Migration to ICD-10
ü ICD-10 isn't new, it's now beginning to make a big impact on health plans.
ü ICD-10 was adopted in the United States in 1999 for reporting mortality, ICD-9-CM (Clinical Modification) remains the U.S. data standard for reporting morbidity.
ü Not only the national code will offer better monitoring of health status, they also believe it's a critical answer to improving the monitoring of disease and potential biological threats in the United States.
ü ICD-10 has the potential to improve interoperability between systems, provide greater specificity and granularity to support medical/disease management programs, and reduce the number of miscoded claims.
ü Most payers' systems will have to be changed because most systems are based on it or have pieces of ICD codes built into their logic.
ü However, payers won't take the biggest hit. While they'll face an enormous undertaking, Fox said physicians and health-care providers will bear the biggest brunt because they'll be the ones responsible for coding data.
ü But there are several things that first need to be done before the industry can tackle the ICD-10 conversion issue. "Industry and government need to take a look at the broader spectrum of other regulations out there that also need to be implemented. Capital and resources in the health-care industry are limited. There needs to be a comprehensive plan developed that identifies the value proposition of the various regulatory initiatives on the table. To some extent, value should drive the priority of activities.
ü The "5010" is a prerequisite for ICD-10 implementation.
ü The Secretary of Health and Human Services published a Final Rule that adopts the NPI its the standard unique health identifier for health-care providers. When implemented, covered entities will use the NPI as their primary identification number to identify health-care providers in all standard electronic transactions.
ü If you look at the costs associated with it, it's not just our costs but also that of physician practices and hospitals who will be looking to insurers to increase reimbursement. So it's a ripple effect, and ultimately comes back to the government, businesses and consumers who are voluntarily purchasing health care.
ü Not only will systems and business processes need to be redesigned to handle the new codes, health plans will have to offer extensive training of clinical and administrative personnel.
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