Come October 1, medical providers and health plans across America will be using a new medical coding system — ICD 10. The codes are much more detailed for billing for specific treatments and procedures. The new system will help perfect reimbursement, aid medical research and could improve medical outcomes.
The new codes also should help better detect scams once medical billers, insurer data systems and fraud fighters learn to effectively use thousands of new codes.
Unfortunately, half of state workers comp systems plan to stick with its predecessor — ICD-9. A big reason likely is the large cost of updating to ICD-10. But in the longterm, it may be pound-foolish not to switch over. They won’t be able to share claims data as easily with other systems to help track fraud trends and pinpoint treatment areas vulnerable to fraud.
The Healthcare Fraud Prevention Partnership recently conducted a study using code combinations from Medicare, health plans and property/casualty insurers. The data analysis resulted in significant savings for all. Each could focus on specific treatment areas that previously failed to appear on anyone’s radar. Fraud was detected more easily and false claims were refused.
Workers comp in the 26 states sticking with ICD-9 should reconsider. Sooner or later, they’ll have to make the upgrade. Might as well bite the bullet now and and join the rest of the medical and insurance communities — and reap the benefits.
About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.