ICD-10  (International Classification of Diseases, version 10 scheduled to go into production in the U.S. on October 1, 2014) introduces a new paradigm for noting the diagnosis (ICD-10 CM) and billable procedures (ICD-10 PCS) for inpatient cases, and in outpatient settings, ICD-10 CM is the standard for diagnosis.  Case Management is intended to be a process that advocates what is best for the patient by serving as a liaison between patients, payors and the healthcare team.

Case Management should benefit the entire system, bridging clinical and financial ares of healthcare.  Underlying Case Management processes are a number of functions. Case Management also relies on specific diagnosis codes.  If hard-coded information or ICD-9 specific methods of capturing this information are in Case Management Systems, they will need to be remediated or replaced to support ICD-10.

Case Management under ICD-10

Case Management is dependent on the diagnosis of the patient, and seeks to manage the medically necessary procedures.  There are several new areas that impact Case Management:

  • Recovery Audit Contractor review and denials (“RAC Audits”)
  • Value Based Purchasing Program created by CMS
  • Dual Eligibles, (meaning those under the Patient Protection and Affordable Care Act, or Obamacare, who are low-income seniors and younger people with disabilities that are covered by both Medicare and Medicaid).

For HIPAA Covered Entities, these impacts should include ICD-10 steering committee dialog regarding:

  1. ICD-10 Assessment
  2. ICD-10 Crosswalks
  3. ICD-10 Impacted systems
  4. ICD-10 Testing
  5. ICD-10 Data quality assessment
  6. Electronic Medical Records and discrete data, ICD-10 intersection with Meaningful Use (especially Stage 2 and Stage 3 patient engagement and access to personal health records)
  7. Chart reviews
  8. ICD-10 coding
  9. Increased denial risk
  10. Increased audit risk

and more.

Related Posts
  1. ICD-10 Consulting
  2. ICD-10 Financial Risk Management
  3. ICD-10 Assessment and Data Quality
  4. ICD-10 Remediation
  5. ICD-10 and Interoperability
  6. ICD-10 Best Practices
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