As the U.S. stumbles forward in the transition from ICD-9 to ICD-10 diagnoses and inpatient procedure codes for healthcare services, U.S. health plans are stuck in limbo. ICD-9 will continue to be required until at least October 1, 2015, before it is replaced by ICD-10. In the meantime, health plans looking to implement a healthcare IT reporting and analytics platform would be wise to choose one that supports both ICD-9 and ICD-10 coding systems to streamline the transition.

The march toward ICD-10

The US has fallen behind other countries by continuing to use ICD-9 diagnosis codes, according to Centers for Medicare and Medicaid Services (CMS), which claims that ICD-9 is out of date, lacks clinical accuracy and doesn’t have enough specificity. Further, because some data has already transitioned to ICD-10, including most other developed countries, we can no longer compare morbidity diagnosis data at the international level until the U.S. catches up. This delay is bound to “cause undue confusion and administrative challenges,” leaving payers and providers in “a stalled transition between two different coding systems,” according to America’s Health Insurance Plans, as reported in Healthcare Payer News in April. Once the ICD-10 requirement goes into effect, everyone covered by HIPAA must use ICD-10 codes, including state Medicaid programs, and even payers who do not deal with Medicare claims. Those not covered by HIPAA might as well move along too, since ICD-9 codes may become obsolete, warns CMS. After the implementation of ICD-10 in October 2015 or later, claims that do not use the ICD-10 diagnosis and inpatient procedure codes cannot be processed – and yet until then the claims for services provide must use ICD-9 codes. In the interim, practice management systems must accommodate both ICD-9 and ICD-10 codes until all claims before the cut-over date have been processed and completed.

Payers: How to minimize impact on HIX edge server, Encounter data submissions

The transition from ICD-9 to ICD-10 will change how healthcare plans do business. ICD-9 and ICD-10 codes have a ripple effect on health plan reporting, including the HIX edge server submissions, encounter data reporting, quality reporting and ACA risk adjustment. A health plan can experience a seamless or bumpy transition depending on the effectiveness of transition planning. Best practices for the ICD-9 to ICD-10 transition are included the following recommendations:

  • Develop a transition plan for switching from ICD-9 to ICD-10.
  • Identify all the places your organization uses ICD-9 codes.
  • Review payment and benefit policies.
  • Understand how the transition to ICD-10 will affect your reporting requirements.
  • Ask healthcare IT software vendors about their ICD-10 readiness plans and ability to support ICD-9 in the interim.
  • Choose an HIX 3R edge server and a encounter data submission (EDS) system that can report ICD-9 and ICD-10 codes for a seamless transition.
  • Coordinate with billing services and business trading partners to test ICD-10 processes end-to-end.
Advalent’s healthcare IT platform supports both ICD-9 and ICD-10

Advalent offers an efficient, robust and scalable model for delivery of healthcare IT via a turnkey, subscription-based solution. Our Platform-as-a-Service (PaaS) solution supports the agility and adaptability needed to address always-changing healthcare business requirements for payers and providers – including the transition from ICD-9 to ICD-10. Unlike other HIX edge servers and encounter data submission solutions, the modular Platform-as-a-Service (PaaS) approach of Advalent ensures you can deploy our solutions quickly and easily – on a common platform with a common user interface and using open standards. The many advantages of Advalent solutions for healthcare payers include:

Healthcare payers benefit from a flexible, scalable and innovative cloud-based healthcare IT solution that can be configured to your requirements without expensive healthcare IT consultants. Payers of all sizes can process, analyze and report healthcare data easily with Advalent solutions. Make your transition from ICD-9 to ICD-10 easier than you could have imagined and free yourself from high upfront IT implementation costs: Sign up for a demo and free trial today and experience the Advalent difference for yourself.