There is a fair amount of concern among hospitals about how much revenue will be lost if DRGs shift the wrong way.
There are a couple ways to estimate the effect of shifting reimbursements:
- Dual code medical claims
- Map ICD-9 codes to ICD-10 codes
The results can be a predictor of how DRG-based revenues can change. But DRG shifts aren't the only way that ICD-10 implementation will affect revenue. There could be:
- A loss of medical coding productivity
- Growing accounts receivables due to slower medical claims processing
- Rejection and denials of medical claims
Maybe the DRG shifts won't be so significant so consider this:
"One of the most discussed DRG shifts, for example, happens due to a change in the coding of esophageal hemorrhage. While the specific code for esophageal hemorrhage has been eliminated, or rather included in the "other diseases of the esophagus" category, the reality is that if the underlying cause of the hemorrhage is identified, there is no DRG change. Paying close attention to details such as these can make a great difference in whether a DRG shift - and its corresponding reimbursement impact - occurs or not. "
Which is a really interesting point in light of the American Medical Association's (AMA) request to have a two-year pass on penalties (or non-payment) for non-specific coding. Jennifer Bresnick at EHR Intelligence says that may not be such a big problem.
Focusing on training, clinical documentation and proper ICD-10 coding could be the measures that will mitigate any negative impacts from DRG shifts.
CMS has released the revised ICD-10-CM code set for 2014:
It has not released the guidelines yet. (Centers for Medicare & Medicaid Services)
AMA refuses to accept ICD-10 implementation again
The opposition to ICD-10 implementation is as vigorous as ever. (ICD10Watch)
PayerView: An Annual Transparent Look at Payer Performance and Medical Billing
Athenahealth does this statistical dive into how good healthcare payers are at turning around medical claims. It's a must read for anyone who pays attention to financials in the healthcare industry. The reason I'm bringing it up is that the 2012 study found a significant drop in reimbursements in the first quarter due to HIPAA 5010 transition issues. Similar performance can be expected in the last quarter of 2014. (athenahealth)
How to work with healthcare payers during the ICD-10 transition
The keys are asking the right questions and establishing relationships. (ICD10Watch)
"The Gathering Storm: Coding Changes Will Have a Far-Reaching Effect on Your Practice."
This is a pretty good white paper listing 22 ICD-10 transition tips. Nice amount of detail make it a good place to start ICD-10 implementation planning if you are with one of the medical practices that hasn't started the transition. (McKesson)
CMS releases OASIS-C1 draft to prepare for ICD-10
CMS has updated the Outcome and Assessment Information Set (OASIS) forms that home health agencies need to complete to participate in Medicare.
[Download: CMS-R-245 [ZIP, 1MB]]
Best white paper title. Ever. This download really boils down the ICD-10 implementation into steps and tips that aren't very hard to get your mind around. The actual implementation in areas may need more expertise than found in this white paper, but it's a very good spot to start. (EHRintelligence.com)
Navicure Announces Key Findings from ICD-10 Readiness Survey
Yeah, another survey that found too many medical practices that haven't started ICD-10 transitions and don't know where to start. It's also an opportunity for Navicure to pitch its services -- which include ICD-10 education and testing. (Navicure)