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CMS Corner: Now Is the Time to Start ICD10 Planning

By Denise Buenning

As public debate continues to focus on healthcare reform, industry needs to be mindful of the upcoming transition to the ICD-10 code set on Oct. 1, 2013. While still four years in the future, the implementation of ICD-10 will affect systems, business processes, payments and policies across the entire healthcare spectrum. Along with transition to the prerequisite Version 5010 of the HIPAA transaction standards (effective Jan. 1, 2012), both represent technical and operational improvements, a key component of the Administration’s move toward healthcare transparency and healthcare system enhancements. The very nature of these transactions and code sets will result in specific and robust data that will be an integral part of various provider incentive programs, and significantly reinforce program integrity efforts.

In preparation for the transition, CMS undertook an agency-wide identification of ICD-9 (and presumed ICD-10) impacts across all its business processes and systems. The agency has used this information as the basis for an impact analysis that maps the interconnectivity between the various business processes and systems, and developed a prioritized risk and opportunities assessment. Next steps will include vetting concept solutions among CMS components, and to ultimately deliver an agency-wide ICD-10 implementation plan with option recommendations by year’s end.  

It is obvious that transition to ICD-10 is a multi-faceted, multi-year project, one that certainly cannot be put off until the Oct. 2013 compliance date is upon us. Planning, implementation and then testing will take years. But what should industry be doing now to start preparing for ICD-10?  Based on CMS’ experience, the first step should be to identify affected business processes and systems. Where do ICD-9 codes currently appear in your systems, databases, business processes, Web sites, etc.? Taking a code set “inventory” throughout your organization to identify these impacts will give you a good start as to where ICD-10 codes likely will appear. Information on how CMS approached this first step of analysis is on our Web site.

But it is not enough to simply identify the impacts. The next step is to trace how these points connect and/or their interdependencies across business processes, policies and systems. Organizing your ICD-10 work by each affected business process instead of by each department, will help you see the entire business process from beginning to end, and help you better understand how business processes that cross multiple departments will be impacted. 

While it is important to identify impacts and interdependencies during this phase of the analysis, it is also important to identify and address risks and opportunities that present themselves through ICD-10. Risks are relatively easy to assess and prioritize; however, opportunities for change and improvement may not be as readily evident. Ask the question, “How can each of our business areas leverage their use of the ICD-10 codes to improve the effectiveness and efficiency of our operations?”

There are numerous tools to help you along the way. CMS has free online ICD-10 resources, including complete ICD-10-CM and PCS systems with guidelines; complete versions of ICD-10-CM for diagnoses and ICD-10-PCS for procedures; general equivalency mappings (GEMs), between ICD-9-CM and ICD-10 (both ways); a GEM user guide; and abbreviated reimbursement mappings. These and other educational resources are available on our Web site. In addition, industry trade and professional associations and work groups are actively involved in pushing out ICD-10 implementation information to their respective constituencies through their Web sites, online training curriculums, and other vehicles.

To complement the analytical and technical requirements that accompany ICD-10 implementation, CMS will conduct a national effort to raise industry awareness; point providers, plans, and other interested stakeholders to available resources; and drive everyone toward the Oct. 2013 compliance date. These activities will include information targeted toward specific industry segments and complement existing Medicare FFS provider outreach and education, such as articles and information available through the Medicare Learning Network, provider open door forums, frequently asked questions (FAQs), etc. Also key will be industry implementation monitoring, initially to establish a baseline and then to regularly track milestones to help identify industry segments in need of additional assistance and resources. A CMS ICD-10 Program Management Office will also soon be established to provide CMS business areas with support, tools, and resources that will ensure timely CMS, contractor, and industry transition to ICD-10-CM and ICD-10-PCS in Oct. 2013.

Denise Buenning is Senior Advisor, Office of E-Health Standards and Services, CMS.

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Upcoming Financial Systems Webinar Examines Future of Healthcare Finance Market

HIT in the Next Five Years: Managing the Mandates of 5010/ICD-10, ARRA, Privacy and Security and Healthcare Reform

Sept. 30, 12 – 1:30 pm Eastern

Explore what the healthcare finance market will look like in the next few years, as a result of the current healthcare activity in Washington, DC, during this month’s financial systems Webinar HIT in the Next Five Years: Managing the Mandates of 5010/ICD-10, ARRA, Privacy and Security, and Healthcare Reform. The Webinar is open to all HIMSS Chapters and HIMSS Members.

A panel of industry experts from the provider, vendor and payer perspectives will discuss the challenges and opportunities presented by the overlapping, and in some cases, conflicting timelines for 5010/ICD-10, ARRA, "Meaningful Use," Privacy and Security and Healthcare Reform between now and 2014. 

Guest Speakers:

• Joseph Miller, Director E-Business, AmeriHealth Mercy, HIMSS Financial Systems Steering Committee Chair
• Miriam Paramore, Senior Vice President, Corporate Strategy, Emdeon, HIMSS Board of Directors
• Philip Bradley, Vice President, Information Systems, Harris County Hospital District, HIMSS Financial Systems Steering Committee Member

Upon conclusion of the Webinar, participants will:

1. Understand the overlapping timelines and key milestones for 5010/ICD-10, ARRA, "Meaningful Use," Security and Privacy, and Healthcare Reform
2. Understand the pain points and opportunities across industry sectors
3. Identify important next steps for key health IT stakeholders

Register here for this free event.

