The October 1, 2014 ICD-10 implementation date is just around the corner. This will be one of the most comprehensive projects healthcare has ever faced with far-reaching impacts throughout our delivery system. Here are our Top 5 Reasons why ICD-10 does matter.
1. ICD-10 will have a positive impact on patient care. The newer code sets emphasize solid reasons why providers would want to share robust clinical documentation that more explicitly defines the patient’s clinical status. Better clinical intelligence data can describe multiple levels of severity, which should result in improved care algorithms to support accurate, more individualized patient care and lead to or foster improved outcomes. The big data analytics provided by the new specificity of ICD-10 codes will improve the overall intelligence for making care decisions at the present moment and more importantly – in the future. Good documentation is a critical part of good patient care.
2. ICD-10 will provide more accurate payment structures for providers. With the increased specificity of the new code sets, specific billing for services and procedures delivered will result in more accurate representation. ICD-10 will result in greater claim accuracy, fewer denials and underpayments, fewer billing inefficiencies and reimbursement processes, and the ability to differentiate reimbursement based on complexity and outcomes. This new level of business intelligence will empower providers to make better decisions that can significantly improve the enterprise and/or practice. ICD-10 provides an opportunity to define much greater detail about risk, severity, comorbidities, complications, causation, and a variety of other key parameters of a patient’s health state.
3. ICD-10 has the potential to reduce costly ROI. Despite initial cost increase during the transition period, the submission of highly specific codes will reduce the need for additional paperwork to be sent to payers during the adjudication process. This should reduce operational costs and provide a faster turnaround on reimbursements. This level of specificity should equate to a reduced amount of claim attachments required to explain a patient’s condition and decreased correspondence due to more information revealed within the code descriptions, thus streamlining the administrative process and leading to a higher quality patient experience.
4. Enhanced clinical, financial and administrative planning for performance monitoring. Increased analytical capabilities with ICD-10 will help improve providers’ clinical practices. With the availability of accumulated ICD-10 data, the ability to effectively schedule patients and make more critical decisions, such as equipment sharing, will improve. Additionally, there will be enhanced ability to identify and resolve problems and differentiate payment based on performance, which should provide for better operational and strategic planning.
5. Increased data analytics will improve research capabilities and provide enhanced quality metrics and public health tracking and reporting. ICD-10 will provide more precise data on which to implement and assess quality standards, patient safety goals, efficacy of care and mandates and compliance requirements. Improved disease and outbreak information via enhanced tracking of public health risks can lead to better outcomes for the whole U.S. population. Health exchange initiatives will be mitigated with ICD-10 by improving semantic interoperability and more effective mapping of clinical terms. As mentioned earlier, improvements due to the reporting of greater detail will enable more comprehensive data mining, resulting in improved analysis of diagnosis, treatment efficacy, disease prevention, epidemiological studies and clinical trials. Factoring severity, risk and complexity into quality and efficiency measures has always been a desired goal for clinicians, and ICD-10 will provide a means to get much closer to this goal.