How Will ICD 10 Affect my Reimbursement?

How Will ICD 10 Affect my Reimbursement?

Top medical billing companiesICD 10 is the new medical coding system that has replaced the old system, which was called ICD 9. ICD 10 will be required for any healthcare practices and medical billing companies that are regulated by HIPAA. With the change from ICD 9 to ICD 10, there have been various upgraded features that affect the medical coding system — for the better. Some of these changes include:

  • A greater range of medical codes – New codes allow for conditions and symptoms to be described more accurately.
  • New modern terminology – ICD 10 uses more modern terminology that is consistent throughout all of the coding sets.
  • Improved medical billing reimbursement – This is something that many companies and healthcare facilities worry about.

ICD 10 vs. ICD 9

There is talk in the medical community about how ICD 10 will drastically change the payment scale and method used in medical billing claims. Some healthcare providers are afraid that the installment of ICD 10 will substantially reduce reimbursements for their practices, especially when it comes to certain services such as cardiovascular testing and surgical procedures. Experts advise, however, that ICD 10 will follow the exact same system as ICD 9, and the ICD-10 Consultantsreimbursement rate will be the same, if not higher.

The ICD 10 coding system is different from ICD 9. However, that does not mean the MS-DRG payment calculation with ICD 10 will differ drastically from how it was used under ICD 9. While there may be some payment differences based on which system is used (ICD 9 vs. ICD 10), it has been noted that these differences will not be as substantial as healthcare practices and companies are expecting. Reimbursement and payments may not be exactly the same under ICD 10, but they will be similar. The majority of the new claims filed using ICD 10 will be processed as with the ICD 9 system, and they will follow the same reimbursement scale.

While it might be difficult for healthcare facilities and medical billing companies to believe that ICD 10 will not have a substantial effect on their reimbursement with all of the talk surrounding it, there is a way for healthcare facilities and company to find peace of mind. It is possible facilities to compare the MS-DRG calculations using both ICD 10 and ICD 9. This would be the most accurate way to really see the difference in reimbursement rates between the ICD 9 and ICD 10 coding systems.

ICD 10 Effects on Reimbursement

The new coding changes and features in ICD 10 may not affect reimbursement directly, but there are ways that ICD 10 may affect a provider’s reimbursement indirectly. Learning how to code claims correctly under the new system may take time, and at first, may cause some confusion for medical billing professionals. This will be due to the fact that the codes are more specific in ICD 10, so it may cause medical billing claims to be rejected at first. This could possibly delay or impeded medical billing claims processing, thus causing a loss of reimbursement due to the need to resubmit denied claims.

The MS-DRG payment calculation under ICD 10 will not change or be affected. However, that Medical Billing Neurologydoes not mean that ICD 10 does not have the potential to affect a healthcare providers reimbursement rates. These problems can be avoided or diminished by making sure healthcare providers and medical billing professionals are well-versed and updated on the ICD 10 coding system. Through proper education and training, healthcare facilities reduce the potential for ICD 10 to affect their reimbursement rate.


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