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Will organizations continue using ICD-9 after the compliance deadline?

As of Oct. 1, 2015, Medicare, Medicaid, and commercial payers will require providers to submit claims in the ICD-10 format. However, both providers and payers will still have a need to use ICD-9 after the deadline, such as in the following situations: Historical Claims Analysis — Coding professionals — as well as payer claims analysts — will need to use mapping tools to translate ICD-9-CM and ICD-10-CM and PCS codes to make meaningful comparisons between diagnoses, procedures, reimbursement, and other issues that took place before and after the October deadline. These analyses may also include the evaluation of claims for case management, outcomes, utilization trends, and population health.

Identifying High-Risk Codes

Today’s trend analytics are based on ICD-9-CM codes and will need to be translated into ICD-10-CM and PCS codes. The translation process can be challenging, since a single ICD-9-CM code might correspond to several ICD-10-CM or PCS codes. HIM departments will need to work with medical management and disease management to determine the applicable codes, or greatly expand on the codes that trigger alerts.

Provider/Payer Contracting

Currently, provider contracts with payers are structured using ICD-9-CM codes. These contracts will require renegotiation using ICD-10-CM and PCS codes after the October 2015 deadline, and possibly before the deadline in cases where the contract expires before October. Providers will likely need to enlist the expertise of outside consultants to help assess and navigate contract negotiations and payer management.

Coding professionals will need to work with other departments within their organizations to assess contract changes based on the differences between ICD-9-CM and ICD-10-CM and PCS. Particularly important is the analysis of new value-based purchasing or incentive-based contracts that place provider reimbursement at risk depending upon the achievement of patient outcomes and other quality measurements. Accurate code mapping between ICD-9-CM and ICD-10-CM and PCS will help providers negotiate fair contract terms.

As of Oct. 1, 2015, Medicare, Medicaid, and commercial payers will require providers to submit claims in the ICD-10 format. However, both providers and payers will still have a need to use ICD-9 after the deadline, such as in the following situations: Historical Claims Analysis — Coding professionals — as well as payer claims analysts — will need to use mapping tools to translate ICD-9-CM and ICD-10-CM and PCS codes to make meaningful comparisons between diagnoses, procedures, reimbursement, and other issues that took place before and after the October deadline. These analyses may also include the evaluation of claims for case management, outcomes, utilization trends, and population health.

Identifying High-Risk Codes

Today’s trend analytics are based on ICD-9-CM codes and will need to be translated into ICD-10-CM and PCS codes. The translation process can be challenging, since a single ICD-9-CM code might correspond to several ICD-10-CM or PCS codes. HIM departments will need to work with medical management and disease management to determine the applicable codes, or greatly expand on the codes that trigger alerts.

Provider/Payer Contracting

Currently, provider contracts with payers are structured using ICD-9-CM codes. These contracts will require renegotiation using ICD-10-CM and PCS codes after the October 2015 deadline, and possibly before the deadline in cases where the contract expires before October. Providers will likely need to enlist the expertise of outside consultants to help assess and navigate contract negotiations and payer management.

Coding professionals will need to work with other departments within their organizations to assess contract changes based on the differences between ICD-9-CM and ICD-10-CM and PCS. Particularly important is the analysis of new value-based purchasing or incentive-based contracts that place provider reimbursement at risk depending upon the achievement of patient outcomes and other quality measurements. Accurate code mapping between ICD-9-CM and ICD-10-CM and PCS will help providers negotiate fair contract terms.

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