What will the ICD-10 transition involve?

Timeline
The implementation date for ICD-10 is October 1, 2013, and applies to all encounters and discharges occurring on or after that date. According to data from AHIMMS, one entity cannot force another entity to be compliant prior to the said date, although testing will require a great deal of communication between providers, suppliers, and insurers. HHS believes that this implementation date timeline allows an adequate time frame for both providers and insurers.

Cost of the Transition
HHS estimates the transition will cost the industry (including providers, suppliers, payers, and software firms) approximately $1,878.68 million. As a ROI, over the next 15 years the estimated benefits will be $4,539.63 million. One of the largest costs of the ICD-10 implementation is the revisions required to payer systems. This is greater for those payers who have more than one core system. These systems will need to identify applications that use or are dependent on ICD-9 codes and change methodologies defined. Initial observation identifies benefits, claims processing, provider contracts, fee schedules, authorizations, and referrals as well as HIPAA transactions. Although different systems may have other dependencies not herein identified.

Requirements
Health Systems will need to be upgraded to handle the new character requirements, they must implement HIPPA 5010, and they will need to access both ICD-9 and ICD-10 codes for a period of two years as the country makes the transition.

Transition Aids
General Equivalency Mappings (GEMs) were developed by CMS and the CDC to translate from ICD-9 to ICD-10 and vice versa. These mappings and crosswalks will be critical, since the differences in ICD-9 and ICD-10 do not allow for a one to one mapping. While in some instances there is a one-to-one match from an ICD-9 code to an ICD-10 code, most of the ICD-9 codes translate to several ICD-10 codes. Once ICD-10 is implemented, a committee will discuss the need to continue updating these mappings for a minimum of three years after the final compliance date. Modified code sets will include instructions on how data elements of health information encoded prior to the modification may be translated to preserve the informational value of the element that existed before the modification. Any modification to a code set will be implemented in a manner that minimizes the disruption and cost of complying with the modification.

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.