In January 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, which cannot support upcoming health system and care delivery needs. ICD-10-CM/PCS intends 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.
Why the Transition to ICD-10?
ICD-10 addresses prior coding space issues and lack of detail; includes mortality reporting and biosurveillance related information, and addresses prior space limitations and workaround impacts. Expected data benefits include:
- Better information on inpatient hospital procedures and diagnoses;
- Improved Medicaid and commercial payer functions; program and payment design, including improved risk adjustment and payment accuracy;
- Improved design of benefit packages and use of quality measures;
- Increased visibility when evaluating co-morbidities and treatment patterns;
- Improved disease management planning and care management;
- Better understanding of population health conditions and healthcare outcomes;
- Improved data for fraud and abuse monitoring;
- Consistent approach to disease monitoring and reporting world-wide.
What are the major hurdles to overcome in implementing ICD-10 for Healthcare Payers?
In short - cost, timing and complexity. HHS estimates that converting payer systems will be the substantially largest cost. While the federal compliance date has been extended to 2015, the complexity and time commitment necessary for a successful implementation are daunting, given the possible code combinations, mapping and cross-walking to ICD-9 codes, technology improvements and modifications, and necessary personnel training.
Navigant’s Healthcare team assists payers, plans and providers with the design and development of HIT requirements, including federal and state healthcare reform mandates for change. For example, we conducted an independent readiness review for Providence Health of Southern California, based on their preliminary transition to ICD-10 and HIPAA 5010 transaction and coding compliance. Our team interviewed health system staff, IT and service vendors, and payers to evaluate Providence’s readiness and testing plans; we also implemented an online management survey to identify other systems and implementations affected by ICD-10 change. We submitted a report, budget forecast and timeline to meet compliance, and assessment recommendations to Providence executives, to enable their next transition stage.
Our expertise differs from our competitors, as we provide core competencies to our clients in the areas of reform and program design, reimbursement methodology development, regulatory compliance readiness and payment transformation. This allows us to serve our clients with additional context and expertise, and provide a greater return on investment.
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