February 2009 | www.healthmgttech.com | Issue 2
	ICD-10: No Need to Panic — No Reason to Procrastinate

By Kenneth Bradley

After hovering outside the door for years, ICD-10 has suddenly appeared like an unwelcome guest and ensconced itself in your waiting room. On Jan. 15, 2009, the Department of Health and Human Services (HHS) issued a final rule setting Oct. 1, 2013, as the deadline for ICD-10 implementation. Simultaneously, it announced a final ruling to adopt the X12 standard Version 5010 for HIPAA-covered electronic transactions, which includes claims, remittance advice, and eligibility inquires and referral authorizations, along with prescriptions (Version D.0), which is due to take effect almost two years earlier on Jan. 1, 2012.

Since the announcement, opinions expressed by healthcare thought leaders appear to fall into one of two categories. Many — perhaps most — are taking a “the sky is falling!” approach, while others maintain a “don’t worry; be happy!” attitude. The proper response probably should fall somewhere in between. Certainly, there is no need to shift into crisis mode. We have, after all, known that ICD-10 was coming for many years. At the same time, a laissez faire outlook is inappropriate, because the transition is significant enough to require preparation well in advance. ICD-9 (the current diagnosis code set) offers about 17,000 codes, according to HHS. ICD-10, on the other hand, contains 155,000 www.hhs.gov/news/press/2009pres/01/20090115e.html. There is plenty of good news surrounding ICD-10 to consider. Healthcare providers are united by a common mission: improving patient care and outcomes. The new diagnosis code set offers greater specificity, providing caregivers with a concise picture of the signs and symptoms, conditions or diseases affecting their patients. They also can share this information with colleagues across the hall and around the world, to provide a global view of healthcare trends and concerns.

In addition, ICD-10 may streamline efforts to comply with pay-for-performance initiatives because reporting requirements may be more focused and easier to identify. It may likewise arm providers with greater detail about patients’ conditions, which could help organizations negotiate higher rates with payers since it will be easier to justify why specific procedures take more time and effort.

Nor is the new standard for electronic transactions something to fear. While it may appear daunting, it truly is not as big a change as some anticipate. Version 5010 relies on the same data structure as its predecessor platforms, 4010 and 4010A1. The new standard has been scaled up to accommodate the larger volume of codes and, in large part, is focused simply on enhancing content.

In short, there is no need to panic — but also no reason to procrastinate either. ICD-10 codes are already available, so providers can begin preparing for the conversion immediately. Doing so reduces the staffing stress and financial strain, a significant consideration in these times of economic instability.

To get started, here are several factors to take into account as practices prepare for ICD-10:

Begin to create an inventory of all documents that contain diagnosis coding information: These may include — but certainly aren’t limited to — superbills, reports and fee schedules, and practice management and electronic medical records software. The conversion will affect all of these items and they will need to be revised.

Begin to develop a budget to help manage the cost of the conversion: Industry experts estimate that the final bill may range from $1 to $14 billion in aggregate costs. Among the expenses organizations might incur are technology upgrades, software purchases and staff training, and the re-assessment and revision of internal policies and procedures. These activities all require an investment of time and money; and, since the Version 5010 is only about 18 months away, these costs will need to be included in forthcoming budget calculations.

Begin to assess the best approach for training staff: ICD-10 should not be totally foreign, since healthcare organizations currently use it for morbidity and mortality reports. Nonetheless, the conversion will affect providers, clinical staff, billers and front-desk personnel. Practices will need to plan when and where to conduct training, as well as how the new information will be delivered — through software training packages, for instance, or by professional trainers who either come onsite or conduct sessions at remote locations.

At the same time, healthcare providers should ensure their partners also are preparing for the new transaction standards and ICD-10. It is entirely appropriate to question practice management and electronic medical records vendors, payers and clearinghouses, as well as revenue cycle management companies about their plans. These entities must also be ready (should be able to assure their customers) about the plans they are making and steps they are taking to meet the HHS deadlines. In addition, best-of-class partners will come forward and provide assistance to ease the impact of conversion.

There can be no doubt that ICD-10 is here to stay. But, by allocating a reasonable level of resources over a reasonable period of time, providers can avoid a crisis situation and increase the likelihood of a smooth transition.

Kenneth Bradley is vice president of Transaction and Interface Development for Navicure Inc., an Atlanta-based provider of automated, Web-based claims management solutions for physician practices and hospitals. Contact him at kbradley@NAVICURE.com.

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