How ICD 10 Could Improve Performance And Efficiency Of Your Agency?

ICD-10 is the 10th revised version of the International Statistical Classification of Diseases and Related Health Problems (ICD), and is published by the World Health Organization (WHO). It is a list that contains codes for various diseases, their signs and symptoms, complaints and causes for injury etc. The ICD is used as a diagnostic tool in clinical settings, for management of health and even in organizational settings. The National Committee on Vital and Health Statistics suggested the initiation of the regulatory process for ICD 10 nearly five years ago to the secretary of Health and Human 

 How ICD 10 Is Better Than ICD 9

With ICD-9, it was hard to stay updated about new codes that would lead to high revenues. This affected the performance of the agencies, as it used to mix together old procedures with the new ones which made it hard to distinguish between them. However, with the new distinctions in ICD-10, it is easier for agencies to have an exact evaluation of medical procedures. Also, agencies using ICD-10 have a lesser need for supporting documentation, as it has great details which helps to support claims.  

ICD-10 is better able to accommodate the new technologies and is more detailed now. The codes have the ability to deliver better data that is used for improving the standard of patient care. The new codes can now comprehend complications and clinical algorithms. It expands the codes that are needed to understand health related complications and medical safety issues, which in result helps health providers to better understand the nature of diseases and how to manage them. Furthermore, ICD-10 is more specific and captures the top causes of mortality and even diseases caused by problems like terrorism.

  ICD-10 based classification system makes it easier to share disease data with a wide array of people, as sharing of information is important when it comes to health. The ICD-10 makes it easier to detect, verify and respond to diseases that may threaten the health of employees. Early detection helps lower the impact not only where an individual is concerned but also helps maintain an agency’s work performance. Furthermore, its adoption will help in facilitating international quality of care and to share the practices globally.   

Agencies will improve efficiency by upgrading to ICD-10 as it offers a better range of data to enhance their efforts when it comes to improving performance, containing costs, improving health policy decision– making, and creating efficiencies. It also provides the opportunity to save cost through a more efficient cost analysis. The improved details help agencies to see their healthcare needs, which help them to analyze their costs, monitor their services and resource utilization, track performances, measure outcomes and finally to calculate costs related to healthcare.  

Using ICD-10 can greatly improve an agency’s performance because it enables agencies to easily track their performance and use the information to promote themselves to healthcare professionals and for the reallocation of resources. The enhanced definitions help to make the codes more specific which leads to believe that coding error rates will drop below their current level.  

How an Agency Can Be More Efficient?

It was seen that often home care agencies failed to claim their full amount from clients and insurance agencies because ICD-9’s coding had errors, which lead to problems like insurance denials, loss of revenue, delays and scrutiny by insurance providers. Using ICD-10 can lead to improved performance be it clinical, administrative or financial in nature. The transition to ICD-10 by agencies will help improve an agency’s efficiency and performance as it helps in- 

Operational Advantages 

• Enhance loyalty between patients and providers
• Increase integration between payers and providers
• Reducing the time and effort that is put into paperwork, which will help in investing the resources and time on operations which will increase an agency’s productivity 
• Allowing IT systems to record precise diagnostic information 
• Importing portfolio management  
• Detecting and helping in preventing abuse fraud when it comes to health care  
• Performing operational and strategic planning 
• Reducing the need for attachments to explain a patient’s condition 
• Monitoring resource utilization 

 Clinical Advantages

• In clinical trials
• Tracking public health and risks
• Identifying specific health problems
• Sending accurate information about an employee’s health to insurance companies.
• Providing accurate data for calculating, quality, safety, efficiency and costs of health care services.
• Setting up a health policy
• Redesigning clinical and administrative operations

 Financial Advantages

• Reducing the number of insurance denials and make claims
• Designing payment systems
• Ending coding errors that are caused by payment delays
• Improving the cash flow.
• Significantly increasing reimbursement 
• Receiving a higher return on investments because due to less coding errors there will be no loss of revenue 
• Lowering the operational and labor costs that are associated with in-house coding 
• Reduce the hassle of audits 

Why a slow roll out of ICD-10 can be of advantage

The delay in ICD-10 can be of advantage to agencies. They should proceed as if there has not been a delay because firstly, the agency’s coders need time to get familiarized with the new coding of ICD 10. After it will be implemented, the codes will increase by five times and the number of diagnostics will reach to 68,000 and this is not a small change.  

Secondly, the coding of both ICD-9 and ICD-10 will allow early rewriting of reports. Thirdly, the ICD-10 codes in the enterprise data warehouse (EDW) can be used to improve analytics and give a comparison of 2014 and 2015’s data. Another reason is that there will be a better projection of financial affect of the transition by health systems and also a budget for it. Lastly, payers will learn about the new opportunities and changes which help establish better professional relationships.

An agency can benefit even more by outsourcing ICD-10 coding to a consultant, because he/she will have precise and reliable coder which can make the entire billing process extremely smooth. Since a lot of time and money is saved this way, an agency can work on its strategies that will help it in expanding.

References: 

• http://www.who.int/classifications/icd/en/ 

• http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_036866.hcsp?dDocName=bok1_036866 
• https://www.optum.com/icd-10-topic.html 
• http://www.healthcarebusinesstech.com/icd-10-financial-impact/ 
• http://www.advisory.com/daily-briefing/blog/2014/10/icd-10-was-supposed-to-take-effect-today