Health Information Management

Tip: Start preparing for reimbursement changes under ICD-10

APCs Insider, June 14, 2013

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Providers will get good and bad news about reimbursement under ICD-10. The bad news is that providers will likely see a slowdown in cash flow after ICD-10 implementation.

The good news is that providers and facilities can reduce revenue disruption by being prepared.  
ICD-10 will fundamentally change the way payers reimburse for healthcare services because it will greatly increase the granularity of the patient data.
 
Currently payers reimburse approximately the same amount for a 9-year-old patient with a respiratory infection and an 89-year-old patient with a respiratory infection.
 
Treating the 9-year-old patient who has no complications or comorbidities is fairly simple, Spain said. However, if the 89-year-old patient also has chronic obstructive pulmonary disease and asthma along with the respiratory infection, the physician will need to provide much more extensive treatment.
 
Once payers can drill down into the patient information, they may reduce the payment for the easier cases.
 
This tip is adapted from “Check out the view from the industry as ICD-10 implementation draws closer” in the June issue of Briefings on APCs.



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