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Thursday, August 15, 2013

ICD-10 will impact workers comp, non-HIPAA entities, too

ICD codes are ruling workers' compensation and the lives and claims of injured workers. Today's post was shared from /

"They might not have to play by all the same rules, but healthcare providers shouldn’t forget the impact ICD-10 will have on non-HIPAA covered entities such as workers compensation, nursing homes, and home health agencies.  While non-HIPAA entities are not mandated to switch to the new code set on October 1, 2014, the changing tide will sweep them along with the complex transition whether they like it or not.  Medical providers should be aware of the struggles of their non-HIPAA partners, especially as the care coordination spectrum expands to include more and more external organizations that may not always be on the same page.
"t may seem like those entities that are allowed to stick with ICD-9 would be happy to do so.  But in fact, staying with the old code set, which will not be maintained or updated after 2014, might be more trouble than it’s worth.  Technically, workers compensation insurance could demand all provider claims to contain ICD-9 codes for as long as they please, but the undue hardship that would place on medical professionals has been deemed too great by some large insurance plans such as the Ohio Bureau of Workers Compensation (OBWC), which is planning to use ICD-10 after the implementation date.
Non-HIPAA entities could also choose to accept ICD-10 codes from providers but crosswalk them back to ICD-9 if they don’t want to upgrade their systems.  But the extra work to create accurate and reliable mappings from a very detailed code to a broader ICD-9 one seems a little pointless.  “Even though claims professionals don’t have to be immediately fluent in ICD-10, they should be forward-thinking and follow the market in the direction it’s headed,” suggests John Sarich, VP of Strategy for VUE Software in a post for Claims Journal. “It will require some upfront investment, but will ultimately outweigh the lost time that accompanies translating every medical record you encounter.”
"And payers such as workers compensation and property and casualty insurance (P&C) do have a vested interest in the detail and specificity provided by ICD-10, mandate or no.  They will spend less time pestering physicians for more and more documentation to validate a claim for an injury, reducing the administrative burden for everyone involved – assuming payer claims processors are properly trained in the new code set and don’t need to return to the provider to ask for clarification.

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