Last December, I prepared a cover story for our print magazine, “Here Comes Trouble,” that laid out the top ten fear factors facing the industry in the transition to ICD-10. After recently attending a leadership conference on ICD-10 sponsored by The Advisory Board Company, I could easily add another 10—or more—fear factors to the list. On the hospital side of the industry, the massive diagnosis and procedural coding system represents a change whose breadth is unprecedented. And as speakers at the summit pointed out, the new coding system—which is at the heart of hospital billing—has major financial implications. The financial risk resides not only in the cost of the transition, but in the eventual impact on service line reimbursement based on the way the government calculates its DRG groupings.

On that first topic, speakers from Mayo Clinic noted that the prestigious delivery system has identified approximately 200 different information systems that will need remediation under ICD-10. Judy Dokken and Christine Beckmann, both revenue analysts at Mayo, took turns describing the delivery system’s approach to preparing for the new code set—whose original compliance date of October 2013 is being pushed back a year, pending a final rule from HHS. Despite the delay, Mayo is pushing ahead with its own transition effort full speed ahead—a wise move no doubt. What do those 200 hundred systems do? They span a wide array of departments and services, both financial and clinical, Dokken told me. The number includes multiple modules under its core EHR system in addition to a number of home-grown systems. Keeping tabs on vendor readiness is a critical undertaking, and many CIOs have told me it is still unclear if ICD-10 remediation will fall under a standard upgrade, or be an additional charge.

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