● Roundup: ICD-10
Next, provider organizations should work proactively with health plans to develop collaborative testing scenarios and assess results to compare reimbursements, identify discrepancies and adjust code maps to decrease the potential for revenue cycle and claim management disruptions. Providers shouldn’t wait for payers to contact them; providers who raise their hands can play a larger role in payers’ testing eff orts, thereby decreasing post-transition surprises. While the move to ICD-10 can seem daunting, those who
haven’t started preparation need to prioritize the project. T e deadline of Oct. 1, 2014, is quickly approaching, and a well- planned and tested transition strategy is a mission-critical endeavor.
Vijay Vishnu Gaware, associate practice manager of healthcare, MphasiS (an HP company)
Neutrality analytics key to successful transition With October 2014 fast approaching, healthcare organi-
zations are changing gears and going at double the speed to achieve ICD-10 compliance. Every healthcare IT organization is going through the traditional route of impact analysis, de- sign, development and testing. Some are taking the crosswalk management route, while others are transforming their systems. While these IT-focused steps may help achieve compliance,
there is a key element of analytics that will ensure appropri- ate change management is performed at the business level. A new type of analytic solution, based on “neutrality” analytics, has emerged as an important part of the ICD-10 adoption strategy. Neutrality has four key dimensions: claims payment neutrality, member benefi t neutrality, clinical neutrality and operational neutrality. • Claims payment neutrality means the claims payment should remain approximately the same irrespective of ICD-9 or ICD-10 codes for a given diagnosis and medical procedure. It will ensure the payers do not end up paying too much (resulting in revenue loss) or too little (resulting in litigation and/or dissatisfi ed provid- ers/members).
• Member benefi t neutrality helps assess whether the member coverage remains the same post-October 2014, with no impact to premiums and out-of-pocket expenses.
• Clinical neutrality is about maintaining the same char- acteristics for patient care and meeting the same medical necessity outcome.
• Operational neutrality minimizes any deviations in operational parameters, such as claims adjudication throughput, fi rst-pass ratio, call volume, etc.
Organizations that have factored in all four neutrality di- mensions prior to an IT implementation should sail through the ICD-10 transition smoothly. Assessment of the above parameters might lead organizations to launch changes on the business side, such as renegotiating certain provider contracts, etc. Organizations bypassing this assessment/analysis could face turbulent times with a downward spiraling chain of events, including increases in claims rejection, manual prior authori- zations, help-desk call volume, manual claim re-adjudication
10 September 2013
percentage and adjudication errors, as well as delayed payments to providers, incorrect payments and dissatisfi ed providers and members – not to mention management’s time and the orga- nization’s reputation. With so much on the line, factoring in neutrality analytics in an overall ICD-10 strategy is extremely critical to deriving business value from ICD-10 compliance and providing greater assurance to stakeholders.
Andrea Clark, chairman and CEO, Healthcare Revenue Assurance Holdings (HRAA)
Many organizations haven't begun preparations A recent survey of hospital health information professionals and compliance employees conducted by HRAA found one in fi ve small- and mid-size hospitals have not begun training for the enormous transition from ICD-9 to ICD-10. Respondents stated:
• Forty percent have not begun ICD-10 CM training, and 55 percent have not begun ICD-10-PCS training for coding staff .
• Forty-seven percent have not begun document improve- ment education for medical staff .
• T irty-one percent do not plan to dual code accounts prior to Oct. 1, 2014.
T e majority of respondents do not plan to begin to dual code until 2014, despite CMS recommendations. Although respondents indicated hospitals are delayed in training and testing, 68 percent will submit ICD-10 coded claims to payers for testing prior to the transition. Hospitals engaging in regular updates from patient account
system (PAS) vendors regarding when their central repository for ICD-9 and ICD-10 data can be housed is critical for a variety of initiatives prior to the 2014 start date: • Hospitals must have ICD-10 data for internal and external testing. End-to-end testing will replicate or- ganizations’ systems to assess operational readiness and will fl ag unexpected outcomes prior to implementation.
• Perform dual coding eff orts that are essential for inter- coder reliability – practicum equates to consistency, integrity and benchmarking of data.
• Building an arsenal of ICD-10 data achieved from dual coding or translation processes will assist the continued progress to mitigate fi nancial risks for all payers. Denials must be anticipated as commercial payers will likely not recognize all of the ICD-10 codes when building their plans. Working with payers will eliminate any revenue suspension.
Amy Larsson, associate VP, emerging solutions, McKesson Health Solutions
A stepwise approach to preventing waste and abuse Waste, abuse and fraud cost the healthcare industry an estimated $234 billion a year. With healthcare reform mandat-
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