I was reading my collegue Mike Berard’s blog, on ICD-10 Revenue Neutrality: A Strategic Approach. We have discussed the importance of testing before production between Payer and Provider (e.g., Physicians and facilities). In his 2nd to last paragraph Mike proposes the following:
“The reality is that Revenue Neutrality verification is still subject to the availability of a Claims and Benefits test environment that will mirror production but accommodate GEMs and reimbursement schedule refinement on the fly. Does this mean that organizations will be subject to an infrastructure investment that also mirrors production? And will the test environment be subject to the same change control rigor of the production environment? I wonder if we have enough “maintenance widows” to support the number of changes to Claims and Benefits systems’ application logic before we know what changes to make the GEMs and reimbursement schedules…”
Based on my experience, I am not seeing Payer’s Business and IT departments addressing testing environments for Revenue Neutrality. What is your experience?
I can see that Revenue Neutrality is being considered the end of the process so not much attention is being placed on it at this time. Everyone is in ID and Stratification Mode. However, as a process person, the end of the process is what drives the beginning of the process. All critical information is gathered and tested at the beginning of the process to ensure the end-of-process can be completed and successfully reported. If we are not testing ICD-9 to ICD-10 all the way through the process for Payer, Provider, and Member neutrality before we go to production, we must take a step back and revisit our Strategic Approach.
Mike concludes with the following:
“Revenue Neutrality may have an initial focus on billing and reimbursement based on clinical accuracy in procedural coding, but will ultimately depend upon remediation of information systems and close collaboration between the payer and provider for ongoing refinement of reimbursement contracts.” These are hand in hand with a Member’s benefits and out-of-pocket expenses for ICD-9 to ICD-10. This should be tested and certified for our patients/members prior to production. Otherwise, we are not member-centric.
Payers and Providers need to reengineer their processes to ensure remediation on the fly after going into production for Member-centric care with ICD-9 – ICD-10. Michael Hammer would not be very pleased with our reengineering efforts for member-centric care without remediation processes once in production.
What are your thoughts?
