ICD-10 Transition is just a Decision Away…

Uncategorized | Garima Rai

Healthcare is an industry characterized by a labyrinth of compliance mandates. Participants within the industry are subject to a multitude of regulations and must ensure compliance with all relevant regulations – state or federal, to avoid potential penalties. However, among all the compliance requirements, transition to ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Version 10) is the current topmost concern for healthcare organizations. The transition-involving a massive restructuring of the United State’s medical coding system, has put immense pressure on payer as well as provider organizations to make enormous cost and time investments  to completely overhaul their business processes.

The Center for Medicare and Medicaid’s (CMS) recently announced decision to delay the ICD-10 implementation deadline (from Oct. 1, 2013 to Oct. 1, 2014), brought some temporary relief to the panic-stricken healthcare industry. Nonetheless, the challenge still remains for healthcare organizations to integrate ICD-10 into their business strategy.

For health plans, ICD-10 calls for a basal shift in their IT and business strategy. Some payers gauge ICD-10 as simply an IT systems upgrade. Such organizations might find themselves overwhelmed by the depth of impact that this new set of codes might have. Others look at ICD-10 as a huge financial burden and are seeking ways to leverage their existing IT and business framework, to lessen this burden. As they say, there’s always a positive side to everything, so is there to ICD-10. Taking into account the business value that ICD-10 would bring to payers in the form of more accurate payments, fewer rejected claims, reduced fraudulent claims, improved member satisfaction, etc., it can certainly be looked at as a potential differentiator for early adopters.  An efficient Business Process Management (BPM) platform can catalyze ICD-10 transition, while reducing operational and implementation costs. As a continuous process improvement platform, BPM can prepare health plans to to align people, processes and systems to ensure a smooth conversion. So… isn’t ICD-10 just a decision away?

Bio: Garima is part of the Marketing team at Newgen Software.