Impact ICD 10: Improving Patient Care and Enhancing ROI

ICD 10: Improving patient care and enhancing ROI

The transition from ICD 9 to ICD 10 codes is the core of the health reforms and marks an era where Health Information Technology is at its zenith in the United States. The conversion from Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010 aims to provide better patient care, speedy reimbursements for physicians, and shorter turnaround time for claims. The codes would be more elaborate compared to the older version and increase the accuracy in medical billing, coding, claims denial, and physician revenue. However, the sheer complexity of the codes and the looming deadlines for expected compliance by almost all the entities in the healthcare industry make it a formidable task.

The Deadlines
The deadline for utilization of ICD-10 codes in HIPAA transactions is October 1, 2013 and includes outpatient as well as inpatient claims. However, since the transition from ICD-9 to ICD -10 codes requires a change from ASC X12 version4010A1 to ASCX12 version 5010, the deadline for transition to 5010 is set for January 01, 2012. There would be a penalty for those who are not HIPAA compliant by the end of 2013 and a danger of falling behind in the quality of care provided to patients along with decreased revenue for clinics, hospitals and physicians.

Compliance Levels
There are two compliance levels – Compliance Level 1 and Compliance Level 2 where Level 1 Compliance according to CMS is “that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing”. This simply means that involved entities should be able to transact with others using the ICD-10 codes. Level 2 states “that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards”. Level 1 Compliance deadline is December 31, 2010 and Level 2 compliance is December 31, 2011 and full compliance is expected by January 1, 2012.

Denial Management
ICD 10 codes would play a major role in denial management since there would be almost eight times the number of codes to deal with and the amount of errors may increase. Insurance companies can simply deny a claim by pointing out a medical coding error whether it is due to non compliance of deadlines or due to the complexity of the codes. However, payers would also benefit from the fact that the ICD-10 codes are more detailed and would help payers to understand the reasons for various steps taken by physicians while providing patient care and whether they should pay for such procedures. Ideally ICD-10 codes should cut down on the turnaround time and make it easier for physicians to obtain speedy reimbursements while benefiting payers who have to spend lesser amount of time on the processes involved in managing claims. However, this is still a theory since it demands due diligence on the part of medical billers and coders as well as payers to make denial management an efficient process.

The costs of implementing ICD-10 codes are not just limited to software changes but also towards training staff, physicians, and insurance company professionals who would use these codes. Training for a migration from 4010 ICD-9 to ICD-10 codes can be costly and requires time and testing for ensuring efficiency. The easiest way of cutting costs is hiring a third party which is experienced and trained in ICD-10 medical billing and coding, claims denial, and armed with the latest technology to provide optimum utilization of resources at lower costs.

Patient Care
The most important aspect of the transition from the 32 year old ICD-9 codes to ICD-10 codes is enhanced patient care along with successful return on investments (ROI) for hospitals and physicians. ICD-10 codes would be HIPAA compliant and would ensure patient privacy, better provisions in areas such as ambulatory care, would include expanded substance or alcohol abuse codes, expanded injury codes, and combination of codes to make them explicit and transparent. This would benefit the patient in a direct manner since payers, physicians, and health care providers can understand trends, changes and future implication in the health industry and the standard of health as a nation.

For more information on how successful implementation of ICD-10 codes is likely to impact physicians and their billing processes effectively and cost-effectively cope with it, or to know more about our consultancy services on how physicians can handle such and similar issues in their practice, please visit, the largest consortium of billers and coders in the US across all specialties.