ICD-10 Impact Assessment - 2

 ICD-10 Impact Assessment

An Impact assessment is a major effort made early in the ICD-10 Transition Process and can take two to three months. The results drive the action items that become part of the project plan and estimate the budget.

The following table shows business processes that must be analyzed and the appropriate actions determined for the ICD-10 transition:

Business Processes and ICD-10 Effects

Business Process	Next Steps to Address ICD-10 Effects
Referrals	Update referral processes and forms for ICD-10 codes
Authorization / pre-certification	Update authorization forms to show the proper ICD-10 codes and to allow for medical necessity review
Patient Practice Intake	Update registration forms for add'l documentation of patient's health state to support ICD-10 codes.
	Update decision support system business rules for ICD-10
	Update existing business policies to determine coverage
	Update business policies to determine eligibility for dual insurance / SS Income, and coordination of benefits for special clinical programs
Patient clinic encounter	Verify service benefits and eligibility using ICD-10 codes
	Update clinical documentation to support ICD-10 coding
	Update existing billing systems, processes, and forms to accomodate ICD-10
Physician Orders	Update any coding on the physician order to capture ICD-10 specifics
Medical Records	Update medical record system including supporting forms, templates, interfaces and decision support.
Analytics	Update existing reports containing ICD-10 codes
	Modify report business rules to support ICD-10
Contracting	Identify which contracts and service level agreements refer to ICD-10
Public Health Reporting	Update ICD codes used to report diseases and conditions as well as immunizations
Financial Operations	Update existing processes to identify and forecast reimbursement payment
Value	Update logic for quality reporting under ICD-10. Identify actions aimed at improving quality measures
Clearinghouse relationship management	Update HIPAA transactions affected. Look for opportunities for Clearinghouses to provide translation / crosswalk ICD-9 to ICD-10 accountability
Payer relationship management	Contracts/reimbursement models: Modify pricing and reimbursement structures, fee schedules for greater diagnosis-specificity

(This Business Process table was taken from the CMS Road to 10: The Small Physician Practice's Route to ICD-10,​)