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Customer Experience and Design

ICD-10 Assessment and Roadmap for Health Plans

It seems that there isn’t enough time to get everything done that is currently required by HIPAA, ARRA, and state and regional priorities – not to mention the consumer driven strategies that you were *hoping* to deploy to differentiate your business and gain competitive advantage. Although large and numerous projects are required, it is nearly impossible to not run these projects concurrently as any delay creates the potential for missed hard dates. With near term priorities moving full speed ahead, ICD-10 runs the risk of a late start. At a minimum you should consider a full ICD-10 assessment and roadmap to ensure that you clearly understand the impact on your organization as well as a high level timeline and budgetary estimate for delivery.

The number of affected systems, processes and policies is large (…consider claims adjudication, medical necessity, reimbursement policies, Medicare, Medicaid, vendors, provider touch points, preauthorization, interfaces, EDI, reports, P4P/Quality programs, databases and education and training to name just a few….). Due to the expansive reach of ICD codes throughout an organization it is possible that some processes that are impacted by ICD-10 may be overlooked. To mitigate this risk you should look at pulling together a multi-departmental group of stakeholders who are charged with auditing their respective departments to identify potential ICD-10 touch points.

Once you compile that high level list you should be prepared to invest time in the development of a detailed assessment and roadmap which should include a system and process inventory, priorities, dependencies, risks and time lines – your resource plan and budgetary estimate for *required* work will follow from that work.

Strategic business improvements should also be considered as part of your ICD-10 plan – preferably after you have a solid grasp of the minimum required work. The advanced level of detail in ICD-10 offers an opportunity to expand your analytics, consumer wellness, quality and EDI modernization programs. We’ll talk about these in a future post.

The assessment and roadmap process can be a quite a project by itself. If you would like to learn more about our approach please feel free to drop me an email @ as we’d be happy to share.

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