On Oct. 1, 2013, if your hospital has not completed the required changes to implement the ICD-10 coding system, payments for all services provided after that date will stop. The consequences for not meeting this deadline include billing backlogs, cash-flow delays, increased claim rejections and denials, unintended shifts in payment and costly back-end work to correct problems. The ICD-10 codes are key foundational components to develop future initiatives such as refining reimbursement models, implementing value-based purchasing, identifying and reporting health care-acquired conditions, preventing readmissions and analyzing and reporting data indicators to help improve the quality of care and patient safety. Not including ICD-10 in your electronic health record plans will result in expensive retrofitting later.
The migration to a new version of the clinical codes used for hospital reimbursement, quality and patient safety reporting has been discussed for more than 20 years. National and international experts determined that the health care of the future required a more robust coding system. That future required the ability to keep expanding the codes to identify new medical conditions and, more importantly, the ability to recognize innovations in medical technology that would one day reshape the way health care is delivered. And of course, that coding system would need to be precise enough and granular enough to distinguish new technologies in order to appropriately recognize them for payment and comparative analysis. There are several other benefits to providers as well, including the decreased need to include supporting documentation with claims, data for improved disease management to prevent readmissions, and better administrative data to evaluate medical processes and outcomes.
The final rule for ICD-10 implementation provided a nearly five-year implementation time frame. This is not merely about educating your coders; nor, is it strictly an IT project, although there are significant information system issues. The change to ICD-10 requires careful coordination across the entire hospital and involves a re-evaluation of your clinical, financial and administrative work processes, which is why strategic planning and executive sponsorship are critical for success.
So where should your hospital be at this point? You should have at least started, if not completed, the following tasks:
- Identify an ICD-10 executive champion
- Convene an ICD-10 interdisciplinary team and identify a team leader
- Conduct a systems inventory and a gap analysis to identify systems (and their corresponding vendors) affected
- Conduct staff awareness sessions
- Assess and plan for staff training needs
- Map how ICD-10 fits into your other health IT projects
- Evaluate health plan contract implications
These activities will help you define the magnitude of the work effort and leave you in great shape to implement the required changes in the next couple of years. Keeping ICD-10 on your radar for the coming months will allow your hospital to meet the October 2013 deadline successfully.
For additional information and other tools to assist you in the implementation, please visit www.ahacentraloffice.org.