With the focus on the American Recovery and Reinvestment Act of 2009 (ARRA), Meaningful Use (MU), accountable care organizations (ACOs) and health information exchanges (HIEs) during the past 24 months, it is difficult for healthcare leaders to know which way to turn and what to work on first. Organizations are hard pressed to determine priorities, except, perhaps, by mandated deadlines. Organizational resources can be leveraged from one project to another. A recent emphasis for many has been demonstrating compliance to MU objectives and installation of a certified electronic health record (EHR). Even with the consent ration on achieving MU, other significant mandated programs on the horizon must be recognized.
Those programs are the implementation of the X-12 version 5010 (5010) transaction code set and, subsequently, implementation of International Coding of Disease Version 10 (ICD-10). Healthcare is moving into the real technology age with the implementation of the EHR. Operational improvements are already occurring, patient care quality indices can be tracked and processes are being streamlined. However, U.S. clinical coding systems are behind the curve in comparison to other countries.
Implementation of the X-12 5010 transaction codes and the improvements in financial, operational and clinical processes needed to implement ICD-10 will lead the healthcare industry toward modernization consistent with patterns that have occurred across the rest of the industrialized world.
This paper examines the impact of the 5010 and ICD-10 initiatives from a strategic standpoint. The objective is to ensure compliance with federal regulations, while considering synergies around MU, business intelligence (BI) and business performance management (BPM) and resource maximization. The goal is to negotiate the curves in the road, without slowing down existing systems, work processes and revenue streams.
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