Sep

3

5010 & ICD 10 Planning

Finally at long last the much discussed and debated draft rules have been published and we see in our not too distant future the adoption of the 5010 transaction set and the move from ICD 9 to ICD 10. Hopefully the industry learned from the first go around when the 4010A1 transaction set was mandated. The initial compliance deadline was delayed by act of Congress (at the request of the industry) by a year and, even after five years the industry is still experiencing problems exchanging standard transactions.

The new version of the HIPAA transactions promises to address flaws noted in the 4010A1 version but it is probably wise to expect new problems that were unanticipated or thought fixed with the 5010 version. In addition, the conversion from ICD 9 to ICD 10 will prove to be a major undertaking and will strain existing applications given there will likely not be a conversion of all old electronic records from ICD 9 to ICD 10, especially given there really is no one-to-one match between the two.

Once again the industry is reliant on vendors to upgrade everything from electronic medical records to practice management systems to billing systems to accommodate the new version of HIPAA transactions and the ICD 10 diagnostic code set. One can hope that vendors will begin the process of upgrade development sooner rather than later. The healthcare industry will have enough problems with what amounts to be significant changes in how business is transacted and diagnoses recorded without the hassle of waiting on needed upgrades. If a healthcare organization is considering acquiring a new claims adjudication system or a new electronic medical record, it would probably be wise to check with the vendor to determine if they are trustworthy and have even begun thinking about what will be required to meet the needs related to the transaction upgrade and the change in the diagnostic code set.

From an industry perspective, now is the time to begin conversion planning. The healthcare industry sometimes has a tendency to wait until too close to the deadline to begin planning which leads sometimes to panic, misinformation and a rather bumpy conversion process. A whole lot of coordination needs to occur between health plans, providers, clearinghouses and business associates and the sooner the communication begins the better. Whether or not the vendor community is prepared will still remain an issue but, especially with the inclusion of clearinghouses, processes can be engineered that can assist with development of likely needed workarounds until all are on the same page.

Now that the draft rules are out, it is a good idea to take the time to review the draft rules or NPRMs, download the 5010 implementation guides and takes a good look at what a conversion to ICD 10 really means. Also, it would be a good time to make a list of comments and concerns that can be submitted as formal comments. Now is the time to raise concerns and not after the rules are final. It is also the time to begin charting out the path to move to the new version of transactions and ICD 10, even though the actual date mandates will rear their ugly head is a few years down the road. Time to remember the pain and avoid past mistakes (as well as current administrative pain)…