Premium Essay

Case Study: How ICD-10 Impacts Healthcare

Submitted By
Words 937
Pages 4
The World Health Organization established the International Classification of Diseases (ICD) to standardize medical records. ICD-10 is an update that reflects changing needs in medicine. The code offers increased detail and flexibility. However, implementing the code presents medical establishments with several challenges. The biggest challenge is finding common ground between the two frameworks.

How ICD-10 Impacts Healthcare

A presentation published by the Centers for Medicare and Medicaid Services explains that the World Health Organization created ICD-9 in 1979 to reflect current medical advances and establish universal coding procedures. [1] The system outlines the diagnoses, procedures and terminology used by caregivers. Medical organizations …show more content…
It will reflect current medical practices and allow physicians to make changes as needed. The classification system will allow caregiver to provide more detailed information about injuries and procedures. Additionally, the system will allow physicians to describe in detail how they performed the procedures.

This enhanced reporting ability is not without shortcomings. The increased data will initially slow classification workflow until caregivers adapt to the new system.

Five: Changes for Medical Record Departments

A report authored by Alexa Arends-Marquez, et al on the American Health Information Management Association (AHIMA) forecasts that ICD-10 implementation will initially slow insurer processing. [3] Caregiving facilities will see backlogs in financial processing in areas such as:

• Scheduling
• Pre-certification
• Pre-registration
• Estimates
• Registration
• Case Management

Caregivers will have to educate staff members and patients on adapting to the new system and providing or obtaining the right information to complete processing. Additionally, caregiving facilities will have to revise their procedures to accommodate the new …show more content…
This creates the possibility that overwhelmed finance departments will leave many procedures un-coded.

Challenges of Initial ICD-10 Implementation

A report issued by Medicaid reveals that the largest challenge present by ICD-10 implementation is that there is no clear way to switch to the new outline. [4] A new code may correspond with a single or several ICD-9 references. Conversely, one ICD-9 code may correlate with a single or several ICD-10 references, and some codes new classifications do not correlate with any references in the ICD-9 framework. As a large healthcare insurance outlet, this creates major implications for Medicaid. State agencies have produced documentation to assist with this process, but only time will tell if these aids will help caregiving facilities make the upgrade to

Similar Documents

Premium Essay

Healthcare

...APPENDIX Checklists A Checklist A-1 Reviewing a Budget 1. Is this budget static (not adjusted for volume) or flexible (adjusted for volume during the year)? 2. Are the figures designated as fixed or variable? 3. Is the budget for a defined unit of authority? 4. Are the line items within the budget all expenses (and revenues, if applicable) that are controllable by the manager? 5. Is the format of the budget comparable with that of previous periods so that several reports over time can be compared if so desired? 6. Are actual and budget for the same period? 7. Are the figures annualized? 8. Test one line-item calculation. Is the math for the dollar difference computed correctly? Is the percentage properly computed based on a percentage of the budget figure? 333 334 APPENDIX A Checklists Checklist A-2 Building a Budget 1. What is the proposed volume for the new budget period? 2. What is the appropriate inflow (revenues) and outflow (cost of services delivered) relationship? 3. What will the appropriate dollar cost be? (Note: this question requires a series of assumptions about the nature of the operation for the new budget period.) 3a. Forecast service-related workload. 3b. Forecast non–service-related workload. 3c. Forecast special project workload if applicable. 3d. Coordinate assumptions for proportionate share of interdepartmental projects. 4. Will additional resources be available? 5. Will this budget accomplish the appropriate managerial objectives for...

Words: 33826 - Pages: 136

Premium Essay

Team Assignment

...benefit of convenience of using EHRs, comes the responsibility of protecting electronic protected health information (ePHI) and safeguarding sensitive patient data.  The Health Insurance Portability and Accountability Act (HIPAA) focuses on protecting ePHI with guidelines to ensure organizations have implemented “reasonable and appropriate” security measures to adhere to HIPAA rules and maintain patient confidentiality. HIPAA requires covered entities to conduct risk assessments to verify compliance and attempt to uncover areas where ePHI is at risk of compromise.  This analysis of the iTrust database, as related to the new requirements that iTrust wishes to implement, will discuss the threats and vulnerabilities and the potential impact on the iTrust web application and database. Section I: iTrust Threats & Vulnerabilities and Countermeasures A detailed analysis of the iTrust database detected several high-risk vulnerabilities that...

