October 2013 will be here before we know it. Remember, making the transition to ICD-10 is not optional. All “covered entities”—as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)—are required to adopt ICD-10 codes for use in all HIPAA transactions with dates of service on or after the October 1, 2013, compliance date. For HIPAA inpatient claims, ICD-10 diagnosis and procedure codes are required for all inpatient stays with discharge dates on or after October 1, 2013. For providers, ICD-10 diagnosis codes are required for dates of service on or after October 1, 2013.
To process ICD-10 claims or other transactions, providers, payers, and vendors must first implement the “Version 5010” electronic healthcare transaction standards mandated by HIPAA. The existing HIPAA “Version 4010/4010A1” transaction standards do not support the use of the ICD-10 codes. Hopefully, your facility has already tested the new standards by now. If not, you are getting into crisis mode, since the 5010 standards go into effect in less than two months on January 1, 2012.
The Centers for Medicare & Medicaid Services (CMS) website contains a lot of information and helpful tools to assist you with your transition to ICD-10. I recommend you check out the recently posted CMS implementation handbooks. These handbooks contain all the information you need to prepare for and conduct your implementation of ICD-10. The step-by-step guides are specifically tailored for small and medium provider practices, large provider practices, and small hospitals. I noticed that they did not publish a guide for large hospital systems. My assumption regarding this is that CMS figures that the large hospitals have already taken appropriate measures to make this transition. To date, many integrated delivery systems are well into their project plan. If your facility has not already established a project plan for ICD-10 implementation, you will find the information in these guides helpful to get started.
The guides will help you assess your needs and then design a plan for all your business processes, suggest communication pipelines, break down the training into meaningful and helpful steps, and show you where you might expect and plan for hiccups in your reimbursements.
The appendix of each handbook references relevant templates, which are available for download from the CMS website in both Excel and PDF files. The templates are customizable and have been created to help entities clarify staff roles, set internal deadlines/responsibilities, and assess vendor readiness.
Speaking of vendor readiness, in anticipation of the October 1, 2013, transition from ICD-9 to ICD-10, Orchard Software is developing product versions that will support the functionality required for ICD-10 coding. The software releases will be available within the next six to nine months. Orchard is involved in the industry and is keeping up with the latest news to ensure that our software will meet the requirements of the regulations and needs of our clients as details emerge and are set regarding the final requirements for ICD-10.
Once the software updates are available for general release, each products’ release notes will contain information regarding how they accommodate the requirements, so clients may begin their testing and implementations well in advance of the transition deadline.
You should be thinking about ICD-10. A successful transition requires a plan, and it only takes one step to get started. It is better to start now and make your transition a leisurely stroll instead of procrastinating and having to start your marathon in September of 2013.
After writing this post, Orchard would like to know what steps your facility has taken to prepare for ICD-10. Please reply in our comments section.
Ginger Wooster, MBA, MT (ASCP)
Director of Regulatory Affairs & Applications Specialist
Orchard Software Corporation