Can medical practices increase revenue with ICD-10 codes?

Carl Natale
by Carl Natale

It's obvious that the ICD-10 transition will require money to be spent on system upgrades and training. But the effect on healthcare provider revenue is less obvious.

There is a post that attempts to detail how ICD-10 coding will affect revenue. Here are six ways that the ICD-10 transition is supposed to improve cash flow:

  1. The greater specificity of ICD-10 codes will prevent miscoding. "As a result, the possibility of claim rejection will come down drastically, and physicians will be able to negotiate for improved claims reimbursement rates on health plans. " I assume the specificity won't increase the chances of making mistakes.
  2. ICD-10-CM/PCS coding will improve "efficiency in the exchange of patient profile information, treatments across the care process and hospital resource management."
  3. Physicians will have more granular medicine data that will help them monitor effectiveness and side effects. Hopefully that will enhance physician reputations which can lead to higher revenue.
  4. "ICD-10’s clinical documentation and coding accuracy enhances the assessment and monitoring of patient safety and quality indicators, as well as compliance with third-party payer coding and billing rules and regulations." This is supposed to reduce expenses.
  5. The necessary upgrades to technology should increase efficiency and productivity. Also meaningful use incentives will help.
  6. Maybe the training will help healthcare providers improve revenue cycle.

I'm taking these points with a grain of salt. Mostly because of what Albert Oriol, chief information officer at Rady Children's Hospital San Diego, wrote about how ICD-10 coding will affect reimbursements. First he explains that the United States needs to curtail healthcare costs. Next comes ICD-10 coding's role: "Health care reform relies heavily on data and on ICD-10 to incentivize providers to lower their costs."

According to Oriol, the healthcare payers will be using the ICD-10 data to justify paying less money. If we don't convert to ICD-10 coding, then they will find some other criteria to cut reimbursements. The trick is for healthcare providers to find efficiencies to offset reduced reimbursements.

Oriol also makes the case that the government and healthcare payers cannot afford to delay ICD-10 implementation any further. They need to find ways to cut costs. So anyone counting on another delay is going to be in trouble.

Are you Ready for an ICD-10 'Non-Enforcement Period?'

Steve Sisko dares to ask if healthcare payers are prepared for a "non-enforcement period" that would require them to process medical claims with ICD-9 codes after Oct. 1, 2014. (ICD-10 Impact to Health Care Payers & Providers)

Staff scarcities have healthcare CIOs strapped

This focuses on a shortage of healthcare IT (HIT) workers needed to implement meaningful use and electronic health records. But the same shortage will affect ICD-10 transition projects. (Healthcare IT News)

6 Observations on Hospitals and ICD-10 Going Into 2013

Amanda Brenegan offers some observations on how hospitals are managing their ICD-10 transitions. She makes an interesting point about training hospital staff on ICD-10 concepts. That will help them more than trying to memorizing codes. (Becker's Hospital Review)

Have you done your ICD-10 coder assessments?

The question you need to ask is "Do you know what you don't know?" That's where the coder assessment comes in. It's gives you a sense of  what your medical coders know and how much training they will need for ICD-10 education. Of course they all will need ICD-10 code training. But how much do they need to improve their anatomy and physiology knowledge? (ICD-10 Trainer)

ICD-10 – Are Healthcare Professionals Prepared?

Survey finds 75 percent of medical practices were just aware or just starting the ICD-10 implementation process. (Hive Health Media)

CMS Urges Physicians to Move Forward with ICD-10

This is for anyone who hasn't heard of ICD-10 coding. (Kareo)