Post-Implementation ICD-10 Challenges

Managed Healthcare Executive

George B. Breen, Jackie Selby, and Bethany J. Hills, Members of the Firm in the Health Care and Life Sciences practice, in the firm’s Washington, DC, and New York offices, authored an article in Managed Healthcare Executive titled “Post-Implementation ICD-10 Challenges.”

Following is an excerpt:

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.