ICD-10 Implementation Vital for Local Health Departments
By Nar Ramkissoon
By October 2014, every healthcare provider or business covered by HIPAA is required to switch their medical coding from ICD-9 to ICD-10 - the new standard diagnosis code set.
This new requirement will affect every organization that files a Medicare/Medicaid or private insurance claim, including local health departments. Though the transition to the new coding standards may be hard and require intense planning and training, ICD-10 should have a strong, positive impact overall on local health departments.
Before we delve into its impact on local health departments though, let’s discuss the implementation of ICD-10. There are two key parts to this transition: replacing ICD-9 with ICD-10 and replacing 4010/4010A1 standards with HIPAA 5010 standards for medical transactions.
The “International Classification of Diseases, 10th Edition” (or ICD-10 for short), is an updated code set for medical diagnosis and procedures. ICD-9 is beginning to show its age and is not able to keep up with where health care practices are trending. The new code sets are updated from the previous version to include new terminology and classification of diseases. In practice, ICD-10 will prove to be logically organized, more detailed/specific, and most importantly, more accurate than anything to come before.
The 5010 standards should already be in place from a compliance standpoint, and refer to new standards that are being implemented for electronic health care transactions- such as insurance verification, claims submission, and payments. The new standards are more detailed and are more efficient to utilize within the framework of a health care provider’s day-to-day workflow. The 5010 standards have also been structured to perfectly accommodate the ICD-10 code sets.
ICD-10 looks like it will actually have a profoundly positive impact on local health departments. As we’ve continued to reinforce in the last few blog posts, funding for public health is dropping as demand is rising. This means local health departments need to implement billing systems that are smarter and more efficient to help boost their revenue stream. ICD-10 plays right into this by making sure a facility’s billing program is up-to-date and ready to support this new type of coding.
ICD-10 is far more granular than ICD-9, and the enhanced level of detail makes tracking revenue and receivables easier than ever. ICD-10 also requires that the departments more closely adhere to insurance company requirements and follow a fee schedule when recording charges on a claim. The increased detail will also mean fewer miscoded or rejected reimbursement claims are encountered. This added level of transparency and urgency for insurance claims should greatly increase the amount local health departments are able to collect. Another great benefit is that yearly audits are recommended to ensure that revenue from services provided is not being left behind.
The expanded abilities to capture data are also attractive for public health. ICD-10 will reduce coding errors, allow for better analysis of disease patterns, and increase a department’s ability to track and respond to outbreaks and emergencies.
As funding continues to become more of an issue for public health departments, they should fully embrace the transition to ICD-10 as a tool to help to continue serving their communities.