ipl-logo

Icd-9 In The Health Care Industry

424 Words2 Pages
bulb-icon

Recommended: Fraud and abuse in the healthcare system

Fraud is all around us. Especially in the health care industry. What is being done to prevent fraud from reoccurring over and over in the health care industry? In the article “New medical codes can better catch fraud, but training is needed” by Tami Rockholt, RN, BSN; Mike Fossey; Mary McLean, BS discuses the topic of health care organizations transferring from ICD-9 to ICD-10 to help decrease fraud in the coding and billing department.
With ICD-9 in place now in the health care industry there is a huge volume of fraud being committed in the coding and billing department. Patients are being over charged for procedures that cost half the price, or charged for procedures that were never performed on them. This is costing health insurance companies …show more content…

The codes used in the ICD-10 will be more precise and accurate creating fewer questions when it comes to diagnoses used for individuals. By replacing the ICD-9 with ICD-10 it will allow, “payers such as Medicare, Medicaid and private health insurers will have more accurate ways of determining accurate reimbursements for sustainable medical care pricing”.
ICD-10 will also allow “Big Data” “(allows policy makers to better decide where and when to allot funds for coordinated, preventative care)” to increase their search for data fraud more quickly then before. Once ICD-10 is in place their will be a less of a risk of corruption in the coding department. ICD-10 codes will be more parallel with “the CPT (Current Procedural Terminology) codes used by providers” so reimbursement rates will be more accurate. This is important to physicians since reimbursements are how they make their money to keep their practices up and running. The effects of ICD-10 will be positive for all health care organizations once it’s in place.
With something new many health care organizations are not looking forward to the change and time it will take to get everything in place. They fear they won’t have the manpower or time to get it up and running. I believe after knowing the effects of having ICD-10 and what it can do once it’s in place it will be worth it at the

Show More
Related
197 Words | 1 Pages

The National Practitioner Data Bank (NPDB) is an electronic information clearinghouse used by health care professionals and authorized organizations where data is collected and managed It contains data on medical malpractice payments and certain adverse actions related to health care practitioners created by congress in order to improve health care quality by preventing fraud and abuse and encouraging patient safety. The website offers a place where authorized users such as health care professionals and organizations are able to submit negative reports confidential that include medical malpractice, Negative actions or findings by a peer review organization, Negative actions or findings by a private accreditation organization, Health care-related

Read More
489 Words | 2 Pages

For example ICD-10 has expanded diagnoses codes from around 14,300 to around 69,000) and so the suggested need for a greater understanding of the logic and relationship affect between ICD-10 codes and current ICD-9-CM contracts and reimbursements means significant change to the status quo. In my experience is that change is feared or at least distrusted. So as I read the article the need for training to both reassure and build confidence seemed the key point. I think if providers can show staff system wide how use of ICD-10 codes will benefit the system and patient care, if the providers can fully integrate ICD-10 codes into the fabric of the organization then in time ICD-10 will become the familiar model to all (including insurers), just another part of daily work probably leading to that same mix of ambivalence. I think the trick is to do exactly what Padarthy suggests, to proactively and methodically integrate ICD-10 across the whole system in a measured and methodical way with due care to the impact on

Read More
1109 Words | 5 Pages

This question represents at least half of the medical community, and makes people question the intended and unintended consequences in a profit - driven health care system, the supposition of quality health today, and whether they

Read More
393 Words | 2 Pages

The ICD-10 switch went live on October 1st and we are now left assessing which predictions were on the money, which missed the mark, and which effects are currently impacting the system the most. Before the compliance deadline, many compared ICD-10 to Y2K and HIPAA 5010 that came before it. Many possessed an almost apocalyptic mentality and expected the worst. Presently, however, it appears as if ICD-10 has been similar to Y2K only in the sense that their courses of action have run in a similar fashion: both have passed with a few hiccups along the way, but relatively smoothly and insipidly.

Read More
306 Words | 2 Pages

Implementation will need to increase by medical staff to decrease disadvantages

Read More
434 Words | 2 Pages

In 2010, the aggregate shortfall of government funding for Medicare and Medicaid beneficiaries was estimated at $28 billion dollars. Currently, Medicare and Medicaid in combined do not cover the complete cost of care for program recipients but their beneficiaries account for about half the care provided by hospitals . In the chart it shows the uncompensated care and payment shortfalls from Medicare and Medicaid in billions of dollars, 2010 Similarly, between 2000 and 2010, the cost of uncompensated care grew by 82 percent, from $21.6 to $39.3 billion. In the below chart it shows the cost-based uncompensated care in billions of dollars, 1990 – 2010 .EMTALA’s

Read More
352 Words | 2 Pages

This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance.

Read More
118 Words | 1 Pages

Your discussion presents an interesting perspective on business principles. Managing financial needs of a hospital and patient’s satisfaction goes hand and hand in the hospital field. This also can create a negative impact when it comes to prescribing pain medication. An ethical dilemma arises for emergency room providers who in relation to new reimbursement tactics centered upon patient satisfaction scores (Kelly, Johnson, & Harbison, 2016)

Read More
589 Words | 3 Pages

ICD-10 helps gather and sort vast amounts of patient data. No way does it increase the quality of care provided. That will be done by advances in medical science. The ICD-10 codes will be entered once there is a diagnosis and the treatment will be the same. ICD-10 is not going to change how our healthcare system functions, it is just going to simplify data handling and facilitate better payments, which will be a win-win situation for everyone involved.

Read More
223 Words | 1 Pages

Meaning they would identify right VS. Left. The CM in ICD-9 means clinical modification, and the PCS in ICD-10 mean Procedure classification system. After graduation

Read More
392 Words | 2 Pages

Following the description of ICPC-2 there will be an example of how the standard is implemented in a healthcare setting. There will be more detail on the organizations involved with ICPC-2, how it is applied, and if the standards functionality is meeting health care needs. Finally there will be a section provided on the benefits

Read More
1358 Words | 6 Pages

In the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives.

Read More
155 Words | 1 Pages

Due to the fact that guidelines in healthcare change

Read More
352 Words | 2 Pages

Health insurances can benefit by saving millions of dollars in health care cost that are spent on wrong treatments for patients. Instead, insurances should focus on hospitals providing quality patient care service

Read More
655 Words | 3 Pages

Throughout the years, there have been efforts to eliminate poor quality care given to patients. Eventually, the Joint Commission on Accreditation

Read More

More about Icd-9 In The Health Care Industry

Related Topics

Open Document