Cathy Thomas Hess, BSN, RN, CWOCN, is President and Director of Clinical Operations, Well Care Strategies Inc (WCS). WCS specializes in focused software solutions, Your TPS, and mapping best clinical, operational, and technology practices. Please address correspondence to Cathy Thomas Hess, BSN, RN, CWOCN, 4080 Deer Run Court, Suite 1114, Harrisburg, PA 17112; e-mail: Cathy@wcscare.com.
It seems we are living our healthcare lives meeting deadline dates and changing workflows based on regulations. Target dates for "meaningful use" began in 2010 and continue until 2015. The target date for International Classification of Diseases, 10th Revision (ICD-10) conversion is October 1, 2013.
Meeting Meaningful Use
Let's begin with electronic health records (EHRs). The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Remaining dates to remember for this task include the following:
* September 30, 2011-Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs.
* October 3, 2011-Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.
* November 30, 2011-Last day for eligible hospitals and CAHs to register and attest to receive an Incentive Payment for Federal fiscal year 2011.
* December 31, 2011-Reporting year ends for eligible professionals.
* February 29, 2012-Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year 2011.
For 2015 and later, Medicare-eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.1
Conversion from ICD-9 to ICD-10
Next, let's take a look at the mandate for ICD-10. A number of other countries already use ICD-10, including United Kingdom (1995), France (1997), Australia (1998), Germany (2000), and Canada (2001).
The mandated date for conversion to this new coding system in the United States is October 1, 2013. According to the American Medical Association, the following exemplifies the differences between the ICD-9 and ICD-10 codes:
"The differences between ICD-9 and ICD-10 are significant, and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the October 1, 2013, compliance deadline. ICD-10 Clinical Modification (ICD-10-CM) codes are the ones designated for use in documenting diagnoses. They are 3 to 7 characters in length and total 68,000, whereas ICD-9-CM diagnosis codes are 3 to 5 digits in length and number more than 14,000. The ICD-10 Procedure Coding System codes are the procedure codes, and they are alphanumeric, 7 characters in length, and total approximately 87,000, whereas ICD-9-CM procedure codes are only 3 to 4 numbers in length and total approximately 4000 codes. Moving to ICD-10 is expected to have an impact on all physicians. Because of the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, and other necessary investments. Before the ICD-10 codes can be used, however, physicians and others in the healthcare community must start using the new version of Health Insurance Portability and Accountability Act transaction standards known as 5010 by January 1, 2012, as the current version, 4010, does not accommodate use of the ICD-10 codes."2
According to the Centers for Medicare & Medicaid Services,3 the new, up-to-date classification system will provide much better data needed to measure the quality, safety, and efficacy of care; reduce the need for attachments to explain the patient's condition; design payment systems and process claims for reimbursement; conduct research, epidemiological studies, and clinical trials; set health policy; support operational and strategic planning; design healthcare delivery systems; monitor resource utilization; improve clinical, financial, and administrative performance; prevent and detect healthcare fraud and abuse; and track public health and risks.
Whether you are meeting the regulations for meaningful use and/or implementing changes for ICD-10, remember that a successful transition and implementation require a well-planned and well-managed implementation process.