees potential problems on the horizon. "If I used to get $150 for the one code I could bid, with those new codes, the reimbursement could go anywhere from $50 to $1,200 depending on the complexity. So a lot of times, the code will get through, but the payer will stop it – the payer will pay at a lower code, and the physician might not expect that. It's not only the administrative side of the claim flow, but also the potential financial impact as we look at this new code set.

"There isn't a direct impact on brokers; it's going to be indirect," he continues. "But brokers' clients are in some way, shape or form going to get impacted by this. It's part of a transaction between payers and providers, and when that transaction does not go smoothly, it rolls out to all the people involved. Employers might see it in their health care costs; some providers are mad and they're quitting the network; payer claims are backed up; and some employees might say, 'My doctor refused to see me because my employer or payer isn't paying my claims.' Those are the collateral damage that will come out of that process.

"Even though brokers aren't in the middle of this, everybody on the fringe is going to be impacted by it in some way, shape or form," he concludes.