Sunday, June 15, 2014

Are ICD-9 and ICD-10 going to be Financial Neutral? Must test your DRG grouper.

ICD-10 has yet to be implemented in USA and yet  to see the real financial impact of ICD-9 to ICD-10.But in theory both ICD-9 and ICD-10 should not  to have  any financial impact and variation.The way ICD-9 and ICD-10 has been designed has nothing to take with the claim pricing in claims as claims pricing depends on HCPCS codes or revenue codes ( used in Provider agreements/networks for pricing   ) that are not going to change by ICD-10 implementation.But one thing that is most important to understand the inpatient claims pricing that uses DRG codes. ICD-9 and ICD-10 has the same DRG but the DRG grouper that uses Diagnosis code has a impact and hence the DRG might changes in claims based on the DRG grouper / or the X-walk that built the DRG codes and then there would be absolutely price variation in ICD-10 claims.Make sure to test enough inpatients claims to make sure that ICD-9 and ICD-10 claims are financial neutral.

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