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The healthcare Industry as a whole is currently weighing its options after the recent announcement by Health and Human Services Secretary, Kathleen Sebelius that the federal government may extend the October 2013 ICD-10 implementation deadline.
As of right now, no one knows what the time frame for the extension would be or who would be exempt from the exception. In addition, ICD-11 is fast approaching and expected to be implemented around 2015, just a year away if the industry were granted a one-year extension for ICD-10. This begs the question, if companies delay ICD-10 implementations now, how will they be ready for ICD-11? There are multiple options to weigh, which I will discuss in this blog post.
Let’s look at some key areas that will benefit from implementing ICD-10 right now:
1. Existing Capability with 5010: Because the 5010 implementation has been completed already and the transactions are now ready to accept ICD-10 codes, it would be easier to implement ICD-10 data collection capabilities within the front end claims processing to enable submission of ICD-9 or ICD-10 data. Payers can also test with new edits for ICD-10 codes to identify claims that could be rejected later in the process thereby costing more to adjudicate.
2. Phased Migration to ICD-10: Moving from ICD-9 to ICD-10 is less complex than going from ICD-9 to ICD-11. Migrating to ICD-10 is a natural progression and would enable Payers to capture required historical information that might not be available if we went to ICD-11 directly. Also, the time extension allows Payers to implement a phased approach thereby allowing ample time in between migrations from partial to full remediation.
3. Reimbursement Based on ICD-10: ICD-10 is intended to help Payers save millions of dollars every year that would otherwise have been wasted due to improper coding and payment due to lack of sufficient data and better utilization of resources for the right procedures.
4. ICD-10 Training: ICD-10 implementation will enable Payers with ample time to train their employees before the actual mandate. Without this training, the ICD-11 transition will be more complex and confusing.
5. Data Collection & Analytics: Implementing ICD-10 prior to ICD-11 will allow for the much-needed revamp of the in-house data structures. Most of these are already undergoing changes due to various other mandates. This will provide Payers with insight into the various benefits of having ICD-10 data.
Apart from the above benefits, ICD-10 implementation will help improve customer confidence and thereby enhance the business due to lowered cost in premiums. At the same time, Providers will also benefit from more accurate payments and less rejections and delays.
Baskar Mohan is director healthcare practice at Virtusa, an IT consutling and outsourcing services vendor.