A major U.S. medical billing standards change seems to be causing some problems for hospitals, but the effects on overall financial performance have been limited.
Analysts at Crowe Horwath LLP, a Chicago-based accounting firm, have given that assessment in a report based on the performance of 597 hospitals in the company’s hospital performance database.
The Centers for Medicare & Medicaid Services began requiring all health care providers covered by the Health Insurance Portability and Accountability Act of 1996 to shift to use of the ICD-10-CM diagnostic code set Oct. 1, 2015.
Complaints from insurers about the diagnostic codes on inpatient hospital bills spiked in late 2015, after providers switched to the new code set, from the old ICD-9-CM code set, but the code problem rate fell back down close to the 2015 level in January, according to Crowe Horwath data.
Insurer claim denial rates have been a little lower since Oct. 1 than they were before the ICD-10-CM switch data, the analysts say.
But the analysts say the average number of days an inpatient hospital bill spent in “discharged and not final-billed status” was about 6.2 percent higher in February and March this year than it was in February and March in 2015.
In March, inpatient hospital bills were spending an average of about 7.5 days in not-final-billed status, the analysts say.
The analysts did not look at how the diagnostic code shift has affected physicians or other nonhospital providers.
U.S. health care providers began using the old ICD-9-CM diagnostic code set — the U.S clinical modification of the ninth revision of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems — in 1979.