The transition to ICD-10 and the impact on providers

November 1, 2011

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Dear Valued Provider and Office Staff:

The mandated transition to ICD-10 represents one of the biggest challenges in health care history, as the change is far-reaching and affects a number of entities in the health care industry. Increasing the number of codes from approximately 24,000 ICD-9 codes to over 140,000 new ICD-10 codes will not be an easy task and will require significant upgrades to systems and processes for payers and providers. Therefore, it is important that preparation begin now to comply with the mandated ICD-10 implementation date of October 1, 2013.

Beyond the ability to diagnose diseases on a more granular level, increasing the number of diagnosis codes has many additional benefits for providers, including reducing payment errors, speeding up the reimbursement process throughout the industry, and the possibility of enhancing quality measurement and research to inform changes in health care.

A number of negative scenarios could potentially affect the workflow of providers who are not prepared to implement ICD-10 codes by October 1, 2013. Examples include:

  • rejection of claims payments;
  • coding and billing backlogs;
  • inaccurate/incomplete clinical metrics and pay-for-performance reporting that does not meet peer standards.
  • Providers can prepare for the transition and avoid being negatively affected by taking inventory of changes required at their practice, such as evaluating business and IT efforts that are involved (e.g., required upgrades to practice management software). The Centers for Medicare & Medicaid Services (CMS) has established recommended timelines for small and large provider offices to comply with the ICD-10 implementation date of October 1, 2013. Visit www.cms.gov/ICD10/03_ICD-10andVersion5010ComplianceTimelines.asp to review these CMS timelines. Providers are encouraged to use these timelines to gauge their readiness level.

    IBC is committed to sharing information with providers about the mandatory transition to the ICD-10 code sets. As part of that effort, we will continue to publish articles in upcoming editions of Partners in Health UpdateSM that focus on various transition-related requirements and our plans to comply with the mandated transition. Providers can also find information about the ICD-10 transition by visiting www.ibx.com/icd10. If you have any questions about our transition to ICD-10, please email them to ICD10@ibx.com.

    Thank you for your participation in our network and your efforts to prepare for this transition.

    Sincerely,

    Ronald J. Brooks, M.D.     Steven J. Brown, M.D.     Dale M. Mandel,
    Senior Medical Director    Medical Director          Medical Director

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