Archive for October, 2011

ICD-10 Implementation Dealine: Repeal of Omabacare and Affordable Care Act is a Separate Issue

Monday, October 31st, 2011

ICD-10 implementations must move forward despite Presidential campaign promises to repeal ‘Omabacare’ or the Affordable Care Act.  As Business Week pointed out this week, repealing the Accountable Care Act is not that easy. And even if it were repealed ICD-10 is a HIPAA mandate that was enacted prior to President Omaba’s election in August 2008.  Hospital systems should push ahead on ICD-10 Assessments, ICD-10 Implementation Plans, and get ready for the shift to ICD-10-CM which includes many more diagnosis codes than ICD-9.  ICD-10 PCS also include many more procedure codes than ICD-9.

According to Business Week, Repealing Obamacare” will be harder than politicians let on:  Americans who say they don’t like the law want to preserve most of it.

Related information:

 

 

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ICD-10 Clinical Scenarios and Medical Concepts Help Understanding of Reimbursement Risk

Friday, October 14th, 2011

ICD-10 clinical scenarios can be used to understand potential risks and variations in health care claims reimbursement for procedures that are provided after October 1, 2013.

For example, an 82-year old female patient with a cardiovascular condition could have a procedure under ICD-9 CM with a correlating Diagnosis Related Grouping (DRG) of 251[1] and a reimbursement for the procedure of $9,622.80.  Under ICD-10 after October 1, 2013 this same procedure, if documented and coded one way would lead to the same DRG of 251 and therefore would be “revenue neutral” under ICD-10.  However if documented and coded differently this procedure could result in a DRG 230[2] the reimbursement might shift to $24,343, or a reimbursement risk of $14,721.  This is one hundred and fifty three percent (153%) of the original reimbursement.  However, CMS suggests cross-walking this procedure to a DRG 254[3], which could result in a third reimbursement outcome.

Understanding the how ICD-10 changes medical concepts can help hospitals and other health care providers plan for shifts in reimbursement, and it can help health plans and large self-insured employers to design a path forward in redesigning medical policy and benefit plans.  Proper ICD-10 impact assessment and ICD-10 implementation planning can help health care companies improve their planning and preparation for the best transition possible.  ICD-10 clinical documentation improvements, coder quality and other aspects can be addressed via the right methodology and reference implementation model.

Related posts:

[1] Percutaneous Transluminal Coronary Angioplasty – MS-DRG 251 “Percutaneous cardiovascular procedure without coronary artery stent without MCC”

[2] Coronary Bypass – MS-DRG 230 “Other cardiothoracic procedures without CC/MCC”

[3] Source: CMS https://www.cms.gov/acuteinpatientpps/downloads/CMS-1533-FC.pdf – Vascular Repair – MS-LTC-DR 254 “Other vascular procedures without CC/MCC”

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