In preparation for satisfying the ICD-10 medical diagnosis and inpatient procedure coding on October 1, 2013, Healthcare organizations will need to indentify all instances of ICD-9 codes that are maintained within the application logic of supporting business systems as a component of their ICD-10 Compliance Agenda. Impacted systems will include, but are not limited to, core claims administration, including the assignment of benefit to claims. Healthcare organizations must verify all business processes, data stores, applications, interfaces and reports impacted by the change to ICD-10. All systems that capture, store, send, receive, or edit diagnosis or procedure codes must be modified to accommodate ICD-10. And the clock is ticking…
In addition to claims and benefit administration, ICD-10 has the potential to impact enrollment, eligibility, adjudication, pricing, underwriting, medical management, case management, provider payment, provider contracting and more. Systems remediation must consider people, business processes and technology when assessing the scope of ICD-10 change.
What’s the Holdup?
Often, Healthcare organization “Business Areas” and IT Departments do not have service level agreements (SLAs) to govern the systems remediation functions of scenario, case, requirements and test management. In the absence of SLAs, Healthcare organization IT departments, as internal service provider to Business Areas, often fall short of delivering services that meet Business Areas expectations of change timeliness and minimized cost, as well as accuracy and performance of development and remediation support.
Frequently, Healthcare organization Business Areas fall short in providing enough detail to scenarios, cases and business requirements to enable IT to define acceptable technical specifications to guide development and remediation support.
The traditional change management challenge is the development of effective internal collaboration between business owners, who are accountable for performance and integrity of execution of business process and IT, which are accountable for enabling business process through the use of IT.
Now, more than ever, Healthcare organizations demand the bridging of the gap between business area expectations and IT delivery of services. We don’t have time to wade through the layers of internal political distraction while the ICD-10 Compliance clock is ticking. If you already subscribe to the transition from Waterfall to Agile development, you’re half way home…
Collaboration’s Key Role
The next step is to evolve traditional change management through the development of a dynamic environment of collaboration that will directly support systems remediation through web-based dynamic workflow, cueing and messaging, in support of building a role and permission based system for the development of use scenarios, use cases, user requirements and test outcomes definition.
The reality is that the use of a dynamic environment of collaboration between business and IT is not limited to ICD-10 Systems Remediation. Business and IT collaborative effectiveness needs to be woven into the fabric of organizational culture ongoing. This is not a one and done exercise. The only thing missing is the method, approach, process and enabling tools to ensure repeatability and sustainability.
At what stage is your ICD-10 conversion? What tools are you using?
