ICD-10: A Case Study

The revenue cycle has been defined by the Healthcare Finance Management Association (HFMA) as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” In a hospital, the revenue cycle would include the entire lifecycle of a patient account from scheduling and preadmission through to payment. There are many processes included in the revenue cycle, and they flow into each other. When operating effectively, the revenue cycle is very predictable, but issues along the path can cause major effects later in the cycle. (Revenue Cycle, 2015) The revenue cycle is not just about billing, but the entire flow of a patient and medical record through a hospital – and it affects all …show more content…
Extra time will be required to verify ICD-10 codes, both in correct code selection and validation of code completion. Interpretation of codes during diagnosis validation of physician orders will require more time as well. Medical necessity verification processes will be impacted through requiring ICD-10 levels of data. A solid understanding of ICD-10 will allow all registration and scheduling staff to evaluate ICD-10’s impact to their job duties. Education should focus on the meaning of ICD-10-CM and ICD-10-PCS codes, changes in specificity and impact on severity of illness and length of stay criteria, and the differences between ICD-9 and ICD-10. (ICD-10 and the Delivery, …show more content…
Professional nurses are usually assigned the task of monitoring admissions with a focus on clinical guidelines and intervention to provide coordination of care. Case managers ensure that patients are admitted and transitioned to the appropriate level of care, are advocates for the patients, manage resource utilization, monitor outcomes data, and address the psychosocial needs of the patient. ICD-10 impacts will require case managers will need to evaluate all of their processes as it relates to determining medical necessity, appropriateness of case, referrals, utilization, authorization, and certification. Case managers will need to become familiar with ICD-10 and advanced clinical treatment guidelines based on the expanded information available through ICD-10. ICD-10 documentation training will be a necessity for case managers. (ICD-10 and the Delivery, 2013) The charge capture function will be impacted by ICD-10 in several ways. ICD-10 impacts the charge data master in medical necessity and code mapping. Lab, radiology, and other ancillary departments will need to understand ICD-10 diagnostics and medical necessity. (ICD-10 and the Delivery,