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Centers for Medicare and Medicaid Services (CMS) is leading several eHealth initiatives, including ICD-10.  These CMS eHealth initiatives aim to transform health care delivery through simplified, standardized electronic information and technology.  The goal of these eHealth initiatives is three-fold:

  1. Improve the quality of patient care
  2. Improve the health of populations
  3. Reduce the cost of health care by increasing the efficiency of health care delivery in the United States

It is important to view ICD-10 in the broader context of eHealth to fully understand the ways in which ICD-10 relates to other eHealth initiatives and the dependencies between them.  These initiatives are:

  1. Modifications to the Health Insurance Portability Accountability Act (HIPAA)
  2. The American Reinvestment and Recovery Act (ARRA) – Health Information Technology for Economic and Clinical Health Act (HITECH)
  3. The Affordable Care Act (ACA)

HIPAA and ICD-10:  Supporting Standardization

CMS is advancing a series of Administrative Simplification initiatives, including:

  • Implementation of the ICD-10 system
  • Standardization of electronic administrative transactions
  • Implementation of operating rules for electronic administrative transactions, including electronic fund transfers for healthcare payments and electronic remittance advice
  • Standardization of formatting for unique identifiers for employers, providers, and health plans

Version 5010, one of these specific initiatives, revises HIPAA electronic transaction standards.  It establishes a platform for the adoption of ICD-10 codes by accommodating the increased size and complexity of the new code set.  Version 5010 therefore demands the standardization requisite to support ICD-10.

HITECH and ICD-10:  Supporting Interoperability

Included in the passage of ARRA was HITECH, legislation that dictates the terms of Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  These EHR Incentive programs provide payments to providers that meet meaningful use requirements. ICD-10 builds the infrastructure to support Stage 2 and Stage 3 meaningful use by standardizing the collection and maintenance of patient data.  This “interoperability” allows for uniform, secure data sharing between various EHR and health plan systems.

ACA and ICD-10:  Supporting Quality Initiatives

The enactment of the ACA laid the foundations for various quality initiatives, and while ICD-10 is not a pre-requisite to these initiatives, it does support them. ICD-10 helps to re-set and define medical necessity requirements for expanded Medicaid coverage requirements (Sections 2001, 2002, 2202, 1415). The expanded number of codes under ICD-10 helps the healthcare industry to more easily identify hospital acquired conditions and beneficiaries with chronic conditions (Section 2702, 3008).   ICD-10 also contributes to the success of achieving greater granularity through ICD-10 aligned evidence based measurement requirements (Section 2701, 2713, 2717, 3002, 3004, 3005, 4105, 10322).   Additionally, the analysis of ICD-10 baseline data supports value based purchasing (Section 3001, 3006, 3014, 10301, 10326).