ICD-10 - is there sufficient time for integration?
ICD-10 migration can be broken down into the following phases, with 2 integration milestones.
• Phase-1: Internal system remediation, including updating benefit rules that are coded deep into the home-grown adjudication systems
• Phase-2: Vendor product upgrades, including core benefit systems in some cases, and fraud detection and grouper/pricer software in most cases
• Phase-3: Integration between phases 1 and 2, and testing of transactions end-to-end within the payer environment
• Phase-4: Trading partner upgrades. This will include communication of the new/updated rules with trading partners.
• Phase-5: Integration with trading partners and testing transactions end-to-end in a real production like environment
Product vendors are working aggressively to make their ICD-10 compliant products available as soon as they can. But some vendors have stated that their products are going to be ready in 2013! Payers will need at least 3 - 6 months to conduct integration and testing within their environment. Assuming that the vendors are ready in early 2013, payers will have less than 4 months to test with providers!
May be I'm overcomplicating things. After all HIPAA and NPI implementations required product upgrades and trading partner testing and the industry seems to have managed these implementations without many issues. Also, the industry looks to be on time for 5010 implementation as well. But then, these implementations didn't require as invasive changes to payer internal systems as ICD-10 does, so a new integration need has emerged that wasn't as important in case of NPI or HIPAA.
Comments
Hi Vijay,
It's intresting that you brought subject of tardiness regarding ICD10 Implementation.
It seems that payers have simply decided to ignore the advice that ICD10 should not be looked simply as regulation adherence,but early adaption of ICD10 does have some significant strategic advantage.
Posted by: Apoorva Patel | January 10, 2011 1:33 PM