Key Challenges for ICD-10 Transition

ICD-10 codes are ten times as granular as their predecessors opening up fresh opportunities

for improving healthcare facilities, improved patient safety, better disease detection, more sophisticated care delivery and streamline provider reimbursements. However, there are a number of challenges which prevent the immediate transition of ICD-9 to ICD-10. If the provider continues to capture I-9 codes and that's what is going to be sent to the payer, chances of benefits to be realized very slim. Based on the market feedback, most providers will continue to capture, store and send I-9 codes for a long period post the compliance date. The transition period will be long, may be very long.

The complexity and scope of ICD-10 will create a number of sweeping challenges within the U.S. healthcare system. Some of the key challenges to ICF-10 transition are:

ICD-9 contains around 17,000 codes, ICD-10 contains more than 150,000 codes

ICD-10 will require several codes to cross-walk to a single ICD-9 code

ICD-9 to ICD-10 code mapping will require detailed translations in benefit plan configuration and claims adjudication logic

Remediation of ICD-10 will require extensive technology modifications to databases, reports, computing logic, data imports and extracts, business desktop and workflow procedures, etc.

The need to process both ICD-9 and ICD-10 codes for a period of time and normalize the data for comparability and trending

Inaccurate processing and reporting of ICD-9 and ICD-10 codes coexisting in a single database

Operational productivity loss across the organization

Extensive training across many cross-operational departments

Claims backlogs and payment delays due to coding and reimbursement discrepancies

Impact on historical data used for underwriting and rating due to use of old ICD-9 codes and new ICD-10 codes

Potential increase in fraud and abuse

The need to remediate multiple core claims platforms (if applicable)

The need to replace obsolete legacy/proprietary or packaged applications that will be difficult or very costly to remediate to achieve ICD-10 compliance

Implementation costs are estimated to rival or exceed the costs of Y2K and initial HIPAA implementations

Staffing shortages, especially in IT

Key Challenges for ICD-10 Transition

By: gssmktng

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