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Registration Now Open for Healthcare Finance News Virtual Conference & Expo

October 14-15

Healthcare Finance News, in collaboration with HIMSS, will host its first virtual conference on Oct. 14-15. With 3D exhibits, on-demand event access, networking, and educational sessions, attendees will have access to the latest information available in the healthcare finance sector, without leaving the office. In addition to nationally-recognized keynote speakers opening and closing the Healthcare Finance: Industry Perspectives for Today’s Leaders event, there will be a total of nine, one-hour educational events occurring over the two-day virtual conference. In the “can’t miss” session entitled Positioning the Organization to Respond to RAC Audits, speaker Stephen Forney, vice president, margin development, Ardent Health, Nashville, TN, will provide not only an overview of the latest information regarding RACs but also guidance to organizations when they respond to a RAC audit. Anyone who provides Medicare beneficiaries with procedures, services or treatments, and submits claims for those services, needs to know all the details of the RAC program, including, but not limited to the types of audits, the hierarchy of authority, options for education, and appeals processes. The event is free to qualified attendees.  Click here to learn more or contact Danielle Hartley, vice president, business development, MedTech Publishing, at danielle.hartley@medtechpublishing.com.

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Call for Volunteers for Financial Systems Task Forces

HIMSS is seeking volunteers for FY10 to serve on two task forces focused on healthcare finance.

HIMSS ICD-10 Task Force
The purpose of the HIMSS ICD-10 Task Force is to concentrate on the development of tools and resources that will equip HIMSS’ membership with planning, preparation and implementation of ICD-10. The monthly call is the third Thursday of every month at 10:30 am (ET). New volunteers would begin next month.

Financial Edge eNewsletter Task Force
The Financial Edge eNewsletter Task Force supports the HIMSS financial systems e-newsletter. Activities include identification of authors, content and monitoring the newsletter performance scorecard. See Financial Edge online. The monthly call is the fourth Tuesday of every month at 10 am (ET).

Contact Holly Gaebel to join these task forces.

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HIPAA 5010 Online Testing Service Launched

To ensure providers, payers and vendors are ready for the move to HIPAA 5010 standards for electronic claims and related transactions, the Data Interchange Standards Association (DISA) has launched an online 5010 testing and certification service, DISAcert. This new service enables organizations to upload test transaction files; test these files against pre-defined, comprehensive 5010 testing scenarios; receive results and track progress with detailed scorecards, to ensure data complies with each specific scenario. Jan. 1, 2012 is the compliance date for HIPAA 5010 transactions. Additional details and subscriptions prices for this service are available online; an early subscriber pricing discount is available through Oct. 31. DISA is the official secretariat of ASC X12, the authors of the HIPAA 5010 standard transactions.

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Advocacy Update: Health IT Advocates Gather for 8th Annual Policy Summit and National Health IT Week

Next week, health IT advocates from across the nation will join together in Washington, DC, for National Health IT Week 2009, to promote widespread adoption of health IT as a means for improving patient safety and healthcare quality. The cornerstone event during National Health IT Week is the highly-anticipated HIMSS 8th Annual Policy Summit, Sept. 22-23 at the Renaissance Washington, DC Hotel. There is still time to register.This year’s Policy Summit features a new HIMSS Health IT “Prep Rally” on Sept. 22, where participants will hear how public policy initiatives have led the health IT industry to this point in the legislative process, as well as enjoy an Anatomy of a Hill Visit comedy sketch featuring HIMSS volunteers. The next day during HIMSS Health IT Advocacy on the Hill and Reception, participants will put their knowledge and skills to use as they travel to Capitol Hill for prearranged meetings with their members of Congress and staff. At the conclusion of Hill visits, participants and legislators will gather for the National Health IT Week Reception, where HIMSS will present its 2009 Federal Leadership Awards.

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Calls for Award Nominations and Scholarship Applications Close Next Month

There’s still time to submit a nomination for HIMSS awards and apply for a HIMSS scholarship. The 2009 Calls for Award Nominations and Scholarship Applications are now open; both close at the end of October.

Award Nominations—Call Closes Oct. 30
Nominations for awards, which recognize the special contributions of individuals, groups and organizations to the advancement of the healthcare profession as encompassed by the Society’s mission, must be submitted online. Awards are presented in four categories: Industry, Service, Publications and Chapters; a complete list is available online. Contact awards@himss.org or call Member Services at 312-915-9202 for more information.

Scholarships Applications—Call Closes Oct. 31
Through the HIMSS Foundation Scholarship Program, student members studying in the healthcare information or management systems field are recognized for academic excellence and the potential for future industry leadership. Recipients receive a cash award and an all-expense paid trip to HIMSS10 in Atlanta (some restrictions may apply). Scholarship applications are available online. For more information, contact foundation@himss.org.

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