Hospitals

Unlike physician practices, hospitals are required to implement ICD-10-CM and ICD-10-PCS under the Electronic Transactions and Code Sets Rule. Hospitals must understand the impacts of ICD-10 on system needs, clinical documentation, and revenue cycle management. During the transition to ICD-10, the compliance effort can be extremely disruptive to operations and must be managed through careful planning.

System Needs

Interoperability of electronic transactions will be advantageous among hospitals and their business trading partners, including physicians, other hospitals, and payer organizations. The intent of HIPAA is to direct the healthcare industry toward a more effective and efficient system, where all of the participants are able to securely exchange data in order to deliver the appropriate care to patients. The task at hand requires hospitals to select the right system. For a detailed discussion on the need to select an electronic medical records product (EMR) and what to look for, visit our EMR page.

Clinical Documentation

In order to get to the point of submitting ICD-10-compliant claims to payers, a hospital will need to reengineer its clinical documentation processes to ensure that physicians provide the level of detail needed to code claims under ICD-10. Reengineering clinical documentation processes will involve extensive training for physicians, hospital staff, and coders. Hospitals must be committed to using a Change Leadership/Business Process Reengineering methodology targeted at enhancing the clinical documentation process and other processes related to coding.

Revenue Cycle Management

For detail on the revenue cycle management concerns that all hospitals will face during the transition to ICD-10, visit our RCM page. During the transition, there may be delays caused by any number of factors in a claims transaction. All of these delays will have negative impacts on the hospital's revenue cycle.