Embracing ICD-10 In Healthcare

The Centers for Medicare & Medicaid Services (CMS) has published the final rule adopting ICD-10-CM and ICD-10-PCS as medical data code sets under HIPAA, replacing ICD-9-CM. Now, U.S. healthcare organizations – including government and commercial payers and providers – must prepare to meet the demands of ICD-10. Coming alongside healthcare reform, economic pressures and introduction of new technologies, ICD-10 will help force decisions about systems modernization and replacement, vendor relationships and business strategies.

Although the extended ICD-10 compliance date of October 1, 2013 may give some payers temporary relief, if payers delay, they may find themselves pressed for time to implement the required changes. EDS, an HP company, believes this extended deadline provides payers with adequate time to plan for and optimize ICD-10 in their business processes and operations if they start soon.

The Basics of ICD-10

The Internal Classification of Diseases (ICD) is the international standard diagnostic classification for many health management purposes. ICD-10 provides a common approach to the classification of diseases and other health problems. It supports the efficient storage and retrieval of diagnostic information for clinical and epidemiological uses. ICD-10 also supports more effective compilation of national mortality and morbidity statistics than previous versions.

Compared to the previous U.S. ICD-9 coding system adopted three decades ago, ICD-10 utilizes expanded coding fields and substantially expanded coding choices. The expansion in the number of the codes is due primarily to added layers of clinical and administrative detail, but room for entirely new codes to describe modern medical treatment is also an important purpose of the new structure.

The complexity of today's technology and software environment in many payer and provider organizations has accelerated significantly even since the Y2K remediation effort. This complexity and automation of today's environment will increase the effort required for minimal compliance. Effective adoption, meaning the consideration of modernization and replacement strategies in addition to systems remediation, and the assessment and adoption of revised and new business operations to maximize the value and mitigate the transition risk in ICD-10, will require even more planning and resources.

Where Should Payers Focus Their Attention?

Payers can maximize their probability of success and minimize risk and disruption by laying the proper groundwork for a multiyear strategy. We believe that this groundwork should consist of the following components:

• Action plan – An overall governance structure necessary to manage change, budgets, priorities and risks
• Business process teams – The establishment of teams to focus on specific areas of business activity within the payer organization
• Risk mitigation – The strategy and approach to anticipate, rate and respond to perceived operational, legal and fiscal threats
• Optimization strategy – A plan to accelerate strategic objectives and business improvements with the investments ICD-10 compliance will require

EDS and ICD-10

In keeping with the recommendations outlined in this paper, EDS has launched a range of activities designed to prepare itself, and its clients, for the coming ICD-10 transition. EDS began those preparations by creating a governing committee to oversee the implementation of ICD-10. This approach provides the structure needed to support EDS clients, to coordinate across federal, state and commercial payers, and to provide a forum for information exchange and best practices.

Just as importantly, EDS is implementing ICD-10 changes to our own healthcare claims processing and care management products. That real-world experience enables us to understand the nuts and bolts of ICD-10 compliance and apply those lessons to commercial and government payer environments.

EDS has vast experience in the healthcare industry and a healthcare administration portfolio – MetaVance, interChange and Atlantes – that will yield fully compliant, flexible solutions payers can deploy to support their enterprise. We believe that by gaining an enterprisewide view of ICD-10 and its effects, payers can correctly position their organizations for ICD-10, allocate resources more efficiently and over a longer time frame, and gain immediate and long-term benefits from this new classification structure.

By partnering with allies like EDS who understand the intricacies of the payer business model and the complex demands of ICD-10 adoption, healthcare organizations can optimize the value and minimize the risks of this important transition.