Physician Reimbursement Amid Quality-Driven Medical Service

Dr. Adam Tabriz

How International Statistical Classification of Diseases and Related Health Problems (ICD) Negatively Affects Physicians' Administrative Workload

Illumination publication initially publicized this article on Medium!

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The degree of excellence or distinctiveness of a commodity or service is relative. Logically defining the quality of a deliverable is the reflection of the trait that makes it preferable in the eye of the beholder.

Quality medical care, just like any other subject of quality measure, comes with sundry quality indicators or reference points. The number of quality indicators is endless. Healthcare leaders have put forward a set of reference points or quality indicators to facilitate quality medical care.

The topic of quality medical care comes with its puddle of contraversies, mainly regarding its definition and what defines quality medical care across the spectrum of diverse populations. The discourse around that topic is out of the scope of this piece—nevertheless, the standard behind a determined quality subjects physicians' practices to the added administrative workload.

The recent value-based healthcare reimbursement has shifted how physicians earn for the care they deliver to patients. That is by focusing more on helping patients stay healthy and away from chronic diseases.

Today, quality indicators are the building blocks of every physician practice payment model.

Produced initially by World Health Organization (WHO), ICD coding serves as a comprehensive universal utility. It provides critical learning on the worldwide extent, causes, and consequences of human disease and death via data that is reported and coded with the ICD.

Clinical terms coded with ICD are the primary basis for health recording and statistics; thus basis for determining the quality indicators of a patient visit. These data and statistics support payment systems based on quality and safety value administration.

According to a report, more than 70% of healthcare costs involve ICD codes. That is why if physicians or medical practices fail to adapt to the most recent version of the coding system, ICD-11, they may encounter potential reimbursement barriers.

The ICD-11 is used for insurance coding intents, for statistical tracking of illnesses, and as an instrument of global health categorization across countries and in different languages.

ICD-11 coding is a data-intensive system, as it has taken the level of bureaucracy to a new level amidst the transition from older versions. In fact, for optimal Reimbursement, physicians must ensure detailed documentation and data entry. That is an added administrative burden not compensated to physicians and medical practices.

Currently, various practice management software and automated coding solutions are available to help streamline correct billing practices and compliance with ICD-11 coding guidelines. These solutions help efficient coding that facilitates proper 3rd party payment and alleviates claim denial. But, it won't ideally reduce their workload.

ICD-11 requires a robust system with internal expertise and communication resources. That transparent digital platform facilitates collaboration between various coders and experts. And, by design, it distributes the data entry task amongst respective players.

The novel coding system serves as the basis for every healthcare decision made today, the basis for pinpointing and interpreting health statistics. ICD coding is the core of mapping tools for disease trends and epidemics. That coding system directly affects healthcare finances.

The ICD-11, the most recent version of the internationally recognized coding system, is a database. It comprises up to 13 dimensions with changes. The ICD-11 is reportedly IT-friendly and facilitates seamless data collection, primarily focusing on receding chronic diseases and costs.

It is a one hundred percent digital system that can manage multiple cases and capture healthcare data.

ICD-11 extends a more user-friendly layout incorporating various data properties and attributes to improve quality and outcome.

ICD-11 is more intricate and comprehensive than the rest of its ancestors, with over 55,000 codes."

According to the World Health Organization, the Implementation and Transition Guide ICD-11 will promote dual coding of traditional medicine diagnoses alongside mainstream medicine and generate a functioning score based on the WHO Disability Assessment Schedule (WHODAS).

ICD Coding system has always been a tiresome task for medical professionals. But, ICD-11 has taken the complexity and labor-intensiveness of its ancestors to a new level. It is a highly resource-intensive plan that requires balanced human intervention and technology automation with fitting logistics.

Physicians' administrative tasks, non-clinical responsibilities, and thus their burden has been rising for decades. However, The ICD-11, despite having been claimed as a "User-friendly" administrative task for medical practice checklists, forces the users to collect and document only required by the administrators of the coding system.

Medical practices and physicians must contribute more valuable time to comply with the ICD-11 coding system. They must also upgrade their system, employ new staff, or train the existing workforce to address the new systems' requirements.

References

  1. Understanding Quality Measurement | Agency for Healthcare Research and Quality. "Understanding Quality Measurement | Agency for Healthcare Research and Quality." www.ahrq.gov. Accessed August 22, 2022. https://www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/understand/index.html.
  2. International Classification of Diseases (ICD). "International Classification of Diseases (ICD)." www.who.int, February 11, 2022. https://www.who.int/standards/classifications/classification-of-diseases.
  3. Practolytics. "Impending ICD-11 Changes, What Your Practice Should Be Prepared For?" practolytics.com, October 14, 2001. https://practolytics.com/blog/impending-icd-11-changes-what-your-practice-should-be-prepared/.
  4. ICD10monitor National Correspondent Stephanie Thompson. "Coding's Role in the MACRA Quality Payment Program — ICD10monitor." ICD10monitor. icd10monitor.com, November 15, 2016. https://icd10monitor.com/coding-s-role-in-the-macra-quality-payment-program/.
  5. Chaplain, Stacy. "ICD's Continued Evolution and Impending Transition to ICD-11: Part 2 — AAPC Knowledge Center." AAPC Knowledge Center. www.aapc.com, July 31, 2020. https://www.aapc.com/blog/51244-icds-continued-evolution-and-the-impending-transition-to-icd-11-part-2/.

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