As of October 1st 2015 the International Classification of Diseases 10th Edition (ICD-10) is the national coding standard in the United States, as mandated by the Department of Health and Human Services in 2009. The International Classification of Diseases is an alpha-numeric coding system to describe patient’s conditions, symptoms and diagnosis for payers, providers and researchers; essentially providing a universal language for medical necessity and statistical analysis. The World Health Organization creates the system and governments around the world adopt it. The previous addition was adopted in 1979. ICD-9 no longer offered enough capacity in categories and codes to encompass variations in medical practice and to reflect the differences
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One of the most taxing efforts will be related to training and documentation. Administrative staff will need training on new codes for billing and clinical staff will need training on increased documentation required for more specification within codes. Related to this level of training, providers will likely experience reduced billing efficiency and decreased productivity of clinical staff especially during initial implementation. In addition, Information Technology systems will likely need to be evaluated and Electronic Health Record (EHR) systems will require extensive attention. Providers will need to dedicate time and resources to conduct testing prior to October 1, 2015 to ensure claims will be processed and paid. This transition will be especially difficult for smaller and more rural providers who have already struggled with compliance related to the HIPPA portability act and Meaningful Use requirements (Fassbender, …show more content…
DRGs or Diagnosis-Related Groups determine Medicare reimbursement rates for hospitals. Hospitals receive reimbursement for various procedures based on DRGs despite actual final cost. The DRGs are assigned based on ICD codes, conversion to ICD-10 will unavoidably impact reimbursement rates. The Center for Medicare and Medicaid (CMS) has communicated that they will begin to optimize DRGs once ICD-10 data becomes more available but has not promised revenue neutrality (Nicohols, 2011). Health plans will modify their contracts to include more specific language related to the increased variation in billing codes as well. Health plans that previously included carve-outs to excluded specific procedures that were grouped under a general ICD-9 code will now include more specific language. Payment schedules will be adjusted to reflect a higher level of specificity. Payers’ and providers’ ability to mitigate these changes will impact every stage of the revenue cycle.
Although some politicians such as Texas’s Ted Poe advocate for further delay of the ICD-10 conversion date, the already four year delay has provided a significant window of opportunity for payers and providers alike to make implementation plans (Fassbender, 2015). CMS has conducted research, collected industry feedback and provided educational and training resources to help payers, providers and vendors
One of the most taxing efforts will be related to training and documentation. Administrative staff will need training on new codes for billing and clinical staff will need training on increased documentation required for more specification within codes. Related to this level of training, providers will likely experience reduced billing efficiency and decreased productivity of clinical staff especially during initial implementation. In addition, Information Technology systems will likely need to be evaluated and Electronic Health Record (EHR) systems will require extensive attention. Providers will need to dedicate time and resources to conduct testing prior to October 1, 2015 to ensure claims will be processed and paid. This transition will be especially difficult for smaller and more rural providers who have already struggled with compliance related to the HIPPA portability act and Meaningful Use requirements (Fassbender, …show more content…
DRGs or Diagnosis-Related Groups determine Medicare reimbursement rates for hospitals. Hospitals receive reimbursement for various procedures based on DRGs despite actual final cost. The DRGs are assigned based on ICD codes, conversion to ICD-10 will unavoidably impact reimbursement rates. The Center for Medicare and Medicaid (CMS) has communicated that they will begin to optimize DRGs once ICD-10 data becomes more available but has not promised revenue neutrality (Nicohols, 2011). Health plans will modify their contracts to include more specific language related to the increased variation in billing codes as well. Health plans that previously included carve-outs to excluded specific procedures that were grouped under a general ICD-9 code will now include more specific language. Payment schedules will be adjusted to reflect a higher level of specificity. Payers’ and providers’ ability to mitigate these changes will impact every stage of the revenue cycle.
Although some politicians such as Texas’s Ted Poe advocate for further delay of the ICD-10 conversion date, the already four year delay has provided a significant window of opportunity for payers and providers alike to make implementation plans (Fassbender, 2015). CMS has conducted research, collected industry feedback and provided educational and training resources to help payers, providers and vendors