ICD-10 & Coding

Some experts are predicting a spike in denials beginning on Oct. 1, 2016 when the Centers for Medicare and Medicaid Services will require claims to be more specific. Forward-looking providers are assembling teams to prepare now. 

Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends. 

Hospitals are starting to hire younger, more diverse people to handle the new coding. The shift will likely benefit healthcare organizations in time, but it won’t happen overnight.  

The healthcare industry appears to have successfully withstood the transition from ICD-9 to ICD-10. But are the sighs of relief premature? Is another shoe waiting to drop?

Looking into its crystal ball – or perhaps digital spreadsheets – PiperJaffray analysts see big plays in the RCM market. That potential is so large, in fact, that Cerner alone has a $40 billion opportunity, and it ranks fifth in market share.

CMS said it plans to add about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the coding system.

Company says up to 20 percent of claims across the United States are still denied or delayed, so while ICD-10 didn’t hurt, it also didn’t help.

Patricia Salber, MD, founder and CEO of Health Tech Hatch and host of the popular blog "The Doctor Weighs In," reflects on discussions from the 2015 Big Data & Healthcare Analytics Forum in Boston.

In 2015, heath IT got BIG: Big data. Big data breaches. Big EHR contracts. Big M&A deals. Big anticipation about ICD-10. Big plans for (and frustrations with) meaningful use. Big fears about cybersecurity. Big hopes for the future of connected care and population health.

AHIMA CEO Lynne Thomas Gordon says she's confident the transition that begins Thursday will go off with few, if any, glitches. As she sees it, all of healthcare will be better for it.