Provider services and solutions

Risk and Compliance Management: ICD-10

PwC's John Dugan discusses business opportunities and best practices for ICD-10 implementation for healthcare payers and provider.

The challenge

ICD-10, the International Statistical Classification of Diseases and Related Health Problems-10th Revision, is the first major coding revision in more than 30 years. The transition to ICD-10 is a complex, time-consuming and expensive compliance challenge, more daunting than HIPAA. It will touch nearly every healthcare operational and IT process and dramatically influence data and financial reporting strategies.

The business and IT changes from the ICD-10 conversion will require a multi-year planning and implementation effort. Although full ICD-10 compliance is not due until October 1, 2013, tackling key components sooner rather than later will allow organizations to be more strategic and appreciate business value from this mandate. It will also allow organizations to realize cost avoidance by effective planning and sequencing with our enterprise strategic initiatives.

ICD-10 compliance can bring opportunities as well as challenges. The more granular codes should provide more accurate and specific data for claims processing, detection of fraud and abuse, value-based purchasing, improved medical management techniques and other possible improvements.

How we can help you

Managing health information successfully depends on accurate documentation and coding, strong internal controls and an information infrastructure able to support both.

We can assess the overall impact of the ICD-10 transition on your organization and identify specific areas of risk and opportunity. We can inform and evaluate the remediation and implementation decisions that will be required to comply with ICD-10. We can help with strategic planning for your ICD-10 transition as well as assist in an end-to-end implementation solution.

Common services include

• Assessing risks, impact and opportunities resulting from your transition to ICD-10
• Strategic planning for your ICD-10 transition
• Training and change management for your employees
• Developing and implementing an end-to-end solution, from business requirements through testing
• Implementing vendor management programs