While providers may have delayed the implementation process, most payors have been "fully immersed" in ICD-10 implementation for some time, according to an AAPC report.
According to the report, payors' interest in ICD-10 lies principally on internal processes and claims adjudication. They must prepare for many areas that coders don't have to worry about, such as medical policies, claims adjudication and underwriting.
Before the ICD-10 implementation date, payors must evaluate and update all coverage determinations containing ICD-9-CM codes. Every ICD-9-CM code has to be mapped to all possible ICD-10-CM codes, and then the determination has to be reviewed again to determine which ICD-10-CM codes will be accepted for each policy.
Once policies have been determined, they will need to be moved to claims adjudication, and auto-adjudication software will need to be programmed to fit the new policies. Those people working in denial and appeals areas will most likely experience an increase in workload.
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According to the report, payors' interest in ICD-10 lies principally on internal processes and claims adjudication. They must prepare for many areas that coders don't have to worry about, such as medical policies, claims adjudication and underwriting.
Before the ICD-10 implementation date, payors must evaluate and update all coverage determinations containing ICD-9-CM codes. Every ICD-9-CM code has to be mapped to all possible ICD-10-CM codes, and then the determination has to be reviewed again to determine which ICD-10-CM codes will be accepted for each policy.
Once policies have been determined, they will need to be moved to claims adjudication, and auto-adjudication software will need to be programmed to fit the new policies. Those people working in denial and appeals areas will most likely experience an increase in workload.
Related Articles on Coding, Billing and Collections:
Supercommittee Democrats Propose $350B in Savings Through Medicare Reform
New York Health Insurers to Refund $114.5M to Policyholders
California Health Insurance Rates Could Be Regulated Like Auto Insurance