What do health care payers need to do?
Most payers are well on the road to action. They are assessing needs to adapt systems within their organizations and facilitating the transition with providers, vendors and other business partners.
This transition poses steep challenges in a time of limited resources, but ultimately it will enable payers to reduce medical loss ratios with more precise clinical documentation, auto-adjudicate more claims and prevent inappropriatepayments. If you're a health care payer, consider the following steps:
|Already completed |
- Convene an executive-level committee to oversee the ICD-10 transformation throughout your organization
- Engage both IT and business leadership
- Complete an inventory of applications and business process impacted
- Begin planning and budgeting for in-depth staff training and customer education
- Developed communication plan
- Understanding the organization competing priorities: 5010, Meaningful Use, Health Care Reform, etc.
- Appoint a physician champion to help bring physicians on board
- Educate physicians on increased demand for thorough documentation
- Develop understanding for impacts and potential improvements within a Medical Review Unit, Medical Management and Data Analytics
|By January 1, 2012 |
- Update to EDI 5010 — "Update to Electronic Data Interchange (EDI) 5010"
- In a test environment, convert ICD-9 paid claims to ICD-10; compare results and address gaps
- Executing on your roadmap for compliance and the strategy investments you are making to advantage your organization
|By October 1, 2012 |
- Update or upgrade information systems to handle ICD-10's expanded character sets
- Assess provider customer readiness for ICD-10 and prepare for increases in call volumes to provider help lines
- Develop new pricing and reimbursement structures to reflect increased specificity of diagnoses
- Train staff in ICD-10 and regularly evaluate and monitor compliance
- Monitor progress toward goals, focus on highest priorities and develop a risk mitigation program to help deter any setbacks in implementation
- Use leading practices in change management to facilitate the transition
- Identify resources to support the system after it goes live
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