By Steff Deschenesfor for HealthcareFinance News
There are plenty of unknowns concerning the financial aspects of ICD-10. Transitioning to the new codes could be a disaster for some providers. However, those who take into careful consideration their current clinical documentation and coding shortfalls and adjust them for ICD-10 specificity could see an entirely different outcome.
Providers can achieve positive financial outcomes from their ICD-10 transition by “preparing, perfecting and protecting” during rollout, said David Van Doren of IOD, Inc., a company that offers healthcare information management solutions to providers.
- Establish or strengthen CDIs. Although some have viewed the ICD-10 implementation delay as a negative, it’s actually created the perfect window of opportunity for all providers to take a second look at their clinical documentation. Providers with an established clinical documentation improvement program can have an assessment completed and take the necessary time to implement recommendations for improvement. Providers without a CDI program should take this opportunity to conduct an in-depth clinical documentation review and implement a CDI or CDI “Lite” program, as well as basic physician education on proper documentation techniques for ICD-10.
- Leverage hospital and physician profiling. With greater specificity in the ICD-10 procedural code set and the ability to reimburse based on those procedures, we’ll not only see newer procedures being performed, but we’ll also begin to see the FDA approve more innovative ones as well. Coupled with improved clinical documentation, we can certainly expect to see better patient outcomes, which will increase the visibility of the physicians performing these procedures and the hospitals where they practice through score card ratings. Given patient access to this score card data – and the proximity of hospitals from one another, especially within urban areas – these physicians and hospitals can expect to see an increase in patient preference and a greater patient population, improving overall financial results.
- Receive appropriate payments for new procedures. The limited code set in ICD-9 – which resulted in lumping certain procedures together – created a reimbursement-neutral result that potentially discourages the performance of newer, more innovative procedures. However, the expanded procedural code set in ICD-10 enables future expansion to accommodate new medical procedures, delivering the opportunity for providers to code procedures uniquely and ensure that appropriate payments are applied.
- Fewer rejected claims and lower administrative costs. With ICD-9, we see high administrative costs associated with rejected claims and/or requests for additional documentation because of the lack of detailed information in code assignment and the grouping of newer innovative procedures in with current or older procedures. However, with the greater code set in ICD-10, providers can expect fewer rejected claims, thereby eliminating the administrative costs typically associated with reviewing those rejections.
- Improved code structure reduces error. With the improved code structure, logically standardized definitions and more accurate clinical terms, it’s reasonable to expect that educated coders will have an easier time selecting the proper diagnosis and/or procedure codes once they become familiar with the system. This should reduce coding timelines and errors.