Meeting the Deadline: A Timeline for Hospitals' ICD-10 Transition

The Centers for Medicare and Medicaid Services has set a deadline for implementation of ICD-10 by Oct. 1, 2013, which suggests hospitals should create a specific timeline for this transition. Developing a timeline can help hospitals budget and plan for system upgrades, training and testing. Being prepared for the new code set by the deadline is critical, as the codes affect the amount and date hospitals get paid. Delaying ICD-10 preparation may result in delayed or reduced payments if the organization does not submit claims with proper codes. James Mechan, senior vice president of EDI services with Emdeon, shares a timeline that hospital leaders can use to ensure an on-time and successful transition to ICD-10.

Now-Oct. 2011: Impact assessment. Mr. Mechan suggests hospitals start conducting an impact assessment of ICD-10 as soon as possible. "Even though Oct. 1, 2013 seems a long way away, [because] of the impact [ICD-10] is going to have to every system across the hospital as well as the business process, we have to get started now," he says. The impact assessment is necessary to determine what areas hospital leaders should focus on during the transition and to begin the development of multi-year budget estimates.

Oct. 2011-Oct. 2012: Outreach. Hospitals will need to work with practice management software vendors, clearinghouses and health plans on an ICD-10 transition plan due to the pervasiveness of medical codes in the healthcare system. Hospital leaders should reach out to these stakeholders to coordinate the schedule for system upgrades and testing opportunities, according to Mr. Mechan. Conversation with vendors is particularly important because new software, where needed, should be in place and operational by a certain deadline. In addition, vendors can differ in their timeline for updating software and their integration of ICD-10 programs with existing systems. Hospitals should ask vendors questions based on the findings from their impact assessment.

Oct. 2012-April 2013: Training. Before beginning training, hospitals should develop a training timeline that delineates the length and type of training for different groups. For instance, while webinars are useful for learning about the structure of ICD-10, Mr. Mechan says onsite training could be necessary for more detailed education. Not all departments within the hospital may need that level of detailed training. For example, coders will need significantly more training for ICD-10 than clinical staff. However, physicians and nurses should not be excluded from education on ICD-10, Mr. Mechan says. The new coding set's increased specificity will force physicians and nurses to document diagnoses differently.

In addition to planning for training, hospital leaders should also use this time to plan a budget for the ICD-10 transition, which could include costs for system upgrades, training and other expenses.

April 2013-Oct. 2013: Testing. Hospitals should contact the clearinghouse and health plans to inquire about their testing schedule, which would give hospitals an opportunity to correct any major errors before the deadline. One anticipated challenge for the transition is using ICD-9 and ICD-10 codes simultaneously as claims submitted before the deadline are corrected and resubmitted after the deadline. Mr. Mechan explains that diagnoses are coded based on the discharge date for inpatient claims and coded based on the date of service for provider and outpatient claims. If a claim with a discharge date or date of service prior to Oct. 1, 2013 is rejected, it may be returned to the hospital after Oct. 1, 2013, which would require hospitals to use ICD-9 codes to resubmit the rejected claim but use ICD-10 codes for current claims. This possible need for using both sets of codes in the beginning of the transition is a concern hospital leaders should address with vendors to ensure software can accommodate both code sets.

Learn more about Emdeon.

Related Articles on ICD-10:

AHIMA Outlines Steps for Phase 2 of ICD-10

4 Tips for Hospitals Implementing ICD-10

6 Tactics to Prepare a Hospital for ICD-10

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