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Why Providers Should Think About the Impact of ICD-10 on Managed Care Reimbursement Now
by Jackie Selby and Bethany J. Hills
November 2014
ICD-10 implementation has been delayed by Medicare until October 2015. Many believe it may be delayed again and are putting off thinking about its impact until it is clear that the updated code set will be implemented by Medicare. However, providers need to appreciate that many of the managed care agreements that they are signing today likely include binding language that will impact reimbursement changes resulting from ICD-10 implementation, particularly for inpatient services.1 Proactively thinking through such provisions, and their implications, now may avoid heartache later (even if ICD-10 were to be delayed again).
Many commentators have focused on the coding details of the ICD-10 transition and the language and coding specificity that will be required. What may be overlooked in these coding discussions is that the updated code set will not only allow, but will likely require, changes in the way that plans reimburse for certain services and coverage is determined.
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