Making the ICD-10 Transition

Vital Signs: March 2013

The Centers for Medicare and Medicaid Services (CMS) recently extended the ICD-10 deadline to allow health care organizations more time to complete their conversions. By the new deadline (now extended to October 1, 2014), all entities covered by HIPAA should be successfully conducting health care transactions using ICD-10 codes.

ICD-10 planning takes time and significant resources. As such, it is important for practices to start planning immediately in order to avoid potential problems in the future. According to CMS, planning for ICD-10 implementation should incorporate six phases: planning, communication and awareness, assessment, operational implementation, testing, and transition.

  • Planning. The planning phase includes establishing a project management structure and governance to support the ICD-10 undertaking. Staff should meet to discuss what the transition plan will look like, given the changes that will be required. Assigning different responsibilities to members of your staff will ensure that everyone is involved in the project.
  • Communication and Awareness. This phase includes creating a communication plan and assessing needs of the organization. Once needs have been established, then a roles-based training plan can be designed for both administrative and clinical staff. The impact of ICD-10 should be communicated throughout the process.
  • Assessment. Once a project plan has been created and clearly communicated, the practice should assess the many business, policy, and technological impacts. It is important to contact your practice management and billing software vendors to determine whether they are on target to meet the transition deadline (depending on where they are in the process, you may need to develop new vendor relationships). Also, review payer contracts and service-level agreements to identify potential impacts of ICD-10. A thorough risk assessment and gap analysis will help minimize potential risks after conversion.
  • Operational Implementation. The operational implementation phase puts the project plan into action. One example of a business modification might be creating "superbills" of frequently used ICD-9 code sets and identifying how they translate to ICD-10. Training of staff should be initiated during this stage as well.
  • Testing. This phase involves internal and external testing. Internal systems will need to be tested to ensure that ICD-10 transactions are processing correctly. Collaborating with payers and clearinghouses early will allow ample time to identify potential problem areas.
  • Transition. Successful transition depends on collaboration among all parties involved. Preparing and establishing the "go live" environment is key during the transition phase. Ideally, the practice should be submitting clean claims to payers prior to the October 1, 2014, deadline. Supporting and communicating with staff, continually monitoring the process, and performing regular audits will ensure a smooth transition to ICD-10.

For more information on ICD-10, please visit www.massmed.org/icd10.

- Talia Goldsmith

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