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ICD-10 Draws Support & Criticism from Healthcare Stakeholders

Posted by Harold Gibson on Thu, May 28, 2015

Throughout 2015, debate has raged regarding the transition to International Classification of Diseases 10, which is a part of the disease classification system for healthcare billing and reimbursement. ICD-10 is contentious among politicians, researchers and healthcare providers, because it’s considered by some to be cumbersome and prone to creating denied claims. However, there are pros and cons on both sides of the argument.

Transition to ICD-11

Proponents of ICD-10 argue that adopting the new coding system will help healthcare providers eventually transition to ICD-11, helping to streamline the billing and reimbursement process. The exact timeline for implementation of ICD-11 is not certain, though, prompting supporters of ICD-10 to argue that it’s an improvement over ICD-9, because there are more codes and better descriptors for healthcare conditions. According to Healthcare Finance, ICD-10 includes 68,000 coding classifications compared to 14,000 for ICD-9.

Streamlined Billing & Reimbursement

All of the detail associated with ICD-10 is designed to make the billing and reimbursement process more accurate and fair for stakeholders throughout the healthcare system. It could remove current confusion regarding the coding of specific medical conditions, helping healthcare providers receive the reimbursement they’re entitled to, while ensuring they’re are not overpaid. Also, the additional detail will help analysts perform better research regarding trends in the healthcare sector. These are some of the potential benefits. However, opponents to the system view the additional detail from a different perspective.

Drawbacks of ICD-10

Opponents to ICD-10 cite the complexity of the system as a main drawback to its implementation. They argue it will make it harder for healthcare providers to submit requests for reimbursement, instead of making it easier. This will have negative ramifications for administrators, billing clerks, hospitals, doctors in private practice and patients. The amount of training required to use ICD-10 will add to the cost of the system’s implementation, putting a strain on healthcare providers and employees alike. Opponents to the system stress that these and other barriers to the implementation and use of ICD-10 need careful consideration.

Impact of Denied Claims

If ICD-10 results in more denied claims, it can have an impact on the creditworthiness of hospitals and medical practices, while detracting from the quality of care provided to patients. These financial and service-related risks cannot be ignored. That is why there are many that oppose implementing a complex coding system for billing and reimbursement, because the potential for errors is greater and the consequences impact multiple stakeholders in the healthcare system. The less money that hospitals and other healthcare providers have, the less care patients will receive and the less time doctors will have to hone their skills.

Adaptive Challenges

Change is never easy, especially when it comes to the implementation of new systems that impact multiple businesses, non-profits and societal stakeholders. However, adaptive challenges can be overcome will the help of strong leadership and change governance. If ICD-10 is going to be successful, stakeholders throughout the healthcare system will have to work together to overcome errors and miscommunication, which can lead to claim denials. This includes professional associations and researchers that currently oppose the implementation of enhanced coding standards for billing and reimbursement.

The healthcare system in America is experiencing momentous change, which is impacting the quality of care patients receive and the amount of money hospitals and healthcare workers make. Billing and reimbursement for claims will always be a point of contention, but it’s a process that heading towards improvement.

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Tags: ICD-10

Telehealth Services: Understanding Issues with Reimbursement

Posted by Harold Gibson on Tue, May 26, 2015

The telehealth industry is continuing to grow at a surprising rate, leading to better patient care and even cost savings.  However, there is one issue that rises above all others in the in this industry; the issuing of payment.  Here's a closer look at the latest reimbursement landscape found in this sector. 

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Tags: Medical Billing

ICD-10 Coding: Paving the Way to Better Data Analytics in Healthcare

Posted by Harold Gibson on Thu, May 21, 2015

There have been many types of healthcare data used within the public health industry for many years.  Way back in the 1600s, when the Black Death took place in London, there were weekly Bills of Mortality posted so that the public could see where the disease was spreading.  In today's age and time, though, healthcare data is distributed by many agencies, including the Centers for Disease Control and Prevention as well as the World Health Organization.  And not only is the data distributed by these entities, but it's also collected and analyzed, which enhances the overall effectiveness of today's healthcare practices.  

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Tags: ICD-10, Medical Billing

Keep Medical Practice on Track with Productivity Metrics

Posted by Harold Gibson on Tue, May 19, 2015

Many busy healthcare providers simply don’t have time or the staffing resources to identify and track all the different factors affecting a practice’s productivity. Dealing with daily business matters often leaves little time for assessing which benchmarks to use in comparing your practice to industry standards and figuring out how to implement the findings with an action plan for problem areas can be challenging. Providers and their administrators may find the following suggestions helpful for taking some of the guesswork out of using metrics and benchmarks effectively while saving time and resources.

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Tags: Medical Billing

Must Have ICD-10 Checklist for Medical Practices

Posted by Harold Gibson on Thu, May 14, 2015

When it comes to ICD-10, medical practices must not simply take into account the new revisions.  Instead, they must know them by heart and operate their medical facilities according to the new changes.  There are more than 68,000 diagnostic codes found in the ICD-10, whereas there are only about 13,000 found in ICD-9.  Because of the extensiveness of ICD-10, it is of paramount importance for medical practitioners to follow a ICD-10 checklist for medical practice. 
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Tags: ICD-10

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