Among the many current changes in the healthcare industry is a transition from ICD-9 to ICD-10 codes. One of the major changes of ICD-10 is an increase of specificity, as it has 68,000 codes compared to ICD-9's 13,000. As the Oct. 1, 2013 deadline looms, many healthcare organizations may be wondering how to best position themselves for the new system. James Swanson, director of the healthcare practice of Virtusa, a global IT services company, offers suggestions on how to prepare for the ICD-10 transition.
1. Understand the magnitude of the change. Mr. Swanson says one of the biggest challenges of transitioning to ICD-10 is understanding the extent of the change, which he compares to that of Y2K. To fully understand what moving to ICD-10 requires, training and education of hospital leaders, staff, employees and physicians is needed. "Put together a communication program throughout the organization so people truly understand the significance and magnitude of the change," Mr. Swanson says.
Mr. Swanson suggests that this understanding should start with hospital executives. "It's incumbent upon the senior leadership — the CEOs and CFOs — to really and truly understand the magnitude of the change coming through," he says. He compares the need for CEOs' leadership in this transition to previous regulations from the Centers for Medicare and Medicaid Services, which typically were driven by the CIO. "Although [CIO involvement] is critical, my sense is that from the perspective of having a healthy company moving forward, the CFOs have to get themselves involved because the financial impact will be greater than anticipated," Mr. Swanson says.
He estimates a 6-10 percent initial decrease in revenue due to the ICD-10 transition. Furthermore, he expects the repercussions of a switch to ICD-10 will affect hospitals and healthcare providers from two to five years after implementation, primarily because of unsettled claims.
2. Assess the financial impact. Because of the magnitude of change involved in transferring coding methods, Mr. Swanson suggests studying existing data to project the financial impact of ICD-10 on the organization. Leaders can estimate the financial effects by studying billing cycles and using models or applications that can convert ICD-9 codes to ICD-10. "Once you go through the assessment of the potential impact and magnitude, you can begin to realize the changes needed [to transition]," Mr. Swanson says.
3. Start transitioning now. Although the official implementation date for ICD-10 is Oct. 1, 2013, Mr. Swanson recommends starting to convert systems now. He says instead of using an existing system to translate codes, updating the program now may help organizations manage problems and improve procedures before the ICD-10 requirements become effective. "My professional opinion is that companies should make the transition and convert over to ICD-10 and start dealing with any of the issues that they run into as soon as they can," Mr. Swanson says. "Organizations that wait and utilize a much more passive approach to the conversion are delaying the inevitable. I think if you roll up your sleeves and start the process of conversion, that will be the teacher in terms of finding out where the issues are, what the financial transitions are and where the back-end applications may be suffering because of the addition of granulary data."
As part of beginning the conversion process, Mr. Swanson says hospital leaders should determine which payors they may work with and ensure that they transfer systems correctly. "I anticipate a period of time where providers and payors are going to have to take a less antagonistic approach," he says. "[To] work cooperatively with vendors, with payors, and move forward is the best strategy."
Learn more about Virtusa.
Read a Virtusa blog on top 10 considerations for ICD-10 implementation.
Related Articles on ICD-10:
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1. Understand the magnitude of the change. Mr. Swanson says one of the biggest challenges of transitioning to ICD-10 is understanding the extent of the change, which he compares to that of Y2K. To fully understand what moving to ICD-10 requires, training and education of hospital leaders, staff, employees and physicians is needed. "Put together a communication program throughout the organization so people truly understand the significance and magnitude of the change," Mr. Swanson says.
Mr. Swanson suggests that this understanding should start with hospital executives. "It's incumbent upon the senior leadership — the CEOs and CFOs — to really and truly understand the magnitude of the change coming through," he says. He compares the need for CEOs' leadership in this transition to previous regulations from the Centers for Medicare and Medicaid Services, which typically were driven by the CIO. "Although [CIO involvement] is critical, my sense is that from the perspective of having a healthy company moving forward, the CFOs have to get themselves involved because the financial impact will be greater than anticipated," Mr. Swanson says.
He estimates a 6-10 percent initial decrease in revenue due to the ICD-10 transition. Furthermore, he expects the repercussions of a switch to ICD-10 will affect hospitals and healthcare providers from two to five years after implementation, primarily because of unsettled claims.
2. Assess the financial impact. Because of the magnitude of change involved in transferring coding methods, Mr. Swanson suggests studying existing data to project the financial impact of ICD-10 on the organization. Leaders can estimate the financial effects by studying billing cycles and using models or applications that can convert ICD-9 codes to ICD-10. "Once you go through the assessment of the potential impact and magnitude, you can begin to realize the changes needed [to transition]," Mr. Swanson says.
3. Start transitioning now. Although the official implementation date for ICD-10 is Oct. 1, 2013, Mr. Swanson recommends starting to convert systems now. He says instead of using an existing system to translate codes, updating the program now may help organizations manage problems and improve procedures before the ICD-10 requirements become effective. "My professional opinion is that companies should make the transition and convert over to ICD-10 and start dealing with any of the issues that they run into as soon as they can," Mr. Swanson says. "Organizations that wait and utilize a much more passive approach to the conversion are delaying the inevitable. I think if you roll up your sleeves and start the process of conversion, that will be the teacher in terms of finding out where the issues are, what the financial transitions are and where the back-end applications may be suffering because of the addition of granulary data."
As part of beginning the conversion process, Mr. Swanson says hospital leaders should determine which payors they may work with and ensure that they transfer systems correctly. "I anticipate a period of time where providers and payors are going to have to take a less antagonistic approach," he says. "[To] work cooperatively with vendors, with payors, and move forward is the best strategy."
Learn more about Virtusa.
Read a Virtusa blog on top 10 considerations for ICD-10 implementation.
Related Articles on ICD-10:
Directory Lists Software for Physician ICD-10 Conversion
6 Points on Avoiding RAC Take-Backs for Incorrect Patient Status
Are Ongoing DME Probes Setting Table For RAC Audit?