Words: 5631 - Pages: 23

Premium Essay

Affordable Care Act

...Affordable Care Act: Impact on Providers Quality vs. Quantity Abstract The Affordable Care Act’s proposal was to make sure that health insurance coverage is affordable for individuals, families, and businesses and decrease the amount of uninsured individuals. . Much of the impact of this act will begin when the major coverage provisions take effect in 2014. Providers will experience an increased burden in many aspects of their medical profession including new legal practicing liabilities, less autonomy, administrative encumbrances, shortages of primary care physicians, and political infringement (Horton, Hollier 2012). The provider is to maintain high quality of care while the ACA’s agenda is cost and quantity over quality. The Affordable Care Act is the largest piece of legislative reform in American history relating to health care. The impact to our economy on many levels of scale and our constitutional rights are all being questioned and debated without a definitive answer to long term reality of its implications. Reform is necessitous to the continuance of providing care, controlling fraudulent activities and waste, as well as, exploring new innovative ways to maintain a high level of quality services within the legalities of our legislative branch. The balance of these aspects have been challenging and perplexing in materializing the reforms into fruition. The concentration during reform has been on quantity of the insured population...

Words: 4064 - Pages: 17

Premium Essay

Itrust Database Software Security Assessment

...paper should be sent to Amy Wees, Brooks Rogalski, Kevin Zhang, Stephen Scaramuzzino and Timothy Root, Department of Information and Technology Systems, University of Maryland University College, 3501 University Blvd. East, Adelphi, MD 20783. E-mail: acnwgirl@yahoo.com, rogalskibf@gmail.com, kzhang23@gmail.com, sscaramuzzino86@hotmail.com and Chad.Root@gmail.com Abstract The healthcare industry, taking in over $1.7 trillion dollars a year, has begun bringing itself into the technological era. Healthcare and the healthcare industry make up one of the most critical infrastructures in the world today and one of the most grandiose factors is the storage of information and data. Having to be the forerunner of technological advances, there are many changes taking place to streamline the copious amounts of information and data into something more manageable. One major change in the healthcare industry has been the implementation of the Electronic Medical Record (EMR) systems. Having risks and benefits, the electronic medical record systems will strive to provide and change the way healthcare industry will operate. iTrust is a role-based health care web application. Through this system, patients can see and manage their own medical records. Medical personnel can manage the medical records of their patients...

Words: 7637 - Pages: 31

Premium Essay

Mental Health Issues and Its Effects Upon the Individual, Their Carers, Family and Friends (Schizophrenia)

...MHR1000 FOUNDATIONS FOR NURSING PRACTICE: MENTAL HEALTH Mental Health Issues And Its Effects Upon The Individual, Their Carers, Family and Friends Summative Assessment 3299 Words 10th July 2013 Identifying and Discussing a Mental Health Condition and Diagnosis   Schizophrenia is a widely recognized chronic and severe psychiatric disorder which according to the National Institute for Health and Care Excellence (NICE, 2009) guidelines, affects one per-cent of the UK population. Schizophrenia can be classified as an overall category for the mental illness; however, diagnostic tools such as the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) reveal the variations of the psychiatric disorder. This essay will explore and focus on one specific subtype of the mental illness. Paranoid Schizophrenia. According to T.Davies and T.Craig (2009, p45), Paranoid Schizophrenia is one of the most common subtypes of the psychotic illness which affects the individuals variation of emotion, thinking and behaviour. Through extensive research, this essay will uncover the definition of paranoid schizophrenia, its manifestations and possible causes. Key issues such as symptoms, epidemiology, prevalence, co-morbidity, prognosis, treatment and interventions will also be critically reviewed and discussed. Lastly, this essay will also analyse guidelines, policies and regulations that influence interventions...

Words: 4246 - Pages: 17

Premium Essay

Healthcare Fraud

...Health care Fraud Health care fraud is a crime that has a significant effect on the private and public health care payment system. According to the Federal Bureau of Investigation, all health care programs are subject to fraud with Medicare and Medicaid being the most visible. It is estimated that fraudulent billings to both private and public health care programs are between 3 and 10 percent of total health care programs expenditures. The most recent Centers for Medicare and Medicaid (CMS) statistical estimates project that total health care expenditures are estimated to total $2.4 trillion, representing 14 percent of the gross domestic product. By the year 2016, CMS also estimates that by the year 2016, the total health care spending is to exceed $4.14 trillion, representing 19.6 percent of the GDP. As one can see, the tens of billions of dollars lost due to health care fraud is a serious financial issue that affects the healthcare system as a whole and affects patients, taxpayers, and government through higher health care costs, insurance premiums and taxes. Health care fraud is defined in Title 18, United States Code (U.S.C) s. 1347 as “whoever knowing and willfully executes or attempts to execute a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations or promises, any money or property owned by or under the custody or control of, any health care benefit program.” In other words, it is intentional...

Words: 2215 - Pages: 9

Premium Essay

Public Health

...community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care that are centered on the individual with public health models of community health that are organized around the needs of the population. There is no way to separate these two components. For example, medical practices that wish to address increases in Type 2 diabetes cannot be successful without addressing the built environment of communities, food access in neighborhoods or the impact of...

