Journal of AHIMA - June 2012

“It is almost intrinsic that there will be a payment impact to your bottom line.” MARIA BOUNOS RN, MPM, CPC-H, business development manager at Wolters Kluwer Law & Business

Conducting a detailed risk assessment is the first step to determining the financial impact.

“If you can convert your issues into dollar signs, you will get a hospital administration’s attention,” Rossiter said.

A payment impact analysis can be done by translating two or more years of ICD- 9 hospital claims into ICD- 10, then using the expected Medicare MS-DRG ICD- 10 payment rates to compare reimbursement between ICD- 9 and ICD- 10. While translated historical data is not the same as live coded ICD- 10 data, the comparison can enable a close look at reimbursement rates.

The impact can be broken down by facility, DRG, service line, and other line items.

In an example model, Rossiter showed how some DRGs can lose more than others. The DRG for “cardiac defibrillator implant w/o cardiac cath w/o MCC” showed a loss in reimbursement of $663,821 between ICD- 9 and ICD- 10 over the entire span of reviewed records. However, a look at all Medicare fee-for-service payments showed a 2. 7 percent increase in reimbursement under ICD- 10.

The model not only attaches a dollar amount to the impact of ICD- 10, but informs strategic planning by service line. ¢

Chris Dimick ( chris.dimick@ahima.org) is staff writer at the Journal of AHIMA.

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