Optum360 coding books logo
Optum360Coding.com
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018


Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More


Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More


OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More


View Article Archive

Subscribe:
To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:
 

Medical Coding News Archives

ICD-10’s Impact on Hospital Payments Expected to Be Zero

 
May 29, 2015:

The transition to ICD-10 this fall may loom large in terms of systems changes, but the net impact on hospital payments is estimated to be close to zero. Whether that impact will be on the positive or negative side of zero depends in large part on the quality of the coding.

According to Ron Mills of 3M, one of the authors of an American Health Information Management Association white paper on ICD-10 impact who presented at the ICD-10 Coordination and Maintenance Committee meeting in March 2015, hospitals will likely experience negligible shifts in MS-DRGs due to differences between ICD-9 and ICD-10 codes. A study involving 10 million fiscal year 2013 MedPAR records that were grouped using ICD-9 MS-DRG Version 32, converted to ICD-10 codes and grouped with MS-DRG Version 32 found that 0.41 percent of the records were assigned a higher-weighted MS-DRG, and 0.66 percent a lower-weighted MS-DRG after conversion, based on fiscal year 2015 weights. The net effect was $4 per $10,000 in reimbursement, or –0.04 percent.

The results hold for all hospital types, with rural hospitals experiencing the largest impact on net reimbursement: –0.06 percent.

Of the shifts to lower-weighted DRGs, 40 percent are due to the ICD-10 code not reflecting a CC or MCC. When records shift to highter-weighted DRGs, 75 percent of the time it is because the code now reflects a CC or MCC.

Mills notes that human error and expertise are the biggest factors in determining whether records undergo an MS-DRG shift when converted to ICD-10. Out of 100 records the authors of the white paper studied, there were 20 instances of a shift. Upon examination, however, it was clear that only two records had truly undergone a shift because of the difference between ICD-9 and ICD-10. The other 18 cases were due to coders missing clinical details.

 

 
Sign in to
Your Account
USERNAME
Forgot your username?
PASSWORD
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:


What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog