It will take a minimum of two years for the transition from ICD-9 to ICD-10 to have a considerable impact on Medicare inpatient Medicare Severity-Diagnosis Associated Groups (MS-DRG) hospital payments.
That is the conclusion of latest research published in the Journal of the American Health Information Management Association (AHIMA).
“The changeover from the ICD-9 version of the MS-DRGs to the ICD-10 version of the MS-DRGs will have a least impact on aggregate payments to hospitals (-0.04 of a percent) and on the circulation of payments across hospital types (-0.01 to -0.06 of a percent),” the study’s authors write. “Although the transition from the ICD-9 version of the MS-DRGs to the ICD-10 version resulted in 1.07 percent of the patients being assigned to different MS-DRGs, overall payment will increase and decrease due to a modification in MS-DRG assignment essentially net out.”
The essential leveling of payments is probable because the new ICD-10 MS-DRG’s are a replication of the ICD-9 version, the authors said.
“Since there is no significant database of records coded in ICD-10 accessible, there is no way of recalibrating the MS-DRG payment weights to resemble to ICD-10 optimized MS-DRGs. Hence the MS-DRGs cannot take full advantage of ICD-10 till there is sufficient ICD-10 data available to allow the recalculation of the MS-DRG payment weights.”
However, the authors, from 3M Health Information Systems, also said the relative status quo should not be assumed to be long-lasting—as additional ICD-10 data is fashioned, recalibration of payments using the more granular ICD-10 codes will be easier to achieve.
“Realistically, the earliest an ICD-10 optimized version of MS-DRGs can be enforced is FY2018. This means that there will be two years of ICD-10 coded data available before an ICD-10 optimized version of the MS-DRGs is realized,” they wrote.
The delay, they resist, can afford the evaluation of changes in coding practices between the two ICD versions, thereby minimizing opportunities for up-coding in the new optimized ICD-10 MS-DRGs.
The authors created a virtual ICD-10 database using 2013 Medicare Provider Analysis and Review data to empower their investigation.
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