ICD-10 So Far: Frustrations and Hopes

Billing Headaches: Is There a Code for That?

Denials become even more of a threat as the finer points of medical coding and billing become overwhelming challenges for many practices. Under ICD-10, the stakes have never been higher. Recent research confirms that ICD-10 as currently implemented is seriously flawed. In 2015, the University of Illinois at Chicago reviewed over 24,000 ER visits, and concluded that 25% were improperly coded for billing. Even more alarming is that 20% of claims were denied. It seems that the continued adoption of full ICD-10 compliance will be an expensive learning experience for all involved. How much time will that take? How much will full compliance cost payers and providers? These are matters for serious debate.

Efficiencies Will Come. But When?

Although concerns persist regarding the implementation of ICD-10, leading healthcare policymakers agree there are significant positives to the MBC system update. The new medical claim codes reflect new disease tracks added since ICD-9, and the greater specificity will allow key industry stakeholders to better track and manage disease trends in their client populations, measure the quality and consistency of care delivery, and evaluate patient outcomes. The real question may be, can we achieve optimum compliance without exploding costs?

Fulfilling its Promise

Ideally, provider anxiety over proper reimbursement will ease, as the US healthcare system transitions from billing for procedures to outcome-centered, value-based reimbursement. Many experiments currently being run in this space, such as Project Sonar and the ACS-Brandeis Advanced APM model, are showing promising results. Once outcome-centered medicine systems are successfully implemented, the increased detail provided by ICD-10 will truly live up to its potential as a valuable resource for evaluating the current and future state of US healthcare delivery.

Will ICD-10 ultimately be a force for change, or just a huge added administrative burden? How long will it take until we know? Watch this space for future updates on this rapidly changing situation.