Icd-9 In The Health Care Industry
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
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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
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