The ICD-10 initiative has received much scrutiny from medical associations. Part of the concern stems from competing initiatives that healthcare providers need to implement, such as electronic health records. Many hospitals and physicians have or are acquiring electronic health record (EHR) systems to modernize their operations. Much of this activity is driven by the HITECH stimulus provisions related to meaningful use of this technology.
Emerging healthcare technologies, new and advanced technologies and the need for interoperability amid the increase in EHRs requires a standard code set that is expandable and sufficiently detailed to accurately capture current and future healthcare. In the larger context, ICD-10 is not a competing initiative but an enabler for the EHR adoption to help build the data infrastructure needed for a nationwide healthcare system where clinicians, hospitals, laboratories and pharmacies can share patient information electronically, in a secure way.
According to CMS, in order to achieve interoperability, data must be standardized so it can be effectively shared between various EHR and health plans’ systems. Classification systems and reference terminologies, such as ICD-10, provide a uniform way of collecting and maintaining patient data.
Furthermore, EHRs and interoperability require a modern coding system for summarizing and reporting data. The legislative history of ICD-10 adoption indicates that its fundamental objectives are to improve the quality of care and provide better data.
As the healthcare market evolves, a new health economy is emerging. There are revenue cycle and associated shifts from Fee-for-Service (FFS) to Pay-for-Performance (P4P) or Pay-for-Value (P4V) models and the impacted business systems that must be upgraded and associated costs to comply with multiple federal initiatives.
CMS is leading several eHealth initiatives to help meet the Triple AIM goals of improvement by increasing the efficiency of healthcare delivery in the United States.
These CMS eHealth initiatives aim to transform health care delivery through simplified, standardized electronic information and technology.
ICD-10, combined with other administrative simplification initiatives, will increase the efficiency and the quality of electronic information that providers exchange with each other, Medicare and other payers.
ICD-10 will improve population health by unifying public health surveillance architectures for interoperability, streamlining quality and health status monitoring, and accelerating research. Together, terminologies and classification systems provide the common medical language necessary for interoperability and the effective sharing of clinical data. These initiatives will help advance the secure exchange of information between providers and patients to support improved patient care coordination across the nation.
Center for Medicaid and Medicare (2014). ICD-10 and CMS eHealth: what’s the connection? Retrieved from http://www.cms.gov/ICD10
Anita Archer, CPC, is a Director of Regulatory Compliance at Hayes Management Consulting. She is a Certified Coder and AHIMA Approved ICD-10 CM/PCS trainer. Anita has more than 30 years of experience in the healthcare industry is focused on revenue cycle optimization, ICD-10 preparedness and business process improvement.
Judy Monestime, MBA, CDIP, CPC, AHIMA ICD-10 CM/PCS Trainer/Ambassador is an Executive Healthcare Consultant, keynote speaker and writer. Her background is in revenue cycle, with a focus on clinical documentation, coding and denial management. She has led several ICD-10 assessment and implementation projects for providers and payers, including evaluating both the business and technical processes and systems for key potential impacts of ICD-10 and confirming ICD-10 impacts by process area.