Key Implications of ICD-10 Implementation on US Healthcare

ICD-10 has been in effect for a few months now and it is indeed a historic period for the U.S. healthcare system. The old ICD-9CM was obsolete and modernization was long overdue. It was expected to be the “Y2K” of the American healthcare system, but all is well and the healthcare system is still intact.

Building more robust and detailed electronic health records (EHRs) was the goal here and there has been a lot of enthusiasm surrounding the potential of ICD-10.

The key characteristics of ICD-10 are as follows:

• Ability to capture detailed patient data
• Almost 5 times more codes than the predecessor
• Capacity to build enhanced patient records
• Up-to-date diagnostics
• Up-to-date procedural data
• Improved patient outcomes
• Safety of patients
• Cost-effective healthcare

So what are the implications of ICD-10 implementation in 2016?

Electronic Health Records (EHRs) will need to be revamped

Since it became effective in October 2015, ICD-10 healthcare information technology (HIT) systems haven’t performed well with healthcare professionals complaining about the complications within the platform that don’t make it user friendly. However, it is still working out so far.

Experts expect healthcare providers to start wondering if they received a good ROI with their systems. So it’s a good idea to start figuring out if the problems lie within the system or with the EHRs instead. Further, EHR interfaces are quite archaic and as a result there will be issues, as they don’t map ICD-9 codes to ICD-10 codes.

So, if there are continuing problems reading the EHRs properly, further modification and training might be necessary to make it work.

Big & Small Data will grow in importance

ICD-10 is predicted to lead the way into the new age of smart healthcare. However, it is yet to be seen if healthcare professionals will embrace it. Big data analytics is far from an easy task, but its value will drive more people into the field as the need for data analysis surges.

You can expect some of the data analytics functions to be outsourced to Eastern Europe.

Whether you like data or not, insurers and the federal government will be carefully going through the latest ICD-10 data to avoid recurring treatments and to cut costs.

Healthcare practices are expected to associate revenue with diagnosis data. This turn of events will start changing the perception of the healthcare business. Further, data on diagnosis trends in the area can also help practitioners make improved findings.

Things will become more specialized

Insurers and healthcare providers have so far accommodated inaccurate ICD-10 codes. But that’s going to change rapidly as institutions start to analyze the data and try to make use of it.

So if you got a medical practice, you will need to make sure that your office is coding ICD-10 correctly ASAP!

It will take some time to iron out all the bugs within this process, but until then, if you have issues with ICD-10 Medicare Claims, you can always pick up a complaint form from the American Medical Association.

Be Ready for a World of Challenges

There will be challenges when it comes to billing for inpatient services, so staff has to be trained and ready for it. ICD-9 had 13,000 codes and ICD-10 has 68,000 codes, so there is a huge learning curve that will take time.

Usually, procedure and diagnosis codes are more often than not grouped together via software into DRGs or diagnostic-related groups. This was the way providers handled ICD-9. As a result, new DRG grouper systems will be required to translate the new codes into DRG for payments.

Inpatient services and reimbursement rates that are based on percentages of what’s paid by Medicare won’t really change much. What will most likely be affected are reimbursement rates that are directly associated with specific DRGs.

Further, it will probably take some effort to adjust or reassign DRGs.

Providers will continue to be concerned about managed care contracts and will probably continue to review them proactively. Although many insurers have managed to map the transition from ICD-9 to ICD-10, it is yet to be seen if it was effective.

And how's your transition from ICD-9 to ICD-10?

Featured image: keystonehp.com