ICD-10 and HIPAA 5010
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating the adoption of ICD-10-CM/PCS as a replacement for the 30-year old ICD-9-CM code set. The ICD-9-CM code set is no longer able to support today’s health information needs. ICD-10-CM/PCS is intended to better capture information about the complexity of healthcare and its delivery systems. This new regulation and its compliance are expected to be larger in scope and cost to providers than the implementation of HIPAA. On January 1, 2012 the United States will transition from version 4010A1 to 5010 and from NCPDP 5.1 to D.0. One of the main purposes for the conversion to v5010 is to accommodate the use of ICD-10 codes.
Competitive Advantage
ICD-10-CM/PCS compliance will require a dedicated effort, careful planning and coordination of resources by providers. The window of opportunity to prepare for the transition to ICD-10-CM/PCS will close quickly. However, with proper forecasting and planning, healthcare providers can transform a government regulation into a competitive advantage. It is imperative that your implementation planning sessions start today. Conversion to v5010 allows for ICD-10 implementation by increasing the field size for ICD codes and adding a field for an indicator to differentiate ICD-9 from ICD-10.
Challenges for Healthcare Providers:
- Cost: HHS anticipates the estimated impact of the ICD-10-CM/PCS transition costs on providers, suppliers, payers and software and system design firms is $1,878.68 million which includes coding professional training costs, productivity losses during transition and vendor, payer and provider system changes.
- Timing: January 1, 2012 the United States will transition from version 4010A1 to 5010. HHS has announced a compliance date of October 1, 2013 for adoption of the ICD-10-CM/PCS code sets. The October 1, 2013 deadline was established as a result of the complexity and time commitment required to successfully implement the ICD-10-CM/PCS code sets across all segments of the healthcare industry.
Services
Navigant is uniquely qualified not only to provide guidance on ICD-10-CM/PCS and HIPAA v5010, but also to recommend solutions and to aid our clients in the implementa¬tion of those solutions. Our professionals have practical, real-world program, process and performance improvement experience including compliance, clinical, revenue cycle and coding, as well as clinical credentials and AHIMA certified ICD-10-CM/PCS trainers.
Approach
Navigant Consulting has developed an approach to assist organizations with managing the preparedness phase of the ICD-10 and HIPAA v5010 transformation with an organizational preparedness assessment to specifically identify and index all people, processes and systems that will be impacted by these conversions.
Navigant’s ICD-10/HIPAA v5010 Preparedness approach includes the following:
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Phase 1 – Assessment and Planning
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Phase 2 – Implementation Strategy
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Phase 3 – Impact Analysis
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Phase 4 – Implementation Roadmap
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Phase 5 – Executive Presentation
Following the Preparedness Assessment, Navigant will provide a report and strategic work plan that will be the foundation for the overall strategy for the implementation and education plan for the migration to ICD-10-CM/PCS and HIPAA v5010. This report will provide a roadmap for your organization to build upon for achieving the desired results for the ICD-10 and HIPAA v5010 conversion.
A list of our ICD-10-CM/PCS and HIPAA v5010 service offerings is as follows:
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HIPAA v5010 GAP Analysis
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ICD-10 Preparedness Assessment
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CDI-10 Documentation Integration Program
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ICD-10 Clinical Documentation Gap Analysis Audit
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ICD-10 Physician Practice Clinical Documentation Education Program
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CDI-10 EMR Clinical Documentation Improvement Design
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Clinical Documentation Improvement Program
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Contract Management Readiness
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Various other Professional Mitigation Services
See Navigant's Health System Performance Improvement services.