The Centers for Medicare and Medicaid Services says that ICD-10 will be revenue neutral. But the transition to the new coding and classification system in 2014 contains any number of likely hidden fiscal landmines.
Lou Rossiter, PhD, director of scientific affairs at New Health Analytics, outlined some of the likely economic pitfalls at Health Data Management's Healthcare Analytics Symposium in Chicago. Rossiter’s firm, which specializes in revenue cycle analytics, performs analyses on behalf of health system clients.
Rossiter laid out the firm’s approach, which starts with a database of historical ICD-9 based claims, translates them to their likely ICD-10 counterpart, and then assigns the claim to the appropriate DRG bucket. The impact on a hospital’s overall cash flow can vary widely, he said, adding that case mix, service mix and geographic region all factor in.
But Rossiter’s group has uncovered likely impact in such service lines as cardiology. “It is caused by the way CMS is sorting the ICD-10s into the DRGs,” he said. Rossiter advised hospitals to “review managed care contracts to negotiate protective language.”
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