Top 5 benefits of implementing ICD-10 now

The healthcare Industry as a whole is currently weighing its options after the recent announcement by Health and Human Services Secretary, Kathleen Sebelius that the federal government may extend the October 2013 ICD-10 implementation deadline.

As of right now, no one knows what the time frame for the extension would be or who would be exempt from the exception. In addition, ICD-11 is fast approaching and expected to be implemented around 2015, just a year away if the industry were granted a one-year extension for ICD-10. This begs the question, if companies delay ICD-10 implementations now, how will they be ready for ICD-11? There are multiple options to weigh, which I will discuss in this blog post.

Let’s look at some key areas that will benefit from implementing ICD-10 right now:

  1. Existing Capability with 5010: Because the 5010 implementation has been completed already and the transactions are now ready to accept ICD-10 codes, it would be easier to implement ICD-10 data collection capabilities within the front end claims processing to enable submission of ICD-9 or ICD-10 data. Payers can also test with new edits for ICD-10 codes to identify claims that could be rejected later in the process thereby costing more to adjudicate.
  2. Phased Migration to ICD-10: Moving from ICD-9 to ICD-10 is less complex than going from ICD-9 to ICD-11. Migrating to ICD-10 is a natural progression and would enable Payers to capture required historical information that might not be available if we went to ICD-11 directly. Also, the time extension allows Payers to implement a phased approach thereby allowing ample time in between migrations from partial to full remediation.
  3. Reimbursement Based on ICD-10: ICD-10 is intended to help Payers save millions of dollars every year that would otherwise have been wasted due to improper coding and payment due to lack of sufficient data and better utilization of resources for the right procedures.
  4. ICD-10 Training: ICD-10 implementation will enable Payers with ample time to train their employees before the actual mandate. Without this training, the ICD-11 transition will be more complex and confusing.
  5. Data Collection & Analytics: Implementing ICD-10 prior to ICD-11 will allow for the much-needed revamp of the in-house data structures. Most of these are already undergoing changes due to various other mandates. This will provide Payers with insight into the various benefits of having ICD-10 data.

Apart from the above benefits, ICD-10 implementation will help improve customer confidence and thereby enhance the business due to lowered cost in premiums. At the same time, Providers will also benefit from more accurate payments and less rejections and delays.

This post was originally published on GovernmentHealthIT on March 12, 2012, and is re-posted here by permission.

Baskar Mohan

Director - Healthcare Practice, Virtusa. Baskar has more than 18 years of professional IT experience with over 13 years of US project experience. He has worked in the Healthcare industry for the past 11 years both on the payer and the provider systems. He has extensive knowledge of the Blues and has worked with them in many corporate initiatives including the HIPAA 4010A1 conversion, SSNE and the NPI project. On the payer side, Baskar has worked on EDI and core claims systems. During his tenure at BCBSMI, Baskar has worked in EDI, Membership & Billing, Facility, Professional, Dental, FEP & NASCO to name a few. Baskar has also very good exposure to the government run Medicare & Medicaid programs and has worked for the Dept of Health Services, Sacramento, California. He also has executed a number of projects in healthcare related to BPM. Baskar is very knowledgeable of the Pega platform and in specific the Healthcare payer framework, Insurance Industry framework & CPM. More recently he has executed projects related Governance, Risk and Compliance using Pega for providers very specific to CoBIT & HIPAA. As a Chief Architect, Baskar is responsible for designing solutions for 5010 & ICD10 solutions. He has created go to market solutions to help customers transition to 5010 & ICD10. As a Program Manager, he is responsible for delivery & execution of all projects both onsite & offshore and currently manages a team of resources. As a Client Services Director, Baskar is responsible for revenues for healthcare book of business, assist the sales team with pre-sales, account radiation and client management. Baskar has experience working with global clients across, USA, UK, France & Netherlands.

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