Health Law Consulting Blog

Monday, August 12, 2013

ICD-10/Health Care Reform Initiatives

The United States health care industry is in the midst of a major transformation. It is estimated that health reform initiatives underway will transform more than 90% of a payers’ information technology (IT) architecture. Providers are realizing these reforms and mandates are not just IT projects, as the initiatives require major changes in the way they provide care. The reforms and mandates issued by the federal government are not independent of one another. They are designed to be complementary and enhance the broad goal of creating a more efficient, cost-effective, modern health care delivery system to counteract the skyrocketing cost of health care. The International Classification of Diseases, 10th revision (ICD-10) is at the core of that system because it provides the standard and high-quality data future systems will require.

ICD-10 is the common thread found in many of the initiatives currently underway and is a critical element in Electronic Health Record (EHR) interoperability, and the electronic exchange of data. The transition to ICD-10 will: (i) help accelerate the widespread adoption of health information technology, and (ii) move the United States toward greater efficiency under a quality-centric health care system. By offering greater specificity and detail, ICD-10 will allow for more precise coding of diagnoses or procedures and reflects the many advances in medicine and medical technology. It makes the code sets more relevant to today’s understanding of disease processes. In addition, ICD-10 standardizes terminology used throughout the health care continuum, making it consistent with national and international public health data reporting.

As practices move forward with implementation plans, it is important to consider not only the impact of the ICD-10 on their business processes and policies, but also how ICD-10 is intertwined with other health reform initiatives underway. In addition to the updated HIPAA standards such as 5010 and ICD-10, the Federal government passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the Patient Protection and Affordable Care Act (also referred to as the Health Reform Law). These initiatives continue to highlight the federal government’s commitment to updating the United States’ health care system and using technology to improve efficiencies in the system and patient care while seeking to expand access to care and “build a healthier future for our nation.” (Office of National Coordinator for Health Information Technology) 

The HITECH Act was passed as part of the American Recovery and Reinvestment Act (ARRA) in 2009. The Act authorizes the Centers for Medicare and Medicaid Services (CMS) to provide reimbursement incentives for eligible providers and hospitals who demonstrate “meaningful use” of certified EHR technology. The United States Department of Health and Human Services (HHS) issued the Meaningful Use Final Rule that further defines meaningful use criteria and provides guidelines on how providers may qualify for Medicare and Medicaid EHR incentives. The Office of National Coordinator for Health Information Technology has been directed by HHS to provide information specific to defining meaningful use. At this time, ICD-10 is not a requirement for meaningful use until 2015, when financial incentives for EHR use end and penalties for non-compliance begin. It is likely that ICD-10 and meaningful use will converge, especially for vendor certification of EHR technology, although when and how remains uncertain.

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act. It requires most Americans to have health insurance coverage and provides subsidies to low and middle income people to help purchase private coverage. It also regulates private insurers more closely and includes numerous provisions designed to modernize Medicare and Medicaid programs to make them more cost-efficient. These provisions enhance the broad goals of ARRA and HITECH, which include improving quality, safety, and efficiency. They also include reducing health disparities, improving care coordination, and improving public health. Although ICD-10 is not named in the Health Reform Law, it plays a large role in the future management of fraud and abuse detection and prevention, Medicare and Medicaid payment demonstration projects, and disease management programs.

I invite you to connect with me for more information about implementing the ICD-10 system for your health organization.

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