Healthcare Payers must determine all business processes and applications impacted by the change to ICD-10. Applications that capture, store, send, receive, or edit diagnosis or procedure codes must be modified. Fields must support alphanumeric characters and expanded to support an extra digit. The new specificity of IDC-10 codes will impact corresponding application logic, business rules, system interfaces and data reporting. And the clock is ticking…
Systems remediation must consider people, business processes and technology when assessing the scope of ICD-10 change. ICD-10 has the potential to impact enrollment, eligibility, claims, adjudication, benefits, pricing, underwriting, medical management, case management, provider payment, provider contracting, and more.
Organizations must understand issues, challenges and opportunities for change when determining extent of change to be undertaken. Clearly, basic coding, revenue cycle processes, EDI transactions and compliance reporting must be changed. Tougher decisions must be made in order to determine the right level of investment in data analytics, reimbursement models and payment monitoring to leverage the detailed data obtained through ICD-10 coding specificity. The most progressive organizations will choose to invest further in development of new products, business relationships, business process and care procedures.
Systems remediation will require a comprehensive assessment of all business process that currently touch ICD9 codes. Organizations must map all enabling technology to business processes. A comprehensive ICD10 systems inventory should include the identification of ownership, accountability and responsibility for both the enabled business process and the enabling technology.
ICD-10 migration complexity will depend upon the underlying technology architecture, count and ease of change of affected system, interfaces and reports. Finally, ICD-10 migration complexity will depend upon data or information transfer relationships with systems vendors, providers, clearinghouses, business partners, regulators and other external entities.
When making “biggest bang for buck” for systems remediation investment decisions, organizations must change business processes and technology, while at the same time trying to maintain normal business operations. This will not be easy. Organizations must focus on core capabilities, and then be diligent in picking the right business partners to support the rest of the journey.
Register for our upcoming ICD-10 webinar and receive a free copy of the Harvard Business Review Article, “How to Solve the Cost Crisis in Health Care” by Robert S. Kaplan and Michael E. Porter along with a copy of our most recent white paper, “Implementing ICD-10: Hard Work Brings Rewards”.
