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The health care industry is preparing for monumental changes as it transitions toward implementing the International Classification of Diseases, Tenth Revision, also known as ICD-10. Simultaneously, the industry is transitioning toward the HIPAA 5010 transaction standard to support electronic transactions. Combined, these changes will impact every aspect of your organization’s revenue or payment cycle. The federal government requires that the transition take effect October 1, 2013.
Why Change to ICD-10?
Upgrading to ICD-10 will provide better data for measuring health care service quality, safety, and the efficacy of care by allowing clinical IT systems to record far more specific and rich diagnostic information. For example, the complete ICD-10 code set contains more than 155,000 codes, compared to only 17,000 in the ICD-9 set. Because the additional codes can accommodate a host of new diagnosis and procedures, ICD-10 will help to enable the implementation of electronic health records by providing more detail for electronic transactions and will help boost efficiencies by helping to identify specific health conditions.
While the code set change brings benefits, it also brings challenges. Many organizations worry they may not be able to prepare for the change in time or if they will be able to afford the high cost of switching IT systems.
What Are ICD-10’s Challenges?
Electronic Transaction Software Updates
In order for a successful transition to occur, CMS set an adoption date of January 1, 2012 for adoption of the HIPAA 5010 transaction standards. That means that in less than three years, providers will need to have electronic transaction software that can handle the upgrade. The same is true for systems that currently utilize ICD-9 codes. Before physicians, hospitals, and others can use the new code sets, they must upgrade their electronic systems to be compatible.
Implementation Costs
Due to the complexity of moving to these new code sets, the total cost of the switch is estimated in the billions of dollars. Being unprepared could cause severe work disruptions as well as delayed payments, lost payments, or overpayments—which only add to the overall cost.
Preparation Timing
Take the likely progression of ICD-10 seriously. Being prepared can significantly improve how your organization fares during this transition by minimizing the financial and productivity impacts in the first years of implementation. The organizations that will realize benefits more quickly from the more precise and comprehensive coding systems are those that plan ahead and use innovative technology.
How Can you Prepare for ICD-10?
The timeline is tight, but Ingenix can help you establish your individual implementation plan and successfully transition with products for both the Clinical Modification (CM) and Procedure Coding System (PCS).
Take Proactive Steps
Become familiar with the new code sets, even in their proposed form; Ingenix provides two books that preview the structure and conventions of ICD-10. The basics of coding will remain the same but coders will need to learn new terminology and specificity of body parts. As a result, organizations need to educate regarding clinical documentation issues so that coders understand the challenges for translating medical record information into the appropriate codes. Finally, plan your navigation between the old and new codes. Ingenix is creating mapping tools that will offer code possibilities based on the information provided and the use of coding data.
Trust Ingenix to Help You Make a Successful ICD-10 Transition
ICD-10 presents a learning curve, but with adequate process and systems preparation, stakeholders will have enough time to overcome the challenges. As a trusted source for coding information, Ingenix can help you navigate through this important change. We have been educating the industry on ICD-10 for nearly ten years—since it was an accepted standard by CMS. Our team of experts provides education, services, and analytics for ICD-10 to help you:
- Understand the conversion with insightful consultations
- Develop migration roadmaps
- Assess vendor readiness
- Analyze systems integration capabilities
- Provide ICD-10 training and education
Our experience speaks for itself: more than 250,000 physicians, 3,000 hospitals, and nearly 1,000 payers trust Ingenix for coding and compliance data and references. We employ industry experts who have been supporting code-based reimbursement for more than 25 years. By serving hospitals, physicians, and payers, we understand coding in the health care industry and offer the expertise and knowledge you need to navigate this transition with ease.
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