Wiki Reimbursement with ICD-10

[JWismer]

One of my providers recently asked me a question about level of specificity and reimbursement amounts with ICD-10. She was wondering if listing more diagnosis, and to their highest level of specificity if the reimbursement would be higher?

This provider works as a primary care/urgent care provider and is afraid all the extra time it will take her to write her notes for each patient is going to be for nothing.

Anyone have any idea if reimbursements will change with ICD-10 at all? So confusing already!!!!

 

[sshm44]

The majority of the major payers at my facility have indicated that they are trying to maintain budget neutrality, meaning that we would not see either a higher or lower reimbursement rate with ICD-10. Since professional fee reimbursement is not based on DRG's at this time, I can't see how having more diagnoses, even if they are documented, would have an effect on reimbursement. We are concerned that ICD-10 codes may trigger a medical policy to come into play that we didn't see before. In our testing, we have not seen this happen and one major payer indicated that it had happened only once during their testing with other providers. Providers are still doing the same work, the same treatments they have always done. For an urgent care provider, their documentation will be just need to be complete so that we know which arm, which leg, foot, etc. is being treated. If they have been documenting properly in the past, there shouldn't be an issue at all. Even, if they have been lax with their documentation it shouldn't take that much more time for them to document completely. It is a confusing, and a little daunting time for everyone, because we won't know all the answers and even all the questions or exactly how we are going to have to respond until it happens. In my conversations with payers, they too have concerns because they don't know how many of their providers will be prepared! Hope this helps a little...good luck!

 

[JWismer]

Thank you, that does help. I didn't think the number of diagnosis would change the reimbursement, but my provider likes to code everything and thought since its so much more work to find the correct code that reimbursements would change.