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November 5, 2012

ICD-10 is Inevitable but so are its Benefits

Posted by Eric Paternoster (View Profile | View All Posts) at 4:48 AM

The US presidential campaign is in full swing and we've entered the final stretch leading up to election day.  The economy is a central topic with taxes front and center.  Regardless of which side you're on, each candidate has his own plan for reforming the tax code to alleviate the burden on the middle class and jump-start the economy.  The final outcome for tax reform may still be up in the air, but an equally transformative change in healthcare is certain to happen with ICD-10 adoption, healthcare's equivalent of the tax code in terms of its complexity.  And while the candidates argue over who benefits with their tax plans, smart adoption of ICD-10 can lead to more efficient, effective and higher quality healthcare for everyone.

For the uninitiated, the International Classification of Diseases, tenth revision (ICD-10) defines the codes for diagnosis and reporting which US healthcare payers and providers must comply with by October 2014.  Simple enough in concept, but the transition from the current ICD-9 will add more than 50,000 new diagnostic codes and 67,000 new reporting codes!  The magnitude of this change brings obvious challenges in understanding the impact of compliance, completing upgrades, training users and managing the transition in a timely manner.

ICD-10 changes should be viewed as an opportunity to deliver benefits and not as a compliance mandate.  The additional granularity in coding can result in fewer rejected claims for payers with more efficient billing and reimbursement processes.  Expanded clinical codes will enable providers to enhance disease and case management.  The application of analytics will help identify complications associated with treatments that can improve the quality of patient care.

ICD-10 implementation can be the forcing function that drives transformation.  Compliance provides an opportunity to adopt best practices and implement solutions that bring alignment around the organization's long term business strategy and technologies.  Organizations that have been successful in deploying ICD-10 consider the full transition lifecycle covering assessment, planning, remediation, testing, training with analytics and support.

Healthcare providers and payers making the transition should be looking at providers with deep domain expertise who can provide end-to-end services to ensure fast track compliance and without impacting revenues or cash flow.  Consulting services establish a migration plan that addresses interdependencies needed to align different initiative and accelerate overall remediation.  An integrated product suite that's modularized to support transition from ICD-10 can accelerate transition in a cost effective manner and ensure revenue neutrality. Last, a solution provider should be able to deliver data analytics capabilities that lead to improved patient care.

ICD-10 transition may be inevitable and painful, but there's plenty of opportunities to be uncovered that will improve patient care... and that's certainly worth the pain!

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