AHA Sees Reimbursement as an ICD-10 Implementation Challenge
By - Reimbursement is a key aspect that will play a big role by ICD-10 implementation as the Oct. 1, 2015 deadline approaches and speculation abounds as to the damaging financial effects an unsuccessful ICD-10 transition could have on healthcare practices of all sizes.
The tenth revision of the ICD system, developed in 1994 by The World Health Organization (WHO), had a significant purpose — to magnify the substance, objective, and range of the system to include ambulatory care services, enhance clinical detail, catch risk factors in primary care, include emergent diseases, and convene diagnoses for epidemiological purposes.
Reimbursement is a key aspect to be immediately and directly affected by ICD-10 as the October 1, 2015 deadline approaches.
To clarify upon this idea further, RevCycleIntelligence.com spoke with Chantal Worzala, MPA, PhD, Director of Policy at the American Hospital Association about anticipated ICD-10 challenges as the healthcare industry adapts a more modernized, up-to-date system later this year.
Reimbursement is one of the challenges associated with the continuation of an outdated coding system that is over three decades, says Worzala.
“We’re not necessarily providing enough granularity and detail. Payments may not be as accurate as they ought to be,” Worzala says.
Sixteen thousand choices of available diagnosis codes will soon become 70,000 choices.
As new technologies are developed, it becomes more difficult to accurately describe them, says Worzala.
ICD-10’s increased specificity includes a greatly expanded detail for various conditions. In ICD-9, many categories were limited to three or four digits. Now, there will be fifth, sixth, and even seventh characters/extensions in ICD-10.
In light of immediate disease outbreak, such as Ebola, this results in comprehensive and correct documentation to strengthen the healthcare industry as a collective whole. This is increasingly imperative with a new system’s implementation.
Coders will likely need to more closely assist physicians to execute a greater long term understanding and awareness of needed documentation.
The active review and revision of medical records means incorporating needed data for the assignment of codes.
This coding system makes it challenging to accurately pay for those new technologies, confirms Worzala.
“On an operational level, having a more granular code set like ICD-10 will enhance the ability to understand resource differences of services that are provided and also the ability to track new medical devices that are put into general categories that aren’t individually identified due to limitations in ICD-9,” Worzala maintains.
Although there are various financial restrictions of ICD-10, such as coders and physicians requiring extended training, the effects of implementation are indeed widespread among healthcare professions across disciplines.
“Hospitals have a lot more at stake than physicians,” says Worzala, regarding the connection between ICD-10 and reimbursement.
There are many reasons for this, including a foreseeable shortage of trained coders within the next several years is a possibility, according to the prediction of labor statistics. Educating new coders may prove to be an arduous task.
Limiting the learning curve and strong retraining and education efforts are key for future ICD-10 success within the healthcare industry.
