A change is coming in the language of health care. Now that the Department of Health and Human Services (HHS) has established ICD-10 as the new national coding standard, healthcare facilities, providers, and payers will be in a better position to meet the growing information demands of todays complex health payment environment.

With the ICD-10 start date set for October 1, 2013, why be concerned now when implementation of the new coding standard is still four years away?

For healthcare facilities, ICD-10 means an overhaul of information processes from the time patients are scheduled for an appointment to the moment the claim closes. To ensure a successful transition, healthcare organizations should have a carefully designed transition plan that addresses the new systems implications for timely reimbursement, information technology, decision support, quality and compliance reporting, staffing, and training.


This presentation will offer a framework for a successful transition that describes how to:

Process map the flow of data across functions and departments, from the time coded data is created or enters the facility to final billing and reconciliation of remittance advice.
Identify every departmental system that requires updating to hold ICD-10 codes and be interfaced to ensure the flow of information across departments
Assess documentation and coding gaps by analyzing your facilitys top 50 diagnoses. Focus physician education on problem areas first since poor documentation for high-volume services represents the greatest potential risk to revenue.
Determine which staff members will require ICD-10 training because they assign codes or use codes in their daily work.

Payer integration is a critical factor in ICD-10 planning. The presentation will offer an approach for contacting FI and payer project managers early in the ICD-10 planning process to assess the need for system upgrades and to establish timelines for data testing. Key discussion points for both parties should include:

X Level of effort required for each side to achieve a smooth transition
X Timeline for updating code sets
X Timeline for system updates, upgrades and changes
X Timeline for sending test data to identify payment issues
X Validation of information flow between the provider and FI/payer. Who will validate data, in terms of how much data was sent and how much was received? What was the dollar amount of revenue expected? What was sent? What was received?

Since patient care, revenue cycle transactions, quality monitoring and reporting must continue during the transition, it is essential that staff have a roadmap to use in bridging ICD-9 data to ICD-10. Mappings from ICD-10 to ICD-9 and back again were created to assist the healthcare industry with the conversion. The presentation will describe how to use two types of mappings available from CMS: Reimbursement Mappings, which focus on equivalent payment results between the two codesets, and General Equivalent Mappings (GEMS), which provide a clinically derived mapping. Providers can use these mapping tools now to convert their systems and applications so that they can accurately and efficiently handle ICD-10 codes. In addition, the ICD-10 mappings can be used to project areas of risk, identify trends, and establish growth goals prior to ICD10 implementation.

The coding changes driven by the shift to ICD-10 will touch every aspect of hospital operations and patient care, so the transition is not to be taken lightly. Initially, the challenges may be more apparent than the opportunities. Healthcare organizations whose leaders plan carefully and strategically will be able to avert implementation problems and capitalize on the opportunity inherent in ICD-10. With careful planning, hospitals can come through this transition well-positioned to manage the reimbursement and regulatory challenges of the next decade.