Welcome to ICD-10 Compliance

The healthcare industry has reached an inflection point. Advances in medicine and the efforts to deliver effective care through those advances have led to rapidly escalating costs within the industry. However, initiatives such as the implementation of 5010 and ICD-10 and healthcare reforms that will follow (EHR adoption, better fraud and abuse monitoring, pay-for-performance, etc.) will serve as key enablers for increasing efficiency and lowering costs within the healthcare industry and offer an opportunity for health plans to gain a competitive advantage.

The implementation of 5010 electronic transactions and ICD-10 code sets mandated by the Department of Health and Human Services (HHS) represents sweeping change for the healthcare industry. Payers and providers should be well underway with their compliance efforts. The first key compliance date under the rule for 5010 implementation is January 1, 2012, less than one year away. We are a little more than two years away from the October 1, 2013, go-live date for ICD-10. Testing for 5010 and ICD-10 will be long and involved processes, and payers and providers that delay any system remediation, upgrade, or replacement work will find conducting adequate internal and trading partner testing difficult to accomplish.

TM Floyd & Company has been providing information technology services to payers and providers for more than 30 years. We have been at the leading edge of HIPAA compliance efforts for our clients and are committed to driving their compliance efforts for the Transactions and Code Sets rule. We offer a set of 5010 and ICD-10 services designed to not only achieve basic compliance but also to approach 5010 and ICD-10 compliance as an opportunity for gaining a sustainable competitive advantage.

Key ICD-10 Facts

• Number of procedure and diagnosis codes increases substantially
• ICD-10-CM contains over 68,000 codes
• ICD-10-PCS contains over 72,000 codes
• Structure of codes changes from three to five predominately numeric characters to three to seven alphanumeric characters
• Reimbursement processes and levels will change because of the precision of new codes
• ICD-10 will have a major impact on inpatient care setting through the implementation of ICD-10-CM and ICD-10-PCS
  
• ICD-10 will have a major impact on payers operating legacy systems
• ICD-10 affects all code-capturing, code dependent, and code driven processes, interfaces, and systems
• There is potential for significant loss of productivity during and after transition
• There is potential for significant increases in accounts receivable and decreases in cash flow for provider organizations
• There is potential for significant increases in call volumes due to rejected claims
  
• There is potential for increased audits and sanctions