Benefits of ICD-10 in Casualty Claims

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

Guest post by Michele Hibbert-Iacobacci, vice president, Mitchell International.

The casualty claim arena involves evaluating and payment of claims for claimants who have suffered from an auto accident or workers’ compensation injury. This side of the health payment continuum has been omitted from the Health Insurance Portability and Accountability Act (HIPAA) as a covered entity.

This means that casualty claim insurers are not required to abide by the standards set forth in HIPAA and that these standards only apply to the health payer. Omitting the ICD-10 in casualty claims from standards does have merit, but when it comes to standardization, all health claims should be adjudicated and paid in the same manner. Why should a provider charge differently and be paid differently when the payer of the claim is not on the health side? This is a question many casualty payers ask and not being part of the standardization only raises the question more.

There is no option for submission of claims by the covered entity to not be compliant by October 1, 2014 with the International Classification of Diseases, 10 Revision (ICD-10). Why is it a good idea to omit the casualty payer from these standards if the majority of health payments are made using this new standard? In addition, if providers are covered entities, then why would the casualty payer not speak the same code language? It’s almost like trying to communicate in a foreign country without the benefit of knowing the language.

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