Prepare Now for Transition to ICD-10

Learn more about Humana's readiness plan and find answers to your frequently asked questions for ICD-10.

On October 1, 2014, the United States health care industry will transition from the International Classification of Diseases, 9th Edition (ICD-9), to the International Classification of Diseases, 10th Edition (ICD-10), for medical diagnosis and inpatient procedure coding. ICD-10 diagnosis codes must be used for all health care services provided in the U.S. ICD-10 procedure codes must be used for all hospital inpatient procedures. Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be processed.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accessibility Act (HIPAA). Health care providers, payers, clearinghouses and billing services must be prepared to comply with the transition to ICD-10. All electronic transactions must use Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes. Humana became fully Version 5010 compliant on January 1, 2012. Humana is scheduled to be fully functional and compliant with the ICD-10 implementation deadline as well.

CMS recommends that health care providers look for specialty-specific ICD-10 training offered by societies and professional organizations. ICD-10 coding training will be integrated into the continuing education units (CEUs) that certified coders must take to maintain their credentials. ICD-10 resources and training materials will be available through CMS, professional associations and societies, software and system vendors.

CMS’ suggested training time recommends that health care providers start intensive training no sooner than six to nine months prior to the implementation for coders who will not assign ICD-10-CM/PCS codes until compliance date. Hospital inpatient coders will need to have 50 hours ICD-10-CM/PCS training. Other coders will require 16 hours of ICD-10-CM.

Health care providers will also need to confirm that billing services, clearinghouses and practice management software vendors are ready to provide the support they need in order to meet the compliance date.

CMS has a dedicated website (www.cms.gov/ICD10) to provide the latest information on training opportunities for health care providers.

Health Care Provider End-to-End Testing

Humana plans to conduct external end-to-end testing with a select group of early adopters during the third and fourth quarters of 2013. Health care providers who would like to participate in Humana’s testing may send an email to ICD10inquiries@humana.com for more information.

Eight Tips to Prepare for the ICD-10 Transition

  1. Identify current systems' touch points and work processes that use ICD-9 codes.
  2. Talk with practice management system vendor about accommodations for ICD-10 codes.
  3. Discuss implementation plans with all clearinghouses, billing services and payers to facilitate a smooth transition.
  4. Talk with payers about how ICD-10 implementation might affect provider contracts.
  5. Identify potential changes to work flow and business processes.
  6. Assess staff training needs.
  7. Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials and training.
  8. Conduct test transactions using ICD-10 codes with payers and clearinghouses.

ICD-10 Frequently Asked Questions and Answers

Find a list of questions and answers about ICD-10.

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