On October 1st 2016, the grace period for ICD-10 coded medical claim will end. Providers under Medicare, Medicaid and Private insurers (few who has yet to implement the change) will have to file reimbursement claims only under the new ICD codes.
International Statistical Classification of Diseases and Related Health Problems, 10th revision is a standardized coding of diseases, conditions, symptoms, complications, causes, etc., developed by WTO. ICD-10 is the updated version of ICD-9 code in general use now.
ICD-9 has 11,000 codes but the improved ICD-10 proposes a comprehensive 70,000 individual codes for each and every condition, treatment and diseases. Herein lies the reason for providers concern. It is feared that when providers are filing on, this may complicate the process, and also so many codes may increase the chances of error, leading to increase in claim denials.
Following are the reason why Federal agencies were ardent on ICD-10 and want to push on with it despite provider’s worries.
3.Public health concerns
ICD-10 is a more robust design, in accommodating new procedures and treatments. It can potentially store more data regarding a patient, treatment and is better in scaling the severity of the situation. Clarity of the situation will help tracking care quality, and for payers, it can identify patient population with their disease.
The effort behind the development of ICD-10 codes was the gathering of data about diseases and treatments. More data will lead to more clarity in healthcare deliverance and accurate identification of expenditure, care and result. Increase in number of codes will allow in standardization and will help remove ambiguity caused by fewer codes, this can also reduce fraud and diversion of healthcare fund.
Code based monitoring of the public health can help identify general public health risks and problems.US has the worst record in population health among the whole of industrious nations. A standard, unique coding system can help in early detection and taking action against any population health concerns.
Precise recording of medical conditions and treatments is crucial in measuring and comparing various parameters such as cost, medical procedures etc. In-depth details will allow providers to evaluate their own performance and payers to understand the population more preciously. As payers are connecting patient health outcome (performance) to cost (reimbursement), a detailed coding system will come in handy.
ICD-10, a more detailed code to mark diseases and healthcare procedures, and the sheer number of them may seem a bit too complicated. But, the fact is ICD-10 code by very reason of being so complex will eliminate ambiguity in reimbursement filing. It is one of the most anticipated change in healthcare, and also the most trained for, partially thanks to the delay.