Some healthcare solutions experts foresee the following five financial benefits of ICD-10:[1]
- Providers can establish or strengthen CDIs by conducting thorough reviews of clinical documentation and implementing improvements, such as a CDI “Lite” program.
- Development of patient preferences due to new procedures being performed based on more thorough and detailed ICD codes. Patient preference will result from information available on physicians and hospitals providing the specific procedures and their rating of the results. Physicians and hospitals have a better opportunity to differentiate themselves to improve their financial positions.
- Providers will be able to receive appropriate and timely payments for procedures performed, because there will be less confusion about the procedure details.
- Because claims will be processed more efficiently due to the specificity of the procedure codes, there will be fewer rejections and lower administrative costs.
- Coding timelines will be improved and errors will be minimized due to “logically standardized definitions and more accurate clinical terms.”
Other experts foresee the following five financial issues emanating from ICD-10:[2]
Everyone who deals with claims in the healthcare industry will need to be trained to properly handle the medical coding and billing. Without proper training, major delays can occur in the timely processing and payment of claims.
- If claims processing and payment is delayed, by 10 to 20 days according to some experts, providers may experience a cash crunch in which they will have to dig into their cash reserves to pay operational expenses while they wait for accounts receivable reconciliation.
- For Medicare and Medicaid claims, a sum is due to the government. If that sum is not paid, the provider will be investigated for fraud and abuse. The government will send RACs who have legal authority to request and view data, and get paid based on the number of errors they find. Not implementing ICD-10 properly and training staff adequately can result in large sums paid in fines due to errors made in submitting claims.
- With the list of procedure codes expanding, providers may find themselves short of medical coders who are adequately trained. Therefore, they will be forced to outsource the work or hire contract coders.
- If providers decide to outsource the medical coding work, they risk data security that can lead not only to issues that have to be dealt with financially but also loss of personal health information of patients.
With yet another delay of the ICD-10 mandate (the new date is still up in the air), providers and payers have more time to consider the benefits and risks, and to work together to make a smooth and successful transition. What do you think? Do the benefits outweigh the costs of ICD-10?
