Ten Things to Know About ICD-10 Implementation

A Department of Health and Human Services (HHS) final ruling states that all health care entities using ICD-9 diagnosis and procedure codes must migrate to ICD-10 by October 1, 2013. This transformation in systems and processes is expected to catalyze significant industry change and provide potential benefits in:

• Cost and quality measurement
• Public health
• Research
• Organizational monitoring and performance measurement

The size and scope of ICD-10 implementation is projected to be expansive, complex and costly: Industry analysts characterize ICD-10 as potentially exceeding Y2K with respect to cost and impact, so advance planning is essential.
Here are ten important things that providers should know about ICD-10 implementation:

1. U.S. adoption of ICD-10 will require a massive overhaul of the nation’s medical coding system. Current ICD-9 codes are deeply imbedded as part of the coding, reporting, research and reimbursement analysis performed today. Adoption will generate a massive wave of new payment schemes, process and educational changes, new medical coding policies, changes to staffing responsibilities and knowledge/training requirements, and modifications to reporting and supporting technologies.
2. In the short term, providers should conduct a three-prong ICD-10 opportunities assessment and develop a roadmap for implementation. The operational assessment focuses on readiness and planning for personnel, policies and business constituents; the finance assessment on changes to financial performance, drivers, working capital and reporting; and the technology assessment on implementing systems changes throughout the organization.
3. Conversion to ICD-10 will impact not only coding, but all areas of the revenue cycle. Areas of impact will include pre-registration/patient access/financial counseling, utilization management, case management, charge capture integrity, managed care contracting, coding, billing and collections. Extensive revenue cycle planning, coordination and communication, both internally and externally, will be required for successful ICD-10 adoption.
4. Hospitals will need to upgrade multiple Information Technology (IT) systems to support the conversion from ICD-9 to ICD-10. Because of ICD-10’s complex code structures, implementing associated changes in electronic medical records, billing systems, reporting packages and other decision-making and analytical systems will require either major upgrades of multiple systems, or outright replacement of older systems. The transition will likely necessitate significant cost outlays and increased staffing to map and load codes, redo system interfaces, redevelop reports, and retrain users. In addition to coders, system changes will impact nurses, physicians, and patient financial services, case management, utilization review and other staff.
5. Physician practices face financial and operational burdens from ICD-10 implementation and other technological requirements. Some practices, especially smaller ones, have outdated practice management systems and may need to purchase entirely new software. Also, most physician offices do not employ coders; typically, administrative staff and physicians are responsible for ICD-10 code assignment, potentially increasing the risk of coding errors.
6. Productivity impacts to the functional areas that use ICD-9 codes on a routine basis are expected during the initial implementation. The greatest impacts will be to case management, clinical documentation, health information management, claims processing (electronic billing system), collections and follow-up and decision support. Also, there may be an increased number of claims denials due to poor understanding of new code sets and coding requirements. Providers should prepare for this reduction in productivity to help reduce or even prevent negative impacts to reimbursement and cash flow.
7. Transition planning is important; providers should be prepared to run dual systems. Hospitals likely will need to support both automated and manual processes (i.e., claims processing) for a period of time to facilitate adequate reimbursement and cash flow.
8. Adoption of ICD-10 will require significant technology changes for providers’ IT vendors, trading partners, external reporting entities and third-party payors. All systems accepting or reporting diagnostic and procedure codes will require modification and the ability to run dual nomenclature solutions. Significant testing, cross-walk analysis, report development and data aggregation across time periods will be essential to prepare for the ICD-10 transition.
9. The move from ICD-9 to ICD-10 diagnosis and procedure codes will cause significant security and privacy implications. Among potential impact areas: existing regulations such as HIPAA, 21 CFR Part 11, etc., could be affected by code changes; access to sensitive data may not be properly restricted due to increased data complexity from new code introductions; and a more complex code set may introduce more complex fraud opportunities. Data access should be logged and monitored to ensure no unauthorized access or data breaches.
10. Training programs on new clinical documentation requirements and coding nomenclature should be developed for medical staff, nurses and allied health providers (RT/PT/OT). Early training (a minimum of two years) will lessen productivity impacts through reduced volume to support the learning curve.

ERP Need in Heath Care Industry

The scope of implementing ERP in healthcare industry has been increased fairly as more and more hospitals are coming up with the growing population and critical diseases causing to the mankind. Nowadays treating patient is no more just a service, the whole hospital sector has become hospital industry.

As number of hospitals are coming up, so every one is looking for better professionalism and better service from the concerned department.
These days patients are more demanding. With so many medical facilities they get and they invest money just to ensure they get the best of treatment so naturally they want the best return of their hard earned money. So this health care industry is developing at a great speed with the two major factors namely business and service.
So now the situation has come that hospitals can’t continue with their old practices and technologies where service are not up to the mark and yet charge huge bill to the patients. Therefore it is mandatory for hospitals to go for the latest trends of technology and ensure the best service to the customer or patients.
So there is a need of implement an ERP solution which has been specially designed and developed for the health care industry. Every hospital has their basic set up in terms of equipments and necessary instruments, devices to give treatment to the patients. Also they hire best doctors, nurses and other clinical and surgical staffs in order to maintain the reputation of the hospital. So the focus here is to manage the whole operation smoothly and in more professional way, so that the patients can be really satisfied by the service of the hospital.
The main focus of the ERP in health care Industry is from the point of view of patients’ satisfaction. The key factors which one has to keep in mind while implementing the software are as follows -
1. Patients should not wait in queue for long to visit a doctor of their choice.
2. There should be option for booking in advance for the specific doctor.
3. All the bills can be paid online by the patient party in case of emergency.
4. Availability of choice of beds should be there in case of admission.
5. Discharge procedure should not be long.
6. Medi claim facilities and procedure should be fast and should be directly with the insurance company.
The hospital authority should also focus on that type of software which can give a proper track of the following.
1. Doctors’ schedule with date and time.
2. Proper intimation to the dashboard when specific doctors are not available on some said days.
3. Daily entry of patients list.
4. Proper billing methods for surgical treatments, and medical treatments along with diagnosis reports.
5. Regular update for the stock of medicines.
6. Regular attendance of the staffs of the hospital.
7. Stock updates of laundry and kitchen materials.
These should be the basic features of the ERP in health care industry. It can reduce hospital overheads as it helps to integrate all functions namely accounts, finance, human resources and bring them under one roof or one common database.
In hospitals connectivity is most important, because every time the information has to be circulated ion various departments in order to maintain a chain of events. Like a chain of events happen when a patient got admitted for certain operation. So keeping a track from admission to discharge is very important.
So for hospital industry there is a need of developing specialized ERP software that can take care of every aspect that has been mentioned above.