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ICD-9 to ICD-10 Conversion – Delayed, but not forever

icd-10_1The transition from ICD-9 to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). The previous transition date of October 1, 2014, generated a flurry of activity for the healthcare industry in preparation for the transition. The transition involves all sorts of activities such as upgrading IT systems, training providers on new documentation requirements, revenue stream contingency planning, designing ICD-10 compliant superbills, etc.

Healthcare IT, a healthcare industry association, surveyed more than 1,000 providers, health plans and vendors in February 2014. The results showed that the majority of respondents were “falling behind” their plans to be ICD-10 compliant by October 2014. Earlier this spring though, a collective sigh of relief could be heard across the U.S. healthcare landscape. On April 1, 2014, the U.S. legislature passed the Protecting Access to Medicare Act of 2014 (PAMA). PAMA states that the U.S. Department of Health and Human Services Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the rule will also require HIPAA-covered entities to continue to use ICD-9 through September 30, 2015.

The delay provides healthcare organizations that had concerns about being ready for the 2014 conversion a little bit of breathing room. There are both positives and negatives as a result of this delay, but it is critical that organizations sustain what has already been done and avoid having to do it all over again. Here are a few suggested actions to keep the momentum going.

Operations Assessment & Improvement – Continue to identify and relieve “pain points” now – for example, medical necessity write-offs, denials, and quality coding.

Technical Migration – Continue communications with vendors and strategize for any upgrades required to achieve ICD-10 compliance. We all know that software upgrades are continuously being provided by developers. Ensure you are on the correct upgrade path so software doesn’t becoming a stumbling block.

Training & Education – Sustain (or start) physician documentation improvement training and work on getting providers documenting with ICD-10 specificity now. Sustain (or start) coder training to ensure they are prepared and have sufficient time for dual coding. Practice makes perfect!

Financial Planning – Begin (or continue) to assess the potential revenue impacts of the ICD-10 conversion. Use this extra time to minimize the financial pitfalls through more systems testing, more training for claims review staff and more focus on revenue cycle process workflows.

Implementation Planning – If you didn’t have a solid project plan for the 2014 deadline, create one now! If you had a plan, update it. A good project manager and project team can take this extra time to keep you on target and incorporate some of the new ‘optimal solutions’ you identified in the steps above.

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Tim Monroe

One Comment

  1. Having read this I thought it was really informative.
    I appreciate you taking the time and energy to put this article together.
    I once again find myself personally spending way too much
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