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ICD-10 Draws Support & Criticism from Healthcare Stakeholders

May 28, 2015

ICD_10_pros_and_consThroughout 2015, debate has raged regarding the transition to International Classification of Diseases 10, which is a part of the disease classification system for healthcare billing and reimbursement. ICD-10 is contentious among politicians, researchers and healthcare providers, because it’s considered by some to be cumbersome and prone to creating denied claims. However, there are pros and cons on both sides of the argument.

Transition to ICD-11

Proponents of ICD-10 argue that adopting the new coding system will help healthcare providers eventually transition to ICD-11, helping to streamline the billing and reimbursement process. The exact timeline for implementation of ICD-11 is not certain, though, prompting supporters of ICD-10 to argue that it’s an improvement over ICD-9, because there are more codes and better descriptors for healthcare conditions. According to Healthcare Finance, ICD-10 includes 68,000 coding classifications compared to 14,000 for ICD-9.

Streamlined Billing & Reimbursement

All of the detail associated with ICD-10 is designed to make the billing and reimbursement process more accurate and fair for stakeholders throughout the healthcare system. It could remove current confusion regarding the coding of specific medical conditions, helping healthcare providers receive the reimbursement they’re entitled to, while ensuring they’re are not overpaid. Also, the additional detail will help analysts perform better research regarding trends in the healthcare sector. These are some of the potential benefits. However, opponents to the system view the additional detail from a different perspective.

Drawbacks of ICD-10

Opponents to ICD-10 cite the complexity of the system as a main drawback to its implementation. They argue it will make it harder for healthcare providers to submit requests for reimbursement, instead of making it easier. This will have negative ramifications for administrators, billing clerks, hospitals, doctors in private practice and patients. The amount of training required to use ICD-10 will add to the cost of the system’s implementation, putting a strain on healthcare providers and employees alike. Opponents to the system stress that these and other barriers to the implementation and use of ICD-10 need careful consideration.

Impact of Denied Claims

If ICD-10 results in more denied claims, it can have an impact on the creditworthiness of hospitals and medical practices, while detracting from the quality of care provided to patients. These financial and service-related risks cannot be ignored. That is why there are many that oppose implementing a complex coding system for billing and reimbursement, because the potential for errors is greater and the consequences impact multiple stakeholders in the healthcare system. The less money that hospitals and other healthcare providers have, the less care patients will receive and the less time doctors will have to hone their skills.

Adaptive Challenges

Change is never easy, especially when it comes to the implementation of new systems that impact multiple businesses, non-profits and societal stakeholders. However, adaptive challenges can be overcome will the help of strong leadership and change governance. If ICD-10 is going to be successful, stakeholders throughout the healthcare system will have to work together to overcome errors and miscommunication, which can lead to claim denials. This includes professional associations and researchers that currently oppose the implementation of enhanced coding standards for billing and reimbursement.

The healthcare system in America is experiencing momentous change, which is impacting the quality of care patients receive and the amount of money hospitals and healthcare workers make. Billing and reimbursement for claims will always be a point of contention, but it’s a process that heading towards improvement.


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