Effective Oct. 1, 2013, the HIPAA-covered healthcare world will officially and completely transition from ICD-9-CM codes to ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) codes. Daryl Dickhudt, a principal in the Healthcare Group at Falls Church, Va.-based Computer Sciences Corp. (CSC), spoke about issues related to ICD-10 implementation at this month's America's Health Insurance Plans conference. Dickhudt has shared with FierceHealthPayer three key "takeaways" from his presentation that health plans (and providers) need to know to prepare for the change that the 2013 deadline will bring:
Takeaway No. 1: Don't expect immediate business benefits. "The business benefits for ICD-10 will occur over time as payers and providers learn the new language of ICD-10," said Dickhudt. To set the stage to achieve those benefits, payers should "engage with providers to understand their timelines and plans for ICD-10 compliance," he said. In addition, "with 5010 external trading partner testing, [payers should] receive ICD-10 codes as part of the testing process to observe which ICD-10 codes are most likely to occur on Oct. 1, 2013. Finally, payers should "conduct analysis on their current claims history to identify the high-volume, high-frequency, high-dollar amount diagnosis codes and procedure codes submitted today," he added.
Takeaway No. 2: Prepare for concurrent ICD-9/ICD-10 processing. "Given the expected transition period, payers and providers will most likely need to process ICD-9 or ICD-10 codes concurrently," advised Dickhudt. "Begin with the Centers for Medicare and Medicaid Services' (CMS) General Equivalence Mappings (GEMS) and Reimbursement Mappings from ICD-9 to ICD-10 and vice versa. Determine whether or not a crosswalk is required based on your organization's business requirements. Then investigate the crosswalk options available in the marketplace and determine the best fit."
Takeaway #3: Create a migration plan for the upgrade and testing of applications to be remediated for ICD-10. "A solid migration plan and well-coordinated approach will be critical given the number of applications that need to be remediated for ICD-10," said Dickhudt. This migration plan "will be a key component of the ICD-10 roadmap for payers and providers," he noted. As part of the plan, Dickhudt recommended that payers and providers do the following: "(1) Evaluate vendor and internal approaches to ICD-10 compliance to align with the enterprise migration approach. (2) Obtain commitments and schedules from vendor resources and internal resources. (3) Use a scheduled release approach to minimize the impact of timing gaps and schedule conflicts. (4) Identify gaps and develop contingency plans for resources and commitment challenges."