HIMSS Webinar: ICD-10 myths busted
Joe Miller, director of e-business at AmeriHealth Mercy in Philadelphia, offered his expertise on ICD-10 to debunk some myths and focus on realities in transitioning to ICD-10 during a virtual briefing webinar by Healthcare Information & Management Systems Society (HIMSS).
One myth Miller refuted is that a clearinghouse will help providers comply with ICD-10. Contrary to that belief, Miller stated that clearinghouses can be instrumental in helping providers comply with 5010 transition but will not be able to create crosswalks from ICD-9 to ICD-10. Providers will be required to send ICD-10 codes as part of their transactions starting Oct. 1, 2013.
“You cannot rely on someone else to translate those codes to an ICD format,” said Miller.
Another myth is that payors will use different crosswalks from ICD-9 to ICD-10 yet, according to Miller, most payors will not use crosswalks because of their inaccuracy. “Payors will process claims based on the ICD-10 code that is sent on the claim,” Miller added.
Miller stated there are fears by providers that payors will deny more claims with ICD-10. However, he remarked that payors are most concerned with maintaining business continuity and ensuring high autoadjudication rates. He stated that most payors are adopting a “reimbursement neutrality” approach which seeks no increase or decrease in provider reimbursement.
Along those lines, one myth is that payors adopting this “reimbursement neutrality” will treat providers equally. “Providers will likely see variations in reimbursement based on their case mix,” Miller asserted.
Finally, Miller posited that, instead of more claims requiring medical necessity review, the granularity of ICD-10 codes has the potential to reduce the rate of claims requiring medical necessity review.
One myth Miller refuted is that a clearinghouse will help providers comply with ICD-10. Contrary to that belief, Miller stated that clearinghouses can be instrumental in helping providers comply with 5010 transition but will not be able to create crosswalks from ICD-9 to ICD-10. Providers will be required to send ICD-10 codes as part of their transactions starting Oct. 1, 2013.
“You cannot rely on someone else to translate those codes to an ICD format,” said Miller.
Another myth is that payors will use different crosswalks from ICD-9 to ICD-10 yet, according to Miller, most payors will not use crosswalks because of their inaccuracy. “Payors will process claims based on the ICD-10 code that is sent on the claim,” Miller added.
Miller stated there are fears by providers that payors will deny more claims with ICD-10. However, he remarked that payors are most concerned with maintaining business continuity and ensuring high autoadjudication rates. He stated that most payors are adopting a “reimbursement neutrality” approach which seeks no increase or decrease in provider reimbursement.
Along those lines, one myth is that payors adopting this “reimbursement neutrality” will treat providers equally. “Providers will likely see variations in reimbursement based on their case mix,” Miller asserted.
Finally, Miller posited that, instead of more claims requiring medical necessity review, the granularity of ICD-10 codes has the potential to reduce the rate of claims requiring medical necessity review.