The transition from ICD-9 codes to ICD-10 codes presents a huge challenge for medical billers and also affects health care delivery system and physicians’ revenues. The staggering number of additional codes makes the learning process complex. Moreover, the scope for error increases which is exacerbated by a harder denial management process. Insurers have a distinct opportunity to target the increased volume of ICD-10 codes for finding ample mistakes to postpone payment.
Here are some of the basic impacts of the transition from ICD-9 to ICD-10 codes pertaining to denials:
The basic difference between ICD-9 codes and ICD-10 codes is that they are more compact even when carrying in-depth information about the case. This helps in identifying the correct rules to be applied as far as reimbursement and insurance policies are concerned. Quantitatively there are more ICD-10 Codes compared to ICD-9 and this also means that the newer codes help in further clarifying the information at hand. However, denial management would face problems due to the increased scope of errors by insurance companies due to the new codes.
Claims and reimbursements may be delayed or rejected due to several reasons by insurers due to – differences in the codes sets that cannot be accounted for because of unavoidable compromises in the conversion, conscious efforts to take advantage of the more precise ICD-10 code set; hence Physician practices will be wise to include ICD-10 in their payer agreement negotiation discussions to decrease their risks concerning compliance errors and claims denials.
The Time Factor
The time factor can play a crucial role in deciphering the codes since the volume of ICD-10 codes is high compared to ICD-9 codes. This might mean longer waiting periods for reimbursements and more number crunching for medical billing and coding companies. Another hurdle facing a clinic or a provider is that medical billing and coding is a highly demanded profession and this transition of codes would make it more competitive, making it costlier than before.
The Impact on Patients
ICD-10 codes have been used in numerous countries and the United States was one of the few developed countries to use ICD-9 medical coding system. Although denial management consists of correcting errors and other important functions, the new health care reform has almost ensured that insurance companies and payers cannot deny claims on the basis of errors which can reach a staggering 19.7% out of total claims submitted. This high percentage of denial of claims is one of the biggest hurdles in denial management and it is difficult to predict whether ICD-10 codes would work in favor of denial management and if it would impact patients favorably.
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