ICD-10 Transition — Ready or Not?

It’s a New Year and there are 262 days left until the October 1, ICD-10 implementation deadline. The road to ten has been very challenging with respect to “Go or No-go” implementation timelines. Due to several delays, many organizations literally stopped transition efforts and redirected funding budgets to other priority projects.

The big day is coming! Currently, it is a known fact that CMS is operating under the October 1, 2015 scheduled deadline. It is now crunch time and with the compliance deadline set organizations have minimal time to complete the transition. Thoughtful planning, and executing conversion plans, will overall make the difference between a successful transition and missing the deadline.

What happens if your organization is not fully ready?

What is your plan for remediation?

The transition does not have to be painful. Timing is everything. Health plans and organizations, such as providers, clearinghouses and vendors can still benefit by using the time left to focus and implement additional readiness and deployment strategies for the code switchover.

The International Classification of Diseases, Tenth Revision (ICD-10), consists of two new areas, clinical modification (ICD-10 CM) for diseases and procedural coding system (ICD-10 PCS) and will replace ICD-9. The switch in code sets will provide expanded detail for inpatient, ambulatory and managed care organizations to better define medical conditions. The conversion is a significant change to the standard healthcare coding systems.

So what exactly are the differences between ICD-10 and ICD-9?

• ICD-9 codes have three to five numeric digits, while ICD-10 has three to seven alphanumeric digits – the switch in 2012 to HIPAA 5010 transaction standards for electronic claims paved the way for practices and payers to be able to accommodate ICD-10 changes
• CMS will transition all diagnosis codes from 13,000 old codes to approximately 68,000 codes included in the ICD-10 version
• ICD-10 has more specificity with a lot more codes, which provide more detail and granularity than the old codes
• Diagnosis Procedure Codes Systems (PCS) will increase from 3,000 ICD-9 to 87,000 ICD-10 PCS

Based on these changes, transition to ICD-10 requires extensive detailed planning, and comprehensive readiness efforts organizational-wide. It’s virtually more than just a coding function. Diagnosis codes affect almost every core functional and operational process, system and reporting. Failure to prepare for the conversion will have dramatic impacts on financials and ultimately the member experience.

By leveraging in-depth regulatory interpretation and guidance with complete operational knowledge base Gorman Health Group provides ICD-10 best practices through financial analysis and impact assessment, which includes people, process and technology. Gorman Health Group will identify gaps between current operational “as is” process flows and recommend future optimal “to be” process flows required for the implementation. The analysis will highlight the impact on margins by line of business and measured through people, process and technology. Additionally, risks and potential return on investments (ROI) for the identified gaps can be provided.

Gorman Health Group ensures end-to-end operational process re-design including but not limited to the following functions:

• Claims
• Benefits & Product
• Configuration
• Codification and mapping
• Contracting
• Division of Financial Responsibility (DOFR)
• Prior Authorization
• Provider Pricing
• Quality Control
• Revenue Cycle
• Reporting and Analytics
• Metrics
• Vendor Alignment
• Vendor Management and Oversight
• All Other Hand-offs “Operational” Areas

If you are behind the eight ball and not exactly on track let us proactively work with you on an expedited readiness plan, contingency plan development, post-production support, post-transition analysis, knowledge transfer, monitoring and reporting. Gorman Health Group includes some of our industry’s most experienced and proficient ICD-10 and operational subject matter experts.

Make your New Year’s resolution to stay on track with transitioning to ICD-10. Time is running out and October will be here before you know it.

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