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Why ICD-10 implementation is falling behind

ICD-10 implementation is catching U.S. providers (who have many other federal health IT mandates to meet) off-guard. Fortunately, HIMSS 2011 will give them a chance to catch up.

Few U.S. health IT professionals are unaware of the upcoming mandated transition to the International Statistical Classification of Diseases and Related Health Problems, 10th Edition, or ICD-10.

Those who have begun making the transition to ICD-10 codes for diagnoses and billing remain in the minority, however, even with an Oct. 1, 2013, deadline for making the switch. Progress on upgrading to version 5010 of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards, which must happen by Jan. 1, 2012 has been equally slow.

According to a survey on ICD-10 implementation and version 5010 compliance that was released last summer by the Healthcare Information and Management Systems Society (HIMSS), roughly one-third of providers had no plans to implement an ICD-10 or version 5010 project by the end of last year.

"The issue they're facing is that there are many things to do," said Jim Daley, the director of information security risk and compliance for BlueCross BlueShield of South Carolina, and the chairman-elect of the Workgroup for Electronic Data Interchange (WEDI), a nonprofit organization advising the federal government on improving administrative efficiency in health care.

The HIMSS survey suggested that conclusion as well: Projects related to other federal and state regulations -- namely, HIPAA compliance, the meaningful use of electronic health record, or EHR technology and other clinical application upgrades -- were getting in the way of ICD-10 and version 5010 projects, respondents said.

For that reason, WEDI and the North Carolina Healthcare Information and Communications Alliance Inc. -- whose joint ICD-10 timeline initially set January 2009 as the target project start date -- had to update their ICD-10 implementation timeline in December. The new timeline set August 2010 as the target project start date. Even with that revision, the process still has been truncated by 19 months.

Providers shouldn't jump right in, however. The inaugural step should be education, Daley said. "Understand what the requirements are," he added. "If you don't understand what you're supposed to be doing, it's going to be very difficult."

Understand what the requirements are. If you don't understand what you're supposed to be doing, it's going to be very difficult

Jim Daley, chairman-elect, Workgroup for Electronic Data Interchange

After that, providers should conduct a "very thorough impact assessment" that identifies both the IT and procedural work elements that must be upgraded to achieve ICD-10 compliance, Daley said. "It really helps to formulate a work plan."

Other key considerations include budgeting -- especially for larger organizations, which will need more than one budget cycle to complete ICD-10 implementation -- and testing, Daley said. Testing represents a key differentiation between ICD-10 and HIPAA version 5010. Thanks to HIPAA version 4010, organizations should be familiar with testing the electronic transaction process.

On the other hand, "ICD-10 is completely different. You need to test thoroughly, and it will be a significant effort," Daley said. "[Providers] need to know how they will be handling it internally and also how to bring information back into the system from the payers."

At the HIMSS 2011 conference and exhibition in Orlando, Daley will lead one of several educational sessions that will help providers gauge their readiness for the ICD-10 implementation.

In addition, WEDI is one of several organizations sponsoring GetReady5010, a site that currently includes several webinars about managing the HIPAA version 5010 transition, Daley said. It soon will offer resources to help providers test their connections with payers, clearinghouses and the Centers for Medicare & Medicaid Services, he said.

"There's a lot of information available," Daley said, adding that it's a matter of addressing the question: "How do you do your best to make it available to everyone and know where to turn?"

Let us know what you think about the story; email Brian Eastwood, Site Editor.

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