Past Provides Clues For Successful ICD-10 Switch

By Lisa Kerner, contributing writer

Experts advise a look at lessons learned from the recent HIPAA 4010-to-5010 transition can help ease the upcoming transition to ICD-10

When it comes to transitioning to ICD-10, it may pay to take a page from history. This according to Holly Louie, chair of the Healthcare Billing and Management Association’s (HBMA’s) ICD-10/5010 committee, who testified recently before the National Committee on Vital and Health Statistics subcommittee on standards.

In a Wall Street Journal article recapping her testimony, Louie compared the upcoming ICD-10 transition to the transition from HIPAA 4010 to 5010 in 2012, noting, “We must allow the ‘lessons learned’ from the 4010-to-5010 transition last year to materially inform the implementation of ICD-10 CM,” since “the economic stability of America's healthcare reimbursement system will be at risk and could be severely compromised, affecting provider financial viability and patients' access to care.”

With ICD-10 implementation delayed one year until October 2014, Louie advised using the time wisely to ensure a successful transition. “If we fail to learn the lessons we will merely be delaying the likelihood for payment disruptions and patient access to care problems from 2013 to 2014,” Louie said.

HBMA is recommending, among other things, end-to-end testing by all payers to meet the definition of “ready,” calling a failure to do so “a recipe for disaster.” Further complicating the transition, and underscoring the need for preparation prior to it, was the announcement by the Centers for Medicare and Medicaid Services (CMS) that it would not perform any external testing of the codes.

Medical Group Management Association (MGMA) president Dr. Susan L. Turney said in a recent Dotmed.com article “ICD-10 presents a set of unique and complex challenges” because it impacts both the clinical and administrative sides of a medical practice when asked to compare it to the HIPAA 4010-to-5010 transition. Turney went on to note the industry’s overall readiness to meet the compliance deadline remains slow, due in part to uncertainty and opposition by physicians to ICD-10.

“In addition, there is currently legislation in both the House and Senate calling for the repeal of ICD-10 — further indication that key constituencies have not been persuaded that the process of implementing ICD-10 adopted by CMS is appropriate,” said Turney. “In our industry, uncertainty, coupled with multiple competing priorities, can lead to inaction.”

MGMA also believes “end-to-end testing is a critical step to minimize the chance for disruption of claims” and has urged CMS to reconsider its no-testing policy.

The reality is the clock is ticking and the deadline is looming. This point was made clear by Farzad Mostashari, M.D., chief of the Office of the National Coordinator for Health Information Technology, at the recent HIMSS ICD-10 Forum. Healthcare Informatics quotes Mostashari as saying, ““There are no plans for any more extensions. At the end of the day, this massive transformation isn’t going to be about ICD-10, it’s going to be about paying for higher quality healthcare, in addition to improved population health, more patient engagement, and better transitions of care.”

There are tools available to help healthcare providers make the switch ICD-10, even as time winds down. CMS offers implementation guides, timelines, and checklists on its website, the AMA offers an ICD-10 Implementation Toolkit, and the American Academy of Professional Coders offers an ICD-10 Conversion Code Widget.