Nearly one-quarter (24 percent) of hospitals now outsource clinical documentation audit, review and programming, and by the third quarter of 2015, 71 percent of hospitals plan on having an international classification of diseases (ICD) services partner help them adjust and survive under the new codes, according to a Black Book survey of 650 hospital technology and physician leaders.
The ICD-9 code, which was set more than 30 years old, has become outdated, and is no longer considered usable for today’s treatment, reporting and payment processes, according to the American Medical Association.
The ICD-10 code set reflects advances in medicine and uses current medical terminology, and the code format has been expanded, which means that it has the ability to include greater detail within the code.
As the national conversion to the new coding set was pushed back a year from October 2014 to October 2015, the new coding set addresses both the physician’s needs for health care delivery and facilitates the accurate reimbursement for medical services required, not necessarily those services rendered.
It is estimated that the change in coding will financially impact unprepared small hospitals in the millions of dollars, and large hospital and chains in the billions of dollars, Doug Brown, managing partner of Black Book, told eWEEK.
“The requirement to document to code rather than document for clinical reasons is a chief complaint of 88 percent of physicians regarding ICD-10,” he said. “Many facilities still lack a bridge between clinical language and coding language, and the learning curve after October 2015 may financially cripple some practices and hospitals.”
The vast majority (88 percent) of 200-plus bed hospitals outsourcing CDI currently report to have realized significant (more than $1 million) gains in appropriate revenue and proper reimbursements following the implementation of clinical documentation improvement program yet before ICD-10.
In 2014, 81 percent of all physicians and nearly all hospitals (94 percent) are in the final stages of electronic health records implementation, which in turn has produced a capability for storing and delivering transcribed medical records.
Additionally, reimbursement reforms are effecting a greater demand for extensive medical documentation for insurance payments and new models of bundling reimbursements among providers.
“This has caused a shortage in local transcriptionists in U.S. communities and forcing physicians and medical facilities to seek offshore services,” Brown explained. “The Philippines, India and Pakistan are filling much of the demand, however, 93 percent of U.S. physicians and 88 percent of U.S. hospital executives surveyed state they prefer their medical transcription remain in their local communities if possible.”
Brow also noted lower costs offshore have also made outsourcing attractive to those that can not find local resources–approximately one-twelfth of medical transcription services is currently performed in India.
“Progress in technologies has played a major role in outsourcing coding. With encryption and verification processes, the confidentiality of patient information is securely communicated and identity protection is assured,” he said. “Breaches in patient confidentiality have been very minor as far as coding outsourcing vendors and systems have been concerned, particularly among large vendors.”