Countdown To ICD-10: Prepared For Success? Or, Prepared To Fail?

The Oct. 1, 2014 ICD-10 implementation deadline is quickly approaching, leaving the healthcare industry little time to prepare for the transition. Although the Centers for Medicare & Medicaid Services (CMS) has previously extended the implementation deadline, the agency has strongly advised the industry that future extensions are unlikely. In short, organizations need to prepare for changes if they are to succeed, or prepare to fail if their efforts fall short of expectations.

Preparation is the key to making a successful transition to ICD-10, as the impact of the new code set is far reaching for providers, payers and clearinghouses. During the pre-implementation stages of ICD-10, organizations need to perform gap analyses to determine if:

• Information systems will require upgrades or replacement to support the new code set
• Current clinical documentation practices support the increased specificity required by ICD-10
• Productivity will be impacted while staff at all organizations — including coders, auditors, claims adjudication specialists, customer support, and others — learn the new code system and clinicians work to improve their documentation practices

In the months following the implementation deadline, organizations need to have plans in place to accommodate the productivity and cash flow decreases that are expected while the industry learns to resolve the issues associated with ICD-10 billing — from increased denials to adjudication troubles. Even the most ready organizations will experience disruptions due to the non-readiness of others in the healthcare revenue cycle chain. After these issues are resolved, a host of other issues will require addressing, such as tracking new claim denial trends, comparing historical ICD-9 claims to ICD-10 claims, and renegotiating provider and payer contracts based on ICD-10 codes.

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