ICD-10 upgrade: what to expect from vendors

It is fascinating, and often unsettling to speak with healthcare organizations and hear the variance as to how physician practices and large-group multi-specialty groups are approaching their ICD-10 conversion. While most organizations recognize the enormity of ICD-10, there are significant differences in their understanding of what specifically they need to do internally to prepare for and convert to ICD-10. 

With the ICD-10 deadline approaching, we often hear from clients who are sitting back and letting their information technology (IT) vendors take the lead in their ICD-10 conversion process. After all, 5010 was largely an IT effort, correct? While many are waiting for IT partners to inform them of their ICD-10 compliance plans, it is essential to realize that ICD-10 is much broader than an IT project. ICD-10 will impact every asset within your organization used to document, bill and collect for healthcare services. 

Unlike the 5010 upgrade — which involved primarily technical issues — ICD-10 will impact every clinical and administrative aspect of healthcare. Its finer detail will support and improve data on medical outcomes and allow a deeper understanding of individual and public health. It will also support changing reimbursement methodologies based on performance and outcomes. Given this broad scope, it’s not surprising that ICD-10 will affect clinical workflow, practice management systems, electronic health records, coding processes, billing, provider contracts, payer protocols, business intelligence and all interfacing systems.

IT vendors will play a pivotal role in providing technology to support ICD-10: however healthcare organizations must take ownership of their ICD-10 conversion as the impact extends well beyond IT.

The first step in your planning for ICD-10 should be to complete an impact assessment to identify the risks by your various functional areas including clinical operations, revenue cycle, IT, reporting and training. The impact assessment ensures that your ICD-10 conversion project plan will be developed in an integrated fashion.

Step 1: an internal assessment
As for clearinghouses and other trading partners, many have ICD-10 upgrade strategies in place, some more realistic than others. But again, it’s a mistake to rely on them. The most effective approach for provider organizations is to understand what ICD-10 migration will involve in terms of hardware/software upgrades, projected costs, testing schedules and training processes — now. It’s the only way 2012 budgets will reflect the time, money and resources to upgrade.

The first step in managing migration is an internal impact assessment to explore workflow, training, IT and financial implications of ICD-10 compliance. Designate someone in your organization to become ICD-10 accredited, conduct the impact study, shepherd you through the migration process and push vendors for accountability. If you don’t have the in-house resources, consider hiring a consultant.

Part of your impact assessment should be to engage vendors in formal discussions — documented in writing — to determine schedules for upgrades, format changes and testing prior to the ICD-10 go-live date. Your internal migration expert should identify individuals in authority who can be held accountable to commitments made on the part of each trading partner. If you’re considering upgrading software, hardware, vendors or operating systems, this is also the time to get input from vendors, consider what new trading partners will support and budget accordingly.

Transition won’t be easy
ICD-10 diagnostic codes will capture significantly more specifics than ICD-9. A broken left arm diagnosis will become a simple fracture of the left ulna, six inches from the wrist, caused by a fall. This level of detail will yield the granular data to support evidence-based medicine and more positive outcomes in the long term. It will also involve adjustments to every clinical, claim and report template, and facilitate more accurate coding, billing and reimbursement.

Transitioning to ICD-10 won’t be easy — especially in the current economic climate — but it is necessary and long overdue. If you’re bracing for this momentous change, the first move is yours and the time to make it is now. Those that procrastinate will find their organizations — and their communities — missing out on ICD-10’s far-reaching benefits to public health, quality care and more efficient performance.

Brad Boyd is a vice president at Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.

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