October 1, 2015 has finally arrived – a day that marks an industry-wide operational disruption for healthcare. I’m of course talking about the launch of the updated International Classification of Diseases (ICD)—ICD-10, the highly anticipated new coding system that will affect every facet of the healthcare industry and offers tremendous new opportunities for healthcare providers and payers.
Let me provide a little context for the dramatic introduction. Healthcare has been operating under ICD-9 for more than 30 years. That’s right, three whole decades. When ICD-9 arrived, Reagan was president, the Berlin Wall divided Europe, and “We Are the World” was the number 1 song.
The world has changed. Think about the advances in medical technology since the early 80s: the procedures, the medicines and especially the smart devices used to enhance medical care. The transition to ICD-10 is designed to align with these advances, so providers and payers alike can better manage their revenue cycles, and of course, take better care of their patients and members.
Naturally, with this magnitude of change, there are bound to be obstacles and complexities. A recent study on the impact of ICD-10 implementation (click here to see the infographic) estimates a period where claim error rates will be two times higher, and denial rates could increase even more! Why? Because ICD-10 carries exponentially higher amounts of data and codes associated with a diagnosis. To put it in perspective, the level of detail is so meticulous, there are even hundreds of codes associated with event-related injuries!
Now I’ve got a whopper of a fish story for you. One example I like to reference is the hundreds of codes that are associated with fishing. That’s right, for something as obscure as a fish bite, or swallowing a hook…well, there’s a code within the ICD-10 data architecture for that. Under ICD-9, there were a grand total of nine results related to fish. Under ICD-10, however, that figure jumps to 272 results and five classifications—a thirty-fold increase! Similar levels of detail extend across the entire ICD-10 system.
Along with this incredible increase in complexity and detail comes opportunity. ICD-10 offers a more precise evaluation of new medical procedures, something lacking in the old system, which often grouped new procedures with old ones. This greater detail will allow providers to evaluate their performance relative to their peers, better allocate resources, and promote themselves to patients and referring physicians.
Opportunity abounds for payers as well. Both providers and payers can utilize ICD-10’s increased specificity to achieve cost savings through a more accurate analysis of diagnosis and care. This greater detail can improve a payers’ ability to forecast healthcare needs and trends and better analyze costs. Payers and providers can harness the data to monitor service and resource utilization, monitor outcomes and measure performance.
Of course, these long-term benefits don’t eliminate the business challenges that will come with the transition. However, it is our priority at RemitDATA to help reduce the estimated financial impact of the ICD-10 integration through the use of benchmarking and peer-to-peer comparisons with comparative data analytics solutions to monitor errors and provide proactive corrective actions to help minimize cycle disruptions.
In a nutshell, our solutions can help payers, providers, and billing companies track and monitor the impact of ICD-10 from a revenue cycle, claims adjudication, and administrative cost perspective. So, no matter how “fishy” the codes can get in ICD-10, comparative data and benchmarking from RemitDATA is a surefire way to gain insights for proactive resolutions.
On that note, anyone want to go fishing?