Post-Implementation ICD-10 Challenges

Existing reimbursement arrangements may be impacted by the ICD-10 transition in several ways. As discussed previously, changes to reimbursement rates, particularly based on some DRGs, may occur - such changes may or may not be effectively “neutralized” by the revenue neutrality provisions in some managed care contracts. We expect to see such issues ultimately going through the dispute resolution process provided for in such contracts.

Clinical documentation sits at the crux of reimbursement challenges and may create a number of unanticipated outcomes. Besides rates, value-based payments – regardless of the specific methodology – could be significantly affected by the ICD-10 transition. How accurately the clinical documentation captures the visit and the diagnosis will ultimately impact incentive payments.