Health care providers can help minimize the downside cash flow and revenue impacts of ICD-10 by organizing and planning for contracting with Payers in anticipation the change to ICD-10 in October 2013. 

Health care payers will be designing their reimbursement plans for 141,000 new ICD10 codes.  It will be critical for providers to know their required reimbursement for these new codes before they negotiate with Payers who will certainly try to reduce reimbursement.

In this adversarial healthcare environment, health care providers must be proactive in understanding a strategy to avert potential disasters in their reimbursement system.  With the thin margins that most hospitals already operate on, we believe this will be one of the most important aspects of implementing ICD10.  ICD-10 is not just a new diagnostic system of coding; it is more importantly a new reimbursement system.

Here are just a few more to think about:

  • Management some payers and providers apprently still perceive that a GEM (General Equivalence Map) will provide the magic bullet they need to automatically convert their systems from ICD-9.  Unfortunately, this is not true.  GEMs are icomplete because they are based on going from less detail to more.

  • Recently we talked to a company that felt that if they simply changed the field length in their databases, they would be ready for ICD-10.  Unfortunately this is not the case.

  • If you rely on an out of network repricer, and your vendor uses automated methods based on historical data, they won’t work under ICD-10.  Significant modifications will be required. 
  • Avoiding the ICD-10 implementation train wreck will be easier if your company is doing an assessment of the business, process, system, clinical and IT impacts early in this process.  Conversely, those health insurance firms, hospitals, clinics, physician groups and other entities who are proactive in seeing an ICD-10 assessment as an avenue to improved revenue and cash flow will be better positioned strategically when the market shifts.

    If you do not believe you have these skills in house, look to partner with a consulting team that has the process, people, methods and tools to successfully navigate this new reimbursement system.

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