Words: 12713 - Pages: 51

Premium Essay

Informatics, Using Data

...Walden University NURS 6051N-13 Transforming Nursing and Healthcare Through Information Technology Instructor: Dr. Wagner March 27, 2016 Using the Data/Information/Knowledge/Wisdom Continuum Introduction Many organizations now have clinical documentation improvement programs (CDIs) designed to help an organization accurately reflect the quality of patient care, prove healthcare services, and make accurate reports of diagnosis and procedures (Cassano, 2014). A Clinical Documentation Specialist (CDS) is a registered nurse who manages, assesses, and reviews a patient’s medical records to ensure that all the information documented reflects the patient’s severity of illness, risk of mortality, clinical treatment, and the accuracy of documentation. Part of the role is to perform concurrent reviews of medical records, validate diagnosis codes, identify missing diagnosis, and query physicians and other healthcare providers for more specifics so documentation accurately reflects the patient’s severity of illness (Cassano, 2014). Health Information Management (HIM) professionals advocate for a strong commitment to accurate and timely clinical documentation as hospital initiatives push forward with programs such as ICD-10-CM/PCS implementation, Accountable Care Organizations reimbursement models, Fraud and Abuse compliance programs, and implementation of electronic health records (EHRs) (AMIHA, 2010). HIM professionals also impact CDI programs by providing education regarding compliant...

Words: 1416 - Pages: 6

Free Essay

Research Paper

...Community Interest Company: a Social Enterprise Organisation Project Report Health Needs Assessment: Stroke in South West and South East London Author: Version: Date: Client: Ref No: Dr John Hayward, Sarah Martin, Dr Michael Soljak Final Version 16.03.09 South West and South East London Cardiac and Stroke Network Boards P132 A Social Enterprise organisation and Community Interest Company Registered office: PO Box 1295, 20 Station Road, Gerrards Cross, Buckinghamshire, SL9 8EL English Company Number: 06480440 VAT Registration: 926 9466 78 www.phast.org.uk E&OE Final Project Report P132 Health Needs Assessment: Stroke in South West and South East London Public Health Action Support Team (PHAST) The Public Health Action Support Team (PHAST) is a Community Interest Company. This is a type of social enterprise that is committed to using its surpluses and assets for the public good. Social enterprises are social mission driven organisations which trade in goods or services for a social purpose.1 PHAST is based at Imperial College, London. It has over 60 experienced and expert public health professionals whose aim is to improve the health of the population and reduce inequalities. Many have worked at high level in the NHS, the Department of Health or in academia. Quality assurance and due diligence processes are in place to ensure all associates work to the highest standard. PHAST also has associates with economic, ethical and legal expertise. For further details see www.phast...

Words: 29085 - Pages: 117

Premium Essay

Athenacollector: a Medical Practice’s Premier Billing and Workflow Application

...advertised as the "first economically sustainable, service-based" electronic medical records (EMR) system (“athenahealth Introduces,” 2006). In August 2008, it announced the acquisition of MedicalMessaging.net (“athenahealth to Acquire,” 2008). Today athenahealth has four main services: • athenaCollector - A web-based physician billing and practice management solution that reduces administrative red tape that allows you to efficiently assess, plan, and improve practice performance while increasing revenue (“athenaCollector,” 2012). • athenaClinicals
- An electronic health records (EHR) system, delivering increased revenue, decreased cost, and more clinical control to medical practices. With flexible, web-based Certification Commission for Healthcare Information Technology (CCHIT) certified software, it incorporate government mandates faster (“athenaClinicals,” 2012). • athenaCommunicator
- A service that deals with daily phone traffic and administrative tasks. It includes an automated messaging platform, patient web portal, live operator and self-pay collections service (“athenaCommunicator,” 2012). • athenaCoordinator
- A cloud-based care coordination service for order transmission,...

Words: 2006 - Pages: 9

Premium Essay

Doctors

...of health insurance, and for other purposes. HIPAA Colloquial acronym(s) Enacted by the  104th United States Congress Citations Public Law Stat. Pub.L. 104–191 110 Stat. 1936 [1] [2] Legislative history [3] • • • • • • • • • Introduced in the House as H.R. 3103 [4] by Bill Archer (D-TX) on March 18, 1996 [5] Committee consideration by: House Ways and Means Passed the House on March 28, 1996 (267–151 Passed the Senate on April 23, 1996 (100-0 [6] ) [7] ) [8] ) and by the Senate on , in lieu of S. 1028 Reported by the joint conference committee on July 31, 1996; agreed to by the House on August 1, 1996 (421–2 [9] August 2, 1996 (98–0 ) Signed into law by President Bill Clinton on August 21, 1996 e v t [10] The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191 [1], 110 Stat. 1936 [2] , enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It has been known as the Kennedy–Kassebaum Act or Kassebaum-Kennedy Act after two of its leading sponsors.[11] Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative...

Words: 7409 - Pages: 30

Premium Essay

Why Finacial Managers Should Be Concerned with Quality Initiatives in Healthcare Organizations

...Quinlan School of Business MBA in Healthcare Management program. He may be reached at cjandel@lumc.edu. Stephen L. Davidow, MBA, APR, is a health care marketing and communications professional with a strong focus on quality and patient safety. He is a graduate of Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at stephen@davidowcommunciations.com or 708-284-2300. Mark Hollander, MBA, is a financial manager at the Department of Veterans Affairs and graduate of Loyola University Chicago ’s Quinlan School of Business MBA in Healthcare Management program. David A. Moreno, MBA, is a biotechnology business analyst and graduate of the Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at dmoreno1@gmail.com. Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries...

Words: 6247 - Pages: 25

Premium Essay

Bactol Alcohol Marketing Plan

...| Contents | Page | 1.0 | Executive Summary | 1 | 2.0 | Marketing Aspect of the Disease / Product Function | 2-3 | | 2.1 | Definition (ICD code) | | | 2.2 | Epidemiology | | | 2.3 | Diagnosis | | | 2.4 | Treatment | | | 2.2 | Environmental factors | | 3.0 | Product Background | 3-4 | 4.0 | Target Market | 4-5 | | 4.1 | Market Definition | | | 4.2 | Current Market Value | | | 4.3 | Market Potential | | | 4.4 | Social and Regulatory Aspects | | | 4.5 | Market Research Results | | 5.0 | Competitive Environment | 5-7 | | 5.1 | Competing Product and Product Revenues | | | 5.2 | Companies and Relevant Portfolios | | | 5.3 | Marketing And Sales Activities | | 6.0 | SWOT Analysis | 7-8 | | 6.1 | Internal Strength | | | 6.2 | Internal Weaknesses | | | 6.3 | External Opportunities | | | 6.1 | External Threats | | 7.0 | Commercial Goals and Financial Forecast | 8-10 | | 7.1 | Qualitative Objectives | | | 7.2 | Quantitative Objectives | | 8.0 | Budget : Planned Marketing & Sales Investment | 10-11 | 9.0 | Product story and Unique Selling Proposition | 11 | 10.0 | Branding Guidelines – Logo, Colours, Layout and Typography | 12 | 11.012.0 | Target groupsInternal Communication Program | 12-13 13-14 | 13.0 | External Communication | 14-15 | 14.015.0 | PackagingPricing Strategy | 15-16 16-17 | 16.017.018.0 | Cooperation and strategic alliances Life Cycle Management Key Success...

Words: 6716 - Pages: 27

Premium Essay

Assistant Professor of Medicine

...de Souza et al. BMC Health Services Research 2012, 12:481 http://www.biomedcentral.com/1472-6963/12/481 RESEARCH ARTICLE Open Access Unsupported off-label chemotherapy in metastatic colon cancer Jonas A de Souza1,2*, Blase Polite1,2,3, Monica Perkins4, Neal J Meropol5, Mark J Ratain1,2,6, Lee N Newcomer4 and G Caleb Alexander7 Abstract Background: Newer systemic therapies have the potential to decrease morbidity and mortality from metastatic colorectal cancer, yet such therapies are costly and have side effects. Little is known about their non-evidence-based use. Methods: We conducted a retrospective cohort study using commercial insurance claims from UnitedHealthcare, and identified incident cases of metastatic colon cancer (mCC) from July 2007 through April 2010. We evaluated the use of three regimens with recommendations against their use in the National Comprehensive Cancer Center Network Guidelines, a commonly used standard of care: 1) bevacizumab beyond progression; 2) single agent capecitabine as a salvage therapy after failure on a fluoropyridimidine-containing regimen; 3) panitumumab or cetuximab after progression on a prior epidermal growth factor receptor antibody. We performed sensitivity analyses of key assumptions regarding cohort selection. Costs from a payer perspective were estimated using the average sales price for the entire duration and based on the number of claims. Results: A total of 7642 patients with incident colon cancer were identified...

Words: 5524 - Pages: 23

Premium Essay

Manager

................................................................................................................7 Vendors and Cost of EMR ......................................................................................................7 EMR Stimulus.........................................................................................................................8 Different Uses of EMR ....................................................................................................................9 Uses of EMR in Health Management .....................................................................................9 Uses of EMR in Disease Management .................................................................................10 Uses of EMR in Genomics Research ....................................................................................11 Management Workflow Training, Implementation...

Words: 5615 - Pages: 23