It is only two years until the compliance date for the ICD-10 code sets and yet not enough hospitals have yet begun readiness assessments and impact analyses, said Jim Jacobs, general manager of health information management at software vendor QuadraMed Corp., Reston, Va.

And that's a problem because for a typical community hospital, the ICD-10 compliance timetable "is a lot more than a year," he said during with interview at the AHIMA 2011 Convention & Exhibit in Salt Lake City. To get a more precise look at the work ahead, questions to ask in a readiness assessment include: How adapt are your coders to change? How good is your clinical documentation to start with now? How much of your documentation systems are already electronic and how much of the overall documentation is a hybrid record?

Questions for an impact analysis include: How will changing case mixes and DRGs affect your financials? How long can you afford not to have billings go through without appropriate coding? What are you going to do about productivity losses? "This is not just a HIM problem," Jacobs added. The bottom line, he said, is that an impact analysis is a minor investment with high-end value.

ICD-10 will affect every part of a hospital and virtually every information system, he noted. Hospitals that elect a piecemeal approach and focus on "critical systems" will have an adverse impact as there are too many systems and interfaces and they can't be done in an ad hoc fashion.

Jacobs also urges hospitals to use dual coding systems that support ICD-9 and ICD-10 from six months before the compliance deadline to six months after. Providers will be going live on ICD-10 with payers one at a time during that period; a lot of payers won't make the deadline and will still be accepting ICD-9 for some time afterward. This transition period is of concern he said, because many hospitals are underestimating the impact of the period.


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