Much of the delay in healthcare claims processing comes from insurance companies’ requests for supporting medical documentation.  This, in and of itself, a byproduct of the relative dearth of information the outdated ICD-9 coding system provides on the submitted claim.  The assembly and submission of patient records and the subsequent time for the insurance company to review those records and render a determination can add 60 days or more of additional processing time and untold costs for both sides of the claims processing equation.

The promise of ICD-10 is that more specific descriptions of patient conditions and the services used to treat those conditions will enable insurance companies to render payment determinations without the need to request additional documentation.  In a recent interview with RevCycle Intelligence, Pam Jodock, Senior Director of Health Business Solutions for the Health Information & Management Systems Society (HIMSS) articulated how the increased granularity and specificity of ICD-10 coding can lead to a more efficient claims processing cycle with insurance carriers.

“There should be fewer claims pended for requests for medical records because the ICD-10 code will provide the information not included in ICD-9 codes today,” Jodock says. “Hopefully over the course of time, we’ll see a streamlining of claims payment and providers will see a reduction in the number of claims that get pended or rejected at first pass.”

In addition, providing details in the form of coding related to social, psychological, economical, and clinical circumstance allow providers to better defend the severity of their respective patient populations.  Jodock states, “Providers can only control a small portion of outcome with their patients. There are other things — comorbidities, lifestyle choices and adherence to medication protocol — that will impact outcome,” claims Jodock. “The more of that type of information that providers are able to capture, the better able they’ll be able to account for those factors when negotiating appropriate reimbursement levels.”

With 6 months to go before October 1, documentation and coding proficiency in ICD-10 is pre-requisite to achieving revenue cycle and claim processing efficiencies.  Continue to check in with ICD-10 AnTENna for tools and resources to ready your department for October 1, 